UH Study: Hot or Cold Treatment for Jellyfish Stings?

Christie Wilcox and Angel Yanagihara. University of Hawai’i photo.

Hot or cold heat on a jellyfish sting? The question was recently answered by researchers at the University of Hawai’i at Manoa in a study published in the journal “Toxins” this month.

Based on the study, hot packs and hot water immersion are the winning options for treatment of jellyfish stings.

Across the globe, jellyfish stings are a growing public health concern and cause more deaths on an annual basis than shark attacks. Despite the stings being dangerous, UH researchers say that scientists and medical professionals are still not in unison when it comes to treatment and management of the stings.

“People think ice will help because jelly stings burn and ice is cold,” said Dr. Christie Wilcox, a postdoctoral fellow at the John A. Burns School of Medicine and lead author of the paper. “And if you Google it, many sites – even those considered reputable – will tell you to put ice on a sting to dull the pain. But research to date has shown that all marine venoms are highly heat sensitive, thus hot water or hot packs should be more effective than cold packs or ice.”

Dr. Angel Yanagihara, an assistant research professor at the UH Pacific Biosciences Research Center and JABSOM and senior author of the pape,r says that web articles with information on treating jellyfish stings are “bombarding the public with unvalidated and frankly bad advice.”

For nearly two decades, Dr. Yanagihara has served as director of the Pacific Cnidaria Research Laboratory studying the pathophysiology of jellyfish stings.

“In Hawaiʻi and around the world, we have seen that first responders and public health decision-makers rely on non-evidence-based claims found on websites. It’s not too strong to point out that in some cases, ignorance can cost lives,” said Dr. Yanagihara. “We conducted this study to rigorously assemble all the published data in hopes that policymakers will revisit this issue and carefully consider the available evidence.

“We are also engaged in new experimental work with models looking at vinegar effects, as well as well-designed randomized clinical trials. The goal of my laboratory’s efforts is to contribute to evidence-based best clinical practices for jellyfish stings. ”

Dr. Wilcox and Dr. Yanagihara conducted a systematic review to compare the use of cold or heat in jellyfish sting treatment using a common ranking system for clinical evidence.

The pair went through more than 2,000 related articles from searches of major scientific journal article databases to find every study to date that examined the effects of using temperature-based treatments for jellyfish stings. The overwhelming preponderance of evidence supported the use of hot-water immersion (about 45 degrees Celsius). This is consistent with findings in more than a dozen articles, demonstrating that venom components are inactivated at temperatures between 40 and 50 degrees Celsius.

“I was shocked that the science was so clear, given that there is so much debate over the use of hot water,” said Dr. Wilcox.

Hot water immersion is already the standard of care for other severe marine envenomations, including potentially life-threatening stonefish stings, so these results help streamline the first-aid response.

“It’s simple, really: If you’re stung, use hot water or hot packs rather than ice or cold packs,” Dr. Wilcox said.