Interventions for the symptoms and signs resulting from jellyfish stings Stable (no update expected for reasons given in 'What's new')

Abstract

Background

Jellyfish envenomations are common amongst temperate coastal regions and vary in severity depending on the species. Stings result in a variety of symptoms and signs, including pain, dermatological reactions and, in some species, Irukandji syndrome (including abdominal/back/chest pain, tachycardia, hypertension, sweating, piloerection, agitation and sometimes cardiac complications). Many treatments have been suggested for the symptoms and signs of jellyfish stings. However, it is unclear which interventions are most effective.

Objectives

To determine the benefits and harms associated with the use of any intervention, in both adults and children, for the treatment of jellyfish stings, as assessed from randomised trials.

Search methods

We searched the following electronic databases in October 2012 and again in October 2013: the Cochrane Central Register of Controlled Trials (CENTRAL;The Cochrane Library, Issue 9, 2013); MEDLINE via Ovid SP (1948 to 22 October 2013); EMBASE via Ovid SP (1980 to 21 October 2013); and Web of Science (all databases; 1899 to 21 October 2013). We also searched reference lists from eligible studies and guidelines, conference proceedings and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and contacted content experts to identify trials.

Selection criteria

We included randomised controlled trials that compared any intervention(s) to active and/or non‐active controls for the treatment of symptoms and signs of jellyfish sting envenomation. No language, publication date or publication status restrictions were applied.

Data collection and analysis

Two review authors independently conducted study selection and data extraction and assessed risk of bias using a standardised form. Disagreements were resolved by consensus with a third review author when necessary.

Main results

We included seven trials with a total of 435 participants. Three trials focused on Physalia (Bluebottle) jellyfish, one trial on Carukia jellyfish and three on Carybdea alata (Hawaiian box) jellyfish. Two ongoing trials were identified.

Six of the seven trials were judged as having high risk of bias. Blinding was not feasible in four of the included trials because of the nature of the interventions. A wide range of interventions were assessed across trials, and a wide range of outcomes were measured. We reported results from the two trials for which data were available and reported the effects of interventions according to our definition of primary or secondary outcomes.

Hot water immersion was superior to ice packs in achieving clinically significant (at least 50%) pain relief at 10 minutes (one trial, 96 participants, risk ratio (RR) 1.66, 95% confidence interval (CI) 1.01 to 2.72; low‐quality evidence) and 20 minutes (one trial, 88 participants, RR 2.66, 95% CI 1.71 to 4.15; low‐quality evidence). No statistically significant differences between hot water immersion and ice packs were demonstrated for dermatological outcomes.

Treatment with vinegar or Adolph's meat tenderizer compared with hot water made skin appear worse (one trial, 25 participants, RR 0.31, 95% CI 0.14 to 0.72; low‐quality evidence).

Adverse events due to treatment were not reported in any trial.

Authors' conclusions

This review located a small number of trials that assessed a variety of different interventions applied in different ways and in different settings. Although heat appears to be an effective treatment for Physalia (Bluebottle) stings, this evidence is based on a single trial of low‐quality evidence. It is still unclear what type of application, temperature, duration of treatment and type of water (salt or fresh) constitute the most effective treatment. In addition, these results may not apply to other species of jellyfish with different envenomation characteristics. Future research should further assess the most effective interventions using standardised research methodology.

Author(s)

Li Li, Richard G McGee, Geoffrey K Isbister, Angela C Webster

Abstract

Plain language summary

Treatment for jellyfish stings 

Jellyfish stings are common in temperate coastal regions around the world. Specialised stinging cells on the jellyfish called nematocysts produce the sting. The stings of different jellyfish species produce different symptoms of varying severity. Milder symptoms include pain and skin reactions such as redness and itching at the site of the sting.

This review identified seven trials on the treatment of jellyfish stings primarily involving two jellyfish species—Physalia (Bluebottle) and Carybdea alata (Hawaiian box) jellyfish—as well as two trials that are in progress. Many different types of treatments were tested in these trials. Large variation was observed between the duration of treatment among trials. Evidence of limited quality from a single study suggested that hot water immersion relieved pain. This evidence may not apply to other species of jellyfish because of large variability in the effects of stings. Further research should be conducted to help practitioners better understand the most effective treatments for jellyfish stings.

Author(s)

Li Li, Richard G McGee, Geoffrey K Isbister, Angela C Webster

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

Low‐quality evidence suggests that hot water application is effective in relieving the pain of Physalia (Bluebottle) stings. Our findings cannot be extended to other species of jellyfish because of absent reporting of standardised outcomes from the remaining studies included in the review. Further clinical research is required to determine the most effective treatments.

Implications for research 

With regard to analgesia, it is unclear whether heat alone is sufficient to cause a beneficial effect (in which case heat packs may be of use), or if the effects are unique to hot water immersion. It is also unclear what temperature, duration of treatment and type of water (salt or fresh) are most effective. Future research should consider these factors, as well as the timing and duration of treatments, blinding of study personnel and the use of standardised outcomes. Researchers may also focus on other species of jellyfish, especially those whose stings are potentially life threatening, such as the Chironex fleckeri species, to better clarify variations in treatment guidelines for different envenomations. In particular, further trials could focus on vinegar as an intervention by using the aforementioned factors to produce higher‐quality evidence, as vinegar is widely used as an intervention for Chironex fleckeri envenomations.

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