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Water in those areas are replaced with poison water, so you are permanently under poison's effect. However, enemies can't spawn in poisoned water, so there are no enemies in the toxic or ancient sewers. But, there is one elite altar in the ancient sewers, so if you survive the duel you can get all three of the old service keys at once and guarantee 3 items of your choosing.
Not to mention, the poison leaves the "Rally", or health you can recover, perfectly intact. So, if you always keep your health above 0(where the poison stops ticking and won't kill you, causing the rally to shrink, and eventually fade entirely) Then that ancient sewers duel can let you recover all of your missing health.
Very interesting, OP!