Repellents and Protectants Jeremy Springer, M.D. Dr. Springer indicated no potential conflict of interest to this presentation. He does not intend to discuss any unapproved/investigative use of a commercial product/device. Disclosures None No off label use of FDA approved Products
Why use them? Mosquitoes Example: Malaria, Dengue, Zika, Yellow Fever, Encephalitis, West Nile, Chikungunya Ticks Rocky Mountain Spotted Fever, Lyme, Anaplasmosis (Ehrlichiosis), Babesiosis, Tick-borne Relapsing Fever, Flies African trypanosomiasis, onchocerciasis or "river blindness, leishmaniasis What works? NOTHING is completely effective. Put multiple roadblocks between you and the biter. Repellents Prevent the bite, usually by hiding you from the biter. Usually a chemical compound. Several proven to decrease number of bites per minute / hour. Multitude that are unproven or proven not to work. Protectants Kill the biter or shield the skin from contact with the offender. Can be insecticide (impregnated into clothing or bednet or applied to skin), clothing or netting.
Who Tests? EPA Federal law requires registration or license prior to selling or distributing a pesticide in USA. Federal law classifies insect repellents as pesticides. Products labeled as repellents are not designed to eliminate pests EPA According to pesticide law, a pesticide is any substance or mixture of substances intended for: preventing destroying repelling mitigating any pest
Registered Products Before they can be marketed, most skin-applied repellents must be registered by EPA. EPA registration of skin-applied repellent products indicates that they have been evaluated and approved for human safety and effectiveness when applied according to instructions on the label. The evaluation includes assuring that the product does not pose risks to vulnerable populations, including children and pregnant women. Unregistered Products Some insect repellent products for sale in the United States do not currently require EPA registration. In the 1990s, EPA evaluated the active ingredients in these unregistered products for safety. It was determined that the active ingredients posed minimal risk to human health in the percentages found in products on the market. Note that products made from these ingredients have not been evaluated for effectiveness.
Unregistered Products Examples of ingredients used in unregistered repellents are: Citronella oil. Cedar oil. Geranium oil. Peppermint and peppermint oil. Soybean oil. Find the Insect Repellent that is Right for You Search tool online You can specify the: Insect, Protection time, Active Ingredient, Production-specific information. Consider these factors when choosing an insect repellent: Mosquitoes, Ticks or Both? How long exposure activity?
Skin-Applied Repellent Ingredients The following are active ingredients in EPA-registered skin-applied insect repellents: Catnip oil -(Nepeta cataria, also known as catmint) (4 products) Oil of citronella -(3 registered products; also used in unregistered products) DEET - (more than 500 products) IR 3535 - (3-[N-Butyl-N-acetyl]-aminopropionic acid, ethyl ester)(45 products) Oil of Lemon Eucalyptus (chemical name: p-menthane-3,8-diol - (10 products) Picaridin (about 40 products) 2-undecanone - (or methyl nonyl ketone) (1 product) Repellency Awareness Graphic
Repellents and Sunscreen Repellents that are applied according to label instructions may be used with sunscreen with no reduction in repellent activity However, limited data show a one-third decrease in the sun protection factor (SPF) of sunscreens when DEET-containing insect repellents are used after a sunscreen is applied. Products that combine sunscreen and repellent are not recommended, sunscreen may need to be reapplied more often and in larger amounts than needed for the repellent component. Recommendation is to use separate products, applying sunscreen first and then applying the repellent. Due to the decrease in SPF when using a DEET-containing insect repellent after applying sunscreen, travelers may need to reapply the sunscreen more frequently. Repellents and Insecticides for Use on Clothing Clothing, hats, shoes, bed nets, jackets, and camping gear can be treated with permethrin for added protection. Alternatively, clothing pretreated with permethrin is commercially available. Permethrin is a highly effective insecticide-acaricide and repellent. Clothing and other items must be treated 24 48 hours in advance of travel to allow them to dry. Permethrin-treated materials good after repeated laundering but should be retreated, as described on the product label. Pretreated clothing is labeled for efficacy through 70 launderings. Clothing treated with the other repellent products (such as DEET) provide protection but will not last through washing.
Children and Pregnant Women Most repellents can be used on children aged >2 months. Protect infants aged <2 months from mosquitoes by using an infant carrier draped with mosquito netting with an elastic edge for a tight fit. Products containing Oil Lemon Eucalyptus specify that they should not be used on children aged <3 years. EPA does not recommend any additional precautions for using registered repellents (including DEET) on children or on pregnant or lactating women. Other steps Bed Nets, suits, head nets, etc. effectiveness is increased by use of permethrin. Avoid use of flying insect bombs or sprays intended to be used outdoors in enclosed spaces (Nerve gas) Paint containing repellents/insecticides may decrease insects in rooms for up to 5 years, as insects will not land on the walls.
POISON IVY "The poisonous weed, being in shape but little different from our English ivie; but being touched causeth reddness, itchings, and lastly blysters, the which howsoever, after a while they pass away of themselves without further harme; yet because for the time they are somewhat painefull, and in aspect dangerous, it hath gotten itselfe an ill name, although questionless of noe very ill nature." The recorded history of poison ivy dermatitis begins with these words of Captain John Smith in 1609. *
Poison Ivy (Toxicodendron radicans -- eastern poison ivy/toxicodendron rydbergii -- western poison ivy) typically grows as a vine or shrub Found throughout much of North America (except in the desert, Alaska, and Hawaii) It grows in open fields, wooded areas, on the roadside, and along riverbanks. It can also be found in urban areas. Urushiol is the component that elicits a contact dermatitis The Plant it is not a true ivy member of the cashew and almond family Most often thought of as an unwelcome weed The urushiol compound in poison ivy is not a defensive measure; rather, it helps the plant to retain water. Eaten by animals such as deer and bears, and seeds by birds
The Plant The plants can grow as a shrub up to about 1.2 metres (3.9 ft) tall, as a groundcover 10 25 cm (3.9 9.8 in) high, or as a climbing vine on various supports. It grows in a wide variety of soil types, and soil ph from 6.0 to 7.9. It is not particularly sensitive to soil moisture, although it does not grow in desert or arid conditions. URUSHIOL Urushiol-induced contact dermatitis is the Type 4, T-cell mediated allergic reaction. 15% to 30% of people have no allergic reaction, most will have a greater reaction with repeated or more concentrated exposure. Over 350,000 people are affected by poison ivy annually in the United States The pentadecylcatechols of the oleoresin within the sap of poison ivy and related plants causes the allergic reaction; the plants produce a mixture of pentadecylcatechols, which collectively is called urushiol. Urushiol binds to the skin on contact
URUSHIOL Urushiol oil can remain active for several years, so handling dead leaves or vines can cause a reaction. Oil transferred from the plant to other objects (Clothing, tools, pet fur) can cause the rash if it comes into contact with the skin. People sensitive to poison ivy can experience a similar rash from mangoes. Mangoes are in the same family (Anacardiaceae) as poison ivy; the sap of the mango tree and skin of mangoes has a chemical compound similar to urushiol. A related allergenic compound is present in the raw shells of cashews. Similar reactions have been reported occasionally from contact with the related Fragrant Sumac (Rhus aromatica) and Japanese lacquer tree. Airborne Contact Burning plants release urushiol oil aerosol that can cause reactions to exposed skin, eyes, and the respiratory tract. Prevention The first line of defense is to recognize the plants and avoid them When working in areas with poison ivy, minimize skin exposure by wearing pants, gloves and a long-sleeved shirt. Clean the skin with large amounts of isopropyl (rubbing) alcohol within 10 minutes. Wash with cold water (without soap). Using soap alone or alcohol hand cleaner can lift the urushiol oil and move it around the skin. Wearing disposable gloves, clean boots, tools, and anything exposed to urushiol oil. Wipe with rubbing alcohol and water. Do not use detergent or soap. Wash clothes, even shoelaces, with hot water, detergent, and two wash cycles. Discard the gloves.
Prevention Today, a barrier lotion with 5-percent bentoquatam is the only FDAapproved drug that can help prevent contact dermatitis from poison ivy, poison oak, and poison sumac. First tested and approved in 1985. It is available without a prescription. Enviroderm of Kentucky manufactures it under trade name IvyBlock Enveloped in a clay-like medium and contained in a lotion applied at least 15 minutes before exposure. When it dries, it forms a clay-like barrier that protects against or reduces the severity of the rash caused by these plants. Should be reapplied every 4 hours for continued protection. Prevention Bentoquatam can be removed with soap and water. It is not recommended for children under the age of 6. Can be used year round.