Macrophages have long been recognized as important cells associated with filarial infection but their function as effectors and/or suppressors has not been elucidated. Recent advances in our understanding of the role that macrophages may play in lymphatic filariasis have come from in vitro studies and mouse models of filarial infection. Based on these new findings, we hypothesize that while dead or dying worms induce the 'classical' activation of macrophages and a subsequent pro-inflammatory response, live and healthy worms secrete products that induce type 2 cytokines and the differentiation of 'alternatively' activated macrophages that downregulate an inflammatory response. Thus, the balance between the 'classical' and 'alternative' activation pathways of macrophages could be an important factor in inflammatory pathology associated with filariasis.