The Missing Piece in Understanding PANDAS and PANS?
What If Everything We Thought About PANDAS Was Wrong?
For years, scientists have debated how infections can trigger autoimmune diseases. The most widely accepted theory has been molecular mimicry, the idea that certain bacteria and viruses resemble human cells so closely that the immune system gets confused and attacks the wrong target.
But what if that’s not actually what’s happening?
A groundbreaking study from the Garvan Institute in Australia challenges this idea. Instead of simply tricking the immune system, infections appear to push it into overdrive, creating rogue immune cells that continue attacking long after the infection is gone.
This could change everything we thought we knew about PANDAS, a condition where children suddenly develop symptoms like OCD, tics, anxiety, severe mood disturbances, and urinary frequency after a streptococcal infection. If rogue B cells are involved, then PANDAS may not be an autoimmune condition at all. It may be an immune system that has lost control and won’t switch off.
It also raises big questions about PANS, a condition with similar symptoms triggered by a wider range of infections. If both conditions involve immune responses that spiral out of control, we may need to rethink how they are treated.
The Immune System as a Training Camp
B cells are like soldiers trained to fight infections. Normally, once the battle is won, most are dismissed, leaving behind a small, well-prepared reserve.
But what if the training never stops?
Instead of standing down, the immune system keeps pushing B cells through unnecessary training rounds. Some mutate into rogue fighters, attacking not just infections but the body itself.
This isn’t confusion. The immune system isn’t mistaking the body for strep. It is creating a new kind of attacker, one that no longer needs strep to keep causing harm.
This may explain why some children respond to treatments like IVIG and rituximab, which attempt to reset the immune response. IVIG floods the body with donor antibodies, helping to regulate immune activity and reduce inflammation. Rituximab goes even further, wiping out B cells entirely to eliminate the rogue ones.
These treatments can be effective, but they don’t always provide lasting relief. If the immune system remains stuck in this cycle, new rogue B cells may continue to emerge, which could explain why some children relapse even after initially responding to therapy.
What the Study Found and Why It Matters
The Garvan Institute study looked at patients with hepatitis C who developed cryoglobulinemic vasculitis, a condition where rogue B cells produce harmful autoantibodies. Researchers found:
B cell clones persisted even after the virus was eliminated
These clones had accumulated thousands of mutations, making them more aggressive
Instead of targeting the virus, they adapted to attack human tissue
There was no evidence of molecular mimicry. The immune system wasn’t making a mistake. Instead, it had been pushed into a chronic state of activation, allowing rogue B cells to persist and cause ongoing damage.
Could the same thing be happening in PANDAS and PANS?
Another Perspective: Dr. Dritan Agalliu’s Research
While the Garvan study focuses on rogue B cells, another important theory comes from Dr. Dritan Agalliu at Columbia University. His research suggests that PANDAS symptoms stem from blood-brain barrier breakdown, allowing immune cells to infiltrate the brain and trigger neurological symptoms.
Dr. Agalliu’s findings show that:
Repeated strep infections recruit Th17 immune cells, which target the blood-brain barrier
These immune cells weaken the barrier, allowing antibodies and inflammation to enter the brain
This may trigger the sudden onset of OCD, tics, and anxiety seen in PANDAS
Rather than rogue B cells running wild, Agalliu’s work highlights how repeated infections may weaken the brain’s defences, making it vulnerable to immune attacks.
So which explanation is correct? It may not be one or the other. PANDAS could involve both mechanisms, or different children may experience different pathways to the same symptoms.
Why Do Some Children Develop PANDAS While Others Recover?
Not every child who gets strep develops PANDAS. So why does it happen to some but not others? The answer likely lies in genetics, immune function, and environmental stressors– factors that shape how the body responds to infections.
The Role of Genetics
Some children are more vulnerable to prolonged immune activation. While a family history of autoimmunity can play a role, it isn’t the only factor. Variations in immune-related genes can influence how aggressively the body responds to infections and how efficiently it switches off inflammation.
For some, the immune system stays activated long after the infection is gone. Others have weaker immune tolerance, making them more prone to persistent inflammation. Instead of responding appropriately and then returning to a balanced state, their immune system remains on high alert.
Genetics alone doesn’t cause PANDAS, but it can create the conditions for immune dysfunction. When combined with infections, gut imbalances, and chronic stress, it increases the risk of a prolonged immune response that spirals out of control.
The Role of the Environment
Environmental stressors play a major role in shaping immune function and can push a vulnerable system into crisis.
Repeated antibiotic use disrupts gut bacteria, weakening immune regulation
Toxin exposure from mould or heavy metals keeps the immune system in a reactive state
Chronic stress raises inflammation and impairs immune resilience
Gut imbalances contribute to a leaky gut, allowing inflammatory triggers to persist
For some children, a strep infection isn’t the root cause of PANDAS, it is the final stressor that tips an already primed immune system into dysfunction.
Can We Stop Rogue B Cells in Their Tracks?
If chronic immune activation is the real issue, then simply clearing infections isn’t enough. If antibiotics were the solution, one course would be enough to fix PANDAS. Yet that’s not what we see.
In our clinic, we regularly meet children who have been on antibiotics for years, sometimes more than five years straight, yet they remain stuck in the same relentless cycle of flare-ups. Instead of resolving the problem, their immune system continues attacking as if it has forgotten how to switch off.
Antibiotics may suppress an immediate infection, but they do nothing to stop the immune system from spiralling out of control. Long-term antibiotic use disrupts the gut microbiome, weakens natural immune defences, and may even contribute to the chronic immune activation driving PANDAS in the first place.
The key isn’t just killing infections; it’s helping the immune system reset and regain balance.
Microimmunotherapy: A Smarter Approach
Microimmunotherapy is designed to fine-tune immune regulation rather than suppress it. Unlike IVIG or rituximab, which either flood the body with antibodies or eliminate B cells entirely, Microimmunotherapy works in a far more targeted way. Using ultra-low doses of immune messengers, this approach gently modulates immune activity, restoring balance without shutting down essential immune functions.
At Brainstorm Health, we have been using Microimmunotherapy for almost five years with great success. As the world’s leading paediatric clinic for this approach, we have seen remarkable improvements in children with PANDAS, PANS, and other immune-driven conditions, particularly those struggling with persistent immune activation.
Microimmunotherapy helps to:
Regulate chronic immune activation without suppressing protective responses
Reduce inflammation while maintaining immune function
Prevent new rogue B cells from forming
Rather than wiping out immune cells, Microimmunotherapy restores balance, teaching the immune system when to fight and when to stand down.
A Case Study: Sam’s Story
When I first met Sam, he was seven years old, and his parents were at their breaking point. What started as a mild sore throat had turned their happy, easy-going child into someone they barely recognised. Practically overnight, he became anxious, aggressive, and trapped in obsessive thoughts. He couldn’t sleep. He was lashing out. His parents were exhausted, watching their son spiral while feeling powerless to help.
For five years, doctors had prescribed him antibiotics multiple times a year. Each time, his parents were told this round would finally be the one to fix things. But the symptoms always returned. His immune system was stuck in overdrive, reacting as if the infection was still there long after it had gone. His parents had followed the advice they were given, but deep down, they knew something wasn’t right.
By the time they came to us, they were looking for a new way forward.
We started with Microimmunotherapy to help calm his overactive immune response and bring it back into balance. But restoring proper immune function meant looking beyond just the infection. Years of chronic immune activation had left his system inflamed and depleted, so we focused on rebuilding from the ground up.
Gut, adrenal, and liver support helped strengthen his body’s defences, reducing inflammation and restoring stability. Anti-inflammatory strategies eased his neurological symptoms, giving his nervous system a chance to reset. Instead of another cycle of antibiotics, we used natural antimicrobials only when absolutely necessary, allowing his immune system to recover rather than being forced into another battle.
It took nine months of careful, step-by-step intervention, but the transformation was remarkable. Sam, who had once needed antibiotics multiple times a year, has now gone over a year without them. He is thriving at school, sleeping through the night, and back to being the happy, curious child his parents had feared they had lost. Most importantly, his parents no longer feel like they are waiting for the next crash.
Sam’s story shows what happens when you address the root cause rather than treat the infection. The goal was never to wage war on bacteria but to restore balance so his immune system could function as it should. And once that happened, everything changed.
The Bigger Picture: Rethinking PANDAS and PANS
It’s possible that PANDAS and PANS aren’t autoimmune conditions at all or at least not in the way we’ve traditionally thought. Rather than a case of mistaken identity where the immune system confuses the brain for an infection, it could be that the immune system simply doesn’t know when to switch off.
And that changes everything. Antibiotics, IVIG, and rituximab can sometimes interrupt the immune response, offering relief, but they don’t always tackle the underlying issue. What we need are smarter approaches that restore immune balance rather than just pressing pause on the attack. That’s where Microimmunotherapy comes in.
The real hope lies in stopping the immune system from spiralling out of control before lasting damage occurs. This isn’t just about managing symptoms. It’s about altering the course of a child’s life.
For the first time we have a clearer path forward. And if I were a parent facing this I would want to know about it.
IMPORTANT
The information provided in this article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It is crucial to consult with medical doctors or qualified functional medicine practitioners to address specific health concerns and obtain personalised guidance tailored to individual needs. Never add any supplements to your plan until it has been assessed and approved by your medical doctor or a suitable qualified practitioner who is familiar with your health history.
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Reference
Young, C., Singh, M., Jackson, K.J.L., Bull, R.A., Suan, D., and Goodnow, C.C. (2024) ‘A triad of somatic mutagenesis converges in self-reactive B cells to cause a virus-induced autoimmune disease’, Immunity, [online] Available at: https://www.cell.com/immunity/fulltext/S1074-7613(24)00575-2
