Generalized urticaria induced by a diethyltoluamide-containing insect repellent in a child

Insect repellents: An updated review for the clinician

Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IRs) to prevent systemic infections constitutes a fundamental public health effort. Cost effectiveness, availability, and high efficacy against arthropod vectors are key characteristics of an ideal IR. Currently, numerous IRs are available on the market, with N,N-diethyl-3-methylbenzamide (DEET) being the most widely used. DEET has an excellent safety profile and remarkable protection against mosquitoes and various other arthropods. Other Environmental Protection Agency-registered IR ingredients (eg, permethrin, picaridin, IR3535, oil of lemon eucalyptus, oil of citronella, catnip oil, and 2-undecanone) are alternative IRs of great interest because some of these ingredients have efficacies comparable to that of DEET. These alternative IRs possess low toxicity and favorable customer experiences in use (eg, cosmetically pleasant, naturally occurring). This review summarizes the currently available Environmental Protection Agency-registered IRs, including their origins, mechanisms of action, side effect profiles, and available formulations. This review will enable the clinician to select the best IR option to meet a patient's needs and provide the greatest protection from arthropod bites and their sequelae.

Insect hypersensitivity beyond bee and wasp venom allergy

The bites of blood-feeding insects regularly induce sensitization to salivary proteins and cause local hypersensitivity reactions in over 90% of the population, representing either an IgE-mediated immediate wheal and flare reaction or a T cell-driven delayed papule. Long-lasting large local reactions and bullous reactions may cause significant discomfort and reduction in quality-of-life. Anaphylaxis is rarely reported though proven for several insects, above all mosquitoes, horse flies, and kissing bugs. Recently, salivary gland proteins have been thoroughly studied in some blood-feeding insect species, and several allergens have been identified. Interestingly, many of them belong to the same protein families as the well-known honeybee and wasp venom allergens (phospholipases, hyaluronidases, antigens 5, serine proteases) though sequence identities are mostly low. There is still insufficient evidence for the proposed cross-reactivity between salivary proteins from blood-feeding insects and Hymenoptera venom allergens.

[Children arthropod bites protective measures: insecticides and repellents]

Vector transmitted diseases are often a serious threat for child health, especially for children traveller in tropical regions. Few arthropod borne diseases are preventable by immunization or chimioprophylaxis. Prevention of most of them is based on personal protection against arthropod bites. The evidence of its efficacy has been established by the use of impregnated bed nets, impregnated clothes with permethrin or mosquito repellent which reduced significantly child malaria morbidity and mortality in endemic countries. These personal protective measures are able to minimize arthropod bites and prevent Chikungunya infection, dengue fever and Lyme disease. The choice of a repellent among the commercialised products need to be efficacy and safety evidence based. This article propose to raise this issue and to give pragmatic recommendations, with a focus to children below 30 months who are at a high toxicological risk. Severity of these diseases allowed to use potentially toxic repellents if misused.

Toward development of neem-based repellents against the Scottish Highland biting midge Culicoides impunctatus

Oil of neem, from the tree Azadirachta indica A. Juss (Meliaceae), was evaluated for repellent and antifeedant activity against Culicoides biting midges (Diptera: Ceratopogonidae), by three complementary methods with serial dilutions. Electroantennograms revealed the sensitivity of Culicoides nubeculosus (Meigen) females to neem > or = 0.10%. Culicoides impunctatus Goetghebuer females were repelled by > or = 1% in a Y-tube olfactometer, Using a membrane feeder for wild-caught parous females of C. impunctatus, the proportion blood-feeding was significantly reduced by topical applications of neem oil > or = 0.10% concentrations, with blood-feeding completely prevented by > or =1%. On the basis of these response data, we developed 2% neem-based formulations for personal protection against biting midges.

Culicoides midge trap enhancement with animal odour baits in Scotland

Examples of the commercial trap Mosquito Magnet Pro (MMP emitting attractant 1-octen-3-ol in carbon dioxide 500 mL/min generated from propane fuel), were run 24 h/day on the Isle of Skye, Scotland, during June-August 2001 and evaluated for catching Culicoides biting midges (Diptera: Ceratopogonidae). From 30 days trapping, the catch averaged 2626 +/- 1358 Culicoides females/trap/day (mean +/- SE, range 558 +/- 139 to 6088 +/- 3597, for five sets of six consecutive nights), predominantly the pest Culicoides impunctatus Goetghebuer (68% overall), plus C. vexans (Staeger) > C. delta Edwards > C. pulicaris (L.) > C. lupicaris Downs & Kettle > C. albicans (Winnertz) > other Culicoides spp. Attempts were made to enhance the odour baiting system by adding hexane-extracts (2.1 mg/day) of hair samples from large host animals, resulting in the following effects on Culicoides collections: sheep - 53 %, red deer - 26 %, calf + 20%, pony + 40%, water buffalo + 262%, with greatest increases for C. impunctatus and C. pulicaris. Serial concentrations of these animal extracts (10(-1) - 10(-3) x 2.2 g/mL) were assayed on parous female C. impunctatus response in a Y-tube olfactometer (air-flow 150 mL/min), and by electroantennogram (EAG) on Culicoides nubeculosus Meigen laboratory-reared parous females. Positive behavioural responses to host odours were dose-dependent: the water buffalo extract being most active (threshold 0.22 g/mL), similar to deer, whereas other host extracts were > or = 10-fold less active. Correspondingly, the EAG threshold was lowest for water buffalo, 10-fold greater for deer, calf and pony, but not detected for sheep. If the active component(s) of these host extracts can be identified and synthesized, they might be employed to improve the capture of Culicoides midges for local control by removal trapping.

Repellent and antifeedant activity of salicylic acid and related compounds against the biting midge, Culicoides impunctatus (Diptera: Ceratopogonidae)

An artificial membrane, blood-feeding method was used to assess the repellent and antifeedant effects of derivatives of salicylic acid on the biting midge Culicoides impunctatus Goetghebeur. Trans-2-hydroxycyclohexanecarboxylic acid, 6-methylsalicylic acid, 2,6-dihydroxy-4-methylbenzoic acid, and salicyluric acid caused highly significant inhibition of feeding, with salicyluric acid performing significantly greater than the other compounds. Investigating the effects of alkyl substitution of salicylic acid, o-thymotic and o-cresotic acids were also effective. A pilot clinical trial using salicyluric acid indicated that it provided a protective effect and it was hypothesized that this may have resulted primarily from contact, because no significant repellent effects were shown for this compound in a microscope slide test, designed to demonstrate repellency with volatile compounds.