Asia Pac Allergy.  2019 Apr;9(2):e15. 10.5415/apallergy.2019.9.e15.

Tick killing in situ before removal to prevent allergic and anaphylactic reactions in humans: a cross-sectional study

• Taylor BW
• Ratchford
• van Nunen
• Burns B

• KMID: 2444115
• DOI: http://doi.org/10.5415/apallergy.2019.9.e15

Abstract

BACKGROUND
Tick anaphylaxis is a potentially fatal outcome of improper tick removal and management.
OBJECTIVE
To investigate whether killing ticks in-situ with ether-containing sprays or permethrin cream, before careful removal by the mouthparts could reduce this risk.
METHODS
This was a prospective study at Mona Vale Hospital Emergency Department (ED) in Sydney, New South Wales, over a 6-month period during the peak tick season of 2016. Tick removal methods, allergic/anaphylactic reactions were recorded for patients presenting with ticks in situ or having already removed the ticks themselves. Primary endpoint was allergic/anaphylactic reaction after tick killing/removal.
RESULTS
One hundred twenty-one patients met study inclusion criteria. Sixty-one patients (28 known tick-hypersensitive) had ticks killed with Wart-Off Freeze or Lyclear Scabies Cream (5% w/w permethrin) before removal with fine-tipped forceps or Tick Twister. Three patients (2 known tick-hypersensitive) had allergic reactions (5%), none anaphylactic. The 2 known hypersensitive patients suffered reactions during the killing process and the third patient had a particularly embedded tick meaning it could not be removed solely by mouthparts. Fifty patients presented to the ED posttick removal by various methods, none using either fine-tipped forceps or Tick Twister, of which 43 (86%) experienced allergic reactions - 2 anaphylactic. Five patients suffered allergic reactions before presentation despite no attempt at kill or removal, but ticks had likely been disturbed by some other method. Five patients had live ticks removed in ED - 3 refused killing and had no reaction despite 1 having known hypersensitivity; 2 had ticks on eyelids contraindicating killing, 1 with known hypersensitivity but both had allergic reactions post removal.
CONCLUSION
Results support killing ticks in-situ before careful removal by mouthparts to reduce allergic/anaphylactic reactions although further research is still required.

Keyword

Tick bites; Ticks; Anaphylaxis; Humans; Tick toxicoses

MeSH Terms

Anaphylaxis*
Cross-Sectional Studies*
Emergency Service, Hospital
Eyelids
Fatal Outcome
Homicide*
Humans*
Hypersensitivity
Methods
New South Wales
Permethrin
Prospective Studies
Scabies
Seasons
Surgical Instruments
Tick Bites
Tick Toxicoses
Ticks*
Permethrin