Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Meat Tenderizer for a Jellyfish Sting

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Anonymous has left a new comment on your post "Myths to Debunk":

"What about meat tenderizer for a jellyfish sting? I know that hot water works well as it causes the venom proteins to refold, but the usual folk treatment for Man 'o War stings here in Texas is a paste of meat tenderizer or to rub the area with a slice of fresh papaya or pineapple."

Great question. There are numerous remedies that have been recommended as effective against different "jellyfish" stings, but not many that have been tested scientifically in clinical trials. Furthermore, I have seen opinions change based on anecdotes and observation of just a few patients.

Here are some of the substances and methods that have been recommended for immediate treatment (not prevention) of jellyfish-type (e.g., jellyfish, Portuguese man-of-war, hydroid, fire coral, and others) stings, and my current understanding of what we know (or feel) about them:

1. Vinegar (household variety of white vinegar, which is acetic acid 5.0%, is recommended for stings from a box-jellyfish (Chironex fleckeri) and for many other stinging species. It seems to be a good all-purpose decontaminant. It can be cut 50% with water or isopropyl alcohol (see below) and retain its beneficial effect.

2. Isopropyl ("rubbing") alcohol has been observed by many users and practitioners to be effective against may stinging species. However, in at least one laboratory experiment, stinging cells (nematocysts) from jellyfish were observed under the microscope when flooded with isopropyl alcohol, and seen to "fire" their stinging apparatus. However, the meaning of this observation cannot be precisely determined, because it is not known whether the firing occurred with sufficient force to cause an envenomation (had the stinging cells been on a live tentacle placed against human skin), or even whether it was an agonal (occurring in the act of destruction of the stinging cells) activity caused by the alcohol. So far as I know, it has not been reported clinically that application of isopropyl alcohol worsens the sting of any marine creature. If anyone is aware of such a circumstance, please let me know.

3. Meat tenderizer. Most of these products contain papain, which breaks down proteins. This is perhaps the reason why an application of meat tenderizer is effective in diminishing the discomfort associated with the sting of a marine creature. However, one must take care to not leave meat tenderizer on sensitive skin for too long (e.g., longer than 10 to 15 minutes), because it can cause an irritating reaction in and of itself. Furthermore, I have heard from a few users that if the seasoned form of tenderizer is used, it may increase the irritation or even cause stinging with the initial application. The sensitive skin of infants and babies, and facial skin at all ages, may be more prone to an adverse skin irritation from application of papain. With regard to using application of fresh papaya fruit, I have heard that recommendation before. I don't know anything about the use of pineapple.

4. Other substances reputed to be of value are household ammonia, and lemon or lime juice. It's possible that the change in acid-base balance (pH) is what causes this effect, or perhaps it is some denaturation (destruction or inactivation) of protein or other components of venom.

5. Application of fresh water (e.g., tap water) has received mixed reviews. It is fairly well accepted that gentle application (e.g., pouring water without pressure or gentle rinsing under a tap) of fresh water worsens the situation, because fresh water is hypotonic (e.g., contains a lower concentration of salts) than sea water, and causes the stinging cells to "fire" and discharge their stinging apparatus, thus worsening the envenomation and pain. On the other hand, lifeguards in various locations have reported that the brisk spray from a shower or garden hose can be helpful. This is perhaps because the mechanical effect of the spray actually removes stinging cells and supercedes the deleterious effect of the hypotonic water. Application of cold packs, moist or dry, has received mixed reviews. The latest recommendation, which emanates from experts in Australia and other Indo-Pacific regions, is that application of hot water to tolerance can be helpful to treat a sting.

6. Solvents (e.g., acetone) are generally not useful and perhaps dangerous, both because of direct skin irritation and potential absorption of toxic chemicals through the skin.

7. The "pressure immobilization technique" was formerly recommended for stings of the Indo-Pacific box jellyfish (Chironex fleckeri), but has been removed from any formal recommendations, as it does not appear to be helpful, and may actually even be harmful.

One important point bears mention, which is that no topical decontaminant is foolproof, so it is absolutely essential to remember that prevention is extremely important. Whether one chooses to stay out of the water when stinging creatures are expected to be in the vicinity, wears a wet suit or "stinger suit," uses a topical sunscreen-jellyfish sting inhibitor, such as Safe Sea, or some other maneuver, it is much better to not be stung in the first place than to hope for success with any given treatment.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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