To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species

Abstract

There is a growing cause for concern on envenoming European species because of jellyfish blooms, climate change and globalization displacing species. Treatment of envenomation involves the prevention of further nematocyst release and relieving local and systemic symptoms. Many anecdotal treatments are available but species-specific first aid response is essential for effective treatment. However, species identification is difficult in most cases. There is evidence that oral analgesics, seawater, baking soda slurry and 42–45 °C hot water are effective against nematocyst inhibition and giving pain relief. The application of topical vinegar for 30 s is effective on stings of specific species. Treatments, which produce osmotic or pressure changes can exacerbate the initial sting and aggravate symptoms, common among many anecdotal treatments. Most available therapies are based on weak evidence and thus it is strongly recommended that randomized clinical trials are undertaken. We recommend a vital increase in directed research on the effect of environmental factors on envenoming mechanisms and to establish a species-specific treatment. Adequate signage on jellyfish stings and standardized first aid protocols with emphasis on protective equipment and avoidance of jellyfish to minimize cases should be implemented in areas at risk.

Impact of Scyphozoan Venoms on Human Health and Current First Aid Options for Stings

“…As the application of pressure during this procedure may produce further nematocyst discharge, it is likely that it should also be avoided in the case of scyphozoan stings. For the same reason, pressure-inducing bandages (PIB) are no longer recommended [ 31 ]. While it has been proposed to cover the stung body part with sand to enclose tentacle remnants and ease their removal, this practice seems to lack evidence and consensus [ 107 , 108 ].…”

“…For example, rinsing the sting site with seawater was found to help in tentacle removal, relief of pain, and inhibition of venom discharge [ 96 ] and is generally recommended in the case of C . capillata stings [ 31 , 96 , 109 , 110 , 111 ] and for A. aurita , N. nomurai , and P. noctiluca stings ( Table 1 ). However, a very recent study based on a combination of in vitro nematocyst discharge tests and envenomation models concluded that seawater rinsing induced significant increases in venom delivery and, therefore, its use for C. capillata stings should be discontinued [ 95 ].…”

“…Distilled water did not prevent nematocyst discharge in P. noctiluca [ 123 ]. Other authors have strongly recommended avoiding freshwater as the osmotic or pressure changes may trigger discharge of unfired nematocysts [ 31 ]. Overall, there is no evidence in favor of the use of plain water at ambient temperature for scyphozoan stings.…”

“…This may lead to the adoption of remedies that are ineffective or harmful and may delay or impede the application of more rationale measures of intervention. In addition, there is no consensus among the scientific reports on this subject, which is a matter of intense debate [ 27 , 28 , 29 , 30 , 31 ]. Therefore, the aim of the present work is to give an overview of the first aid measures for scyphozoan stings based on scientific information, with special emphasis on the mechanistic activity of specific venom components.…”

Mediterranean jellyfish as novel food: effects of thermal processing on antioxidant, phenolic, and protein contents

“…Jellyfish can belong to very different species, but they all share the common feature to have special stinging cells, the cnidocytes, each characterized by a subcellular organelle (the cnidocyst) containing species-specific toxins. Cnidarian venoms and toxins are heat labile at temperatures safe for treatments on humans after jellyfish stings, as demonstrated by the beneficial effects of local heat treatments in the most clinical studies [44,45]. In addition, no allergic reaction was found in a preliminary trial with raw and boiled Catostylus tagi in seafood allergic individuals [46].…”