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Insect bites

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Related Terms
  • Antibodies, auto recessive, B-cells, bone marrow, bone marrow transplant, CBC, genetic disorder, immune system, immunodeficiency, inherited disorder, inherited immunodeficiency, leukocytes, leukemia, lymphoma, lymphocytes, malignancy, platelets, pneumonia, red blood cells, T-cells, thrombocytes, thrombocytopenia, tumor, WASP, white blood cells, Wiskott Aldrich syndrome, Wiskott-Aldrich syndrome protein, X-linked.

Background
  • Wiskott-Aldrich syndrome (WAS) is an inherited, immunodeficiency disorder that occurs almost exclusively in males. The recessive genetic disorder is caused by a mutation in the WAS (Wiskott-Aldrich syndrome) gene, which is an X-linked trait. The gene mutation leads to abnormalities in B- and T-lymphocytes (white blood cells), as well as blood platelet cells. In a healthy individual, the T-cells provide protection against viral and fungal infection, the B cells produce antibodies, and platelets are responsible for blood clotting to prevent blood loss after a blood vessel injury.
  • Individuals diagnosed with WAS suffer from recurrent infections, eczema and thrombocytopenia (low levels of platelets).
  • Before 1935, patients only lived an average of eight months. Today, patients usually live an average of eight years, according to a recent case study. The cause of death is usually attributed to extensive blood loss. However, cancer (especially leukemia) is common and often fatal among WAS patients.
  • The only possible cure for WAS is a bone marrow transplant. However, if a patient's family member is not a possible match for a bone marrow donation, patients may have to wait years for a potential donor. Other aggressive treatments may also increase a patient's life expectancy. For instance, one study found that patients who underwent splenectomy (removal of the spleen) lived to be more than 25 years old. The spleen may harbor too many platelets, and cause a decrease in the number of platelets in circulation. Antibiotics, antivirals, antifungals, chemotherapeutic agents, immunoglobulins and corticosteroids have also been used to relieve symptoms and treat infections and cancer associated with WAS.
  • Researchers estimate that about four people per one million live male births develop the disease in the United States.
  • The syndrome is named after Dr. Robert Anderson Aldrich, an American pediatrician who described the disease in a family of Dutch-Americans in 1954, and Dr Alfred Wiskott, a German pediatrician who discovered the syndrome in 1937. Wiskott described three brothers with a similar disease, whose sisters were unaffected.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Binder V, Albert MH, Kabus M, et al. The genotype of the original Wiskott phenotype. N Engl J Med. 2006 Oct 26;355(17):1790-3.
  2. Jin Y, Mazza C, Christie JR, et al. Mutations of the Wiskott-Aldrich Syndrome Protein (WASP): hotspots, effect on transcription, and translation and phenotype/genotype correlation. Blood. 2004 Dec 15;104(13):4010-9. Epub 2004 Jul 29.
  3. Natural Standard: The Authority on Integrative Medicine. .
  4. St. Jude Children's Research Hospital. Inherited Immunodeficiencies: Wiskott-Aldrich Syndrome (WAS). .
  5. U.S. Immune Deficiency Foundation. The Wiskott Aldrich Syndrome. .

Integrative therapies
  • Note: Currently, there is a lack of scientific data on the use of integrative therapies for the treatment or prevention of Wiskott-Aldrich syndrome (WAS). The integrative therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
  • Strong scientific evidence:
  • Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during a course of antibiotics has been studied for reducing adverse effects of antibiotics in the intestinal environment. This includes reducing growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics with probiotics.
  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Good scientific evidence:
  • Ginseng: For more than 2,000 years, the roots of ginseng have been valued in Chinese medicine. Several studies suggest that ginseng may be an effective agent for immune system enhancement. Additional high quality research is needed before a conclusion be made.
  • Avoid with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Probiotics: Research suggests that probiotics, especially those in milk or food, may be an effective agent for immune system enhancement. However, commercially produced yogurt may not be as effective. More studies are needed, particularly with yogurt, to give recommendations.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc appears to be an essential trace element for the immune system, but research on the effect of zinc supplementation on immune function is scant and mostly focuses on patients with specific diseases. Zinc gluconate appears to exert beneficial effects on immune cells, improving CD3 and CD4 counts and increasing CD4/CD8 ratios in children. There are relatively few studies that examine zinc levels and the effects of zinc supplementation on the health of the elderly population. Further research is needed before a recommendation can be made.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Amaranth oil: Amaranth is grown in Asia and the Americas and harvested primarily for its grain, which is used as a food source for bread, pasta, and infant food. Limited evidence suggests that amaranth may stimulate the immune system when combined with a heart-healthy diet in patients with heart disease and high cholesterol. However, additional studies of amaranth alone are needed to determine if it is effective for immunomodulation.
  • Amaranth is generally considered safe. Avoid if allergic or sensitive to amaranth. Use cautiously with diabetes, low blood sugar, low blood pressure, immune system disorders, or kidney disorders. Use cautiously if pregnant or breastfeeding.
  • Arabinogalactan: Arabinogalactans belong to a group of carbohydrates called polysaccharides. When consumed in the diet, arabinogalactan comes from the wood of the larch tree (Larix species) and is approved for use as a dietary fiber by the U.S. Food and Drug Administration (FDA). Early research has suggested that arabinogalactan may cause immune stimulation; however, its effect on immunity in healthy volunteers is not clear. More evidence is needed.
  • Avoid if allergic or sensitive to arabinogalactan or larch. People who are exposed to arabinogalactan or larch dust may have irritation of the eyes, lungs, or skin. Use cautiously in people with diabetes, digestive problems, or immune system disorders, and in people who consume diets high in fiber or low in galactose. Arabinogalactan should not be used during pregnancy or breastfeeding.
  • Arginine (L-arginine): L-arginine helps maintain the body's fluid balance (urea, creatinine), and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and fights infection. Preliminary study results suggest that arginine may cause immunomodulation. More studies are needed to confirm these results.
  • Avoid if allergic to arginine or with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinning drugs (like warfarin or Coumadin®) or blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Western herbalists began using astragalus in the 1800s as an ingredient in various tonics. Astragalus has been suggested as an immune system stimulant in preliminary laboratory and animal research, and in traditional accounts. Reliable human studies are lacking. High quality human research is necessary before a firm conclusion can be drawn.
  • Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation or fever, stroke, transplant, or autoimmune diseases. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with a risk of bleeding. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
  • Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, including green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. Preliminary research of beta-carotene for immune system enhancement shows mixed results. Further research is needed before a conclusion can be drawn.
  • Avoid if sensitive to beta-carotene, vitamin A or any other ingredients in beta-carotene products.
  • Berberine: In low-quality research, berberine has been shown to significantly increase platelet production in individuals with thrombocytopenia both as a monotherapy and adjunctive therapy.
  • Avoid if allergic to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric)), or to members of the Berberidaceae family. Berberine has been reported to cause nausea, vomiting, hypertension (high blood pressure), respiratory failure, and paresthesias; however, clinical evidence of such adverse effects is not prominent in the literature. Avoid if pregnant or breastfeeding.
  • Black currant: The black currant shrub is native to Europe and parts of Asia and is particularly popular in Eastern Europe and Russia. There is currently a lack of information in humans on the effectiveness of black currant seed for immunomodulation.
  • Avoid if allergic or hypersensitive to black currant, its constituents, or plants in the Saxifragaceae family. Avoid with hemophilia or in those taking blood thinners, unless otherwise recommended by a qualified healthcare provider. Use cautiously with venous disorders or gastrointestinal disorders. Use cautiously if taking MAOIs (antidepressants) or vitamin C supplements. Avoid if pregnant or breastfeeding.
  • Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum contains immunoglobulins or antibodies that are released into the bloodstream in response to infections. These immunoglobulins may help improve immune function and may be effective in treating immune system deficiencies. More evidence is required before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to dairy products. Use bovine colostrum with caution. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE) have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of developing, cancer. Use cautiously with immune system disorders, atherosclerosis (hardening of the arteries) or if taking medications, such as anti-diarrheal agents (e.g. immodium), insulin, or CNS agents (amphetamines, caffeine). Avoid if pregnant or breastfeeding.
  • Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold despite a lack of high-quality human evidence. Preliminary research of cat's claw for immune system enhancement shows mixed results. Further research is needed before a conclusion can be drawn.
  • Avoid if allergic to Cat's claw or Uncaria plants or plants in the Rubiaceae family such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, or lupus). Use cautiously with bleeding disorders or history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic, Texan grown plant, Acacia gregii being substituted for cat's claw. Avoid if pregnant, breastfeeding, or trying to become pregnant.
  • Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs, (e.g. liver and kidney). Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have adverse effects on immune function, although the exact mechanism is not clear.
  • Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.
  • Dong quai: Poor-quality research reports benefits of Dong quai in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). However, these patients were not compared to individuals who were not receiving Dong quai. Therefore, the results can only be considered preliminary.
  • Avoid if allergic to Angelica radix or members of the Aplaceae/Umbelliferae family (anise, caraway, carrot, celery, dill, parsley). Although Dong quai is accepted as being safe as a food additive in the United States and Europe, its safety in medicinal doses is not known. There are no reliable long-term studies of side effects. Most precautions are based on theory, laboratory research, tradition, or isolated case reports. Avoid if pregnant or breastfeeding.
  • Echinacea: Echinacea is a perennial herb that has been used to treat a variety of medical conditions. Echinacea has been studied alone and in combination preparations for immune system stimulation. It remains unclear if there are clinically significant benefits. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
  • Avoid if allergic to echinacea, its constituents, or any members of the Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies). Use cautiously in patients prone to atopic reactions and in those with hemochromatosis and diabetes. Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). Use parenteral preparations of echinacea(no longer approved for use in Germany) cautiously. Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole. Avoid using echinacea in patients presenting for anesthesia. Use cautiously if pregnant or breastfeeding.
  • Gamma linolenic acid (GLA):Gamma linolenic acid (GLA) is a dietary fatty acid that is found in many plant oil extracts. Few clinical trials have investigated the effect of GLA on immune responses in healthy human subjects. GLA, as blackcurrant seed oil, may offer some benefits. Further study is required to determine if GLA is beneficial for immune enhancement.
  • Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
  • Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. Goldenseal is sometimes suggested to be an immune system stimulant. However, there is little clinical evidence in this area. More research is needed before a firm conclusion can be drawn.
  • Avoid if allergic or hypersensitive to goldenseal or any of its constituents (like berberine and hydrastine). Use cautiously with bleeding disorders, diabetes, or low blood sugar levels. Avoid if pregnant or breastfeeding.
  • Licorice: Early study has suggested that recombinant roasted licorice decoction combined with low-dose glucocorticoids may be more effective than glucocorticoids alone in treating idiopathic thrombocytopenic purpura. This combination has also shown a lower adverse effect rate than glucocorticoids alone.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or with diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Maitake mushroom: Maitake mushrooms (Grifola frondosa) are fungi that can be eaten. Maitake has been used both as a food and for medical conditions. Beta-glucan extracts from maitake have been studied for immune stimulation. Additional high quality research is needed to make a conclusion.
  • Maitake has not been studied thoroughly in humans, and its effects are not well known. Because it has been used historically as a food, it is thought that low doses may be safe. Avoid if allergic or hypersensitive to maitake or its constituents. Use cautiously with low blood pressure, diabetes, or low blood sugar. Use cautiously if taking blood pressure medications, antidiabetic agents, immunostimulants, immunosuppressants, or interferons. Avoid if pregnant or breastfeeding.
  • Massage: The main goal of massage is to help the body heal itself. Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients. Preliminary evidence suggests that massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.
  • Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Many forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. Preliminary research reports increased antibody response after meditation. Further study is needed to better determine if meditation affects immune function.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting meditation and should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Melatonin: Increased platelet counts after melatonin use has been observed in patients with decreased platelets due to cancer therapies (several studies reported by the same author). Stimulation of platelet production has been suggested but not clearly demonstrated. Additional research is necessary to better understand the role of melatonin in thrombocytopenia.
  • There are rare reports of allergic skin reactions after taking melatonin by mouth. Melatonin has been linked to a case of autoimmune hepatitis. Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. Melatonin supplementation should be avoided in women who are pregnant or attempting to become pregnant, based on possible hormonal effects. High levels of melatonin during pregnancy may increase the risk of developmental disorders. In animal studies, melatonin is detected in breast milk and therefore should be avoided during breastfeeding. In men, decreased sperm motility and decreased sperm count are reported with use of melatonin.
  • Mistletoe: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. A few small trials found mistletoe to be promising as an immunostimulant in individuals with the common cold. Further study is needed to determine if mistletoe is effective for immunomodulation.
  • Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking cholinergics.
  • Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is some evidence suggesting that internal Qi gong may help with treatment of immune deficiencies. However, the evidence is still unclear, and further research is needed to understand how Qi gong may potentially benefit immune function. Based on preliminary study, Chan-Chuang Qi gong therapy may be used to treat leukopenia (low white blood cell count) in breast cancer patients treated with chemotherapy. Further study is warranted.
  • Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
  • Probiotics: Results are mixed regarding the ability of probiotics to reduce complications of infections from medical treatment. Reduced incidence of infection has been seen in patients treated for brain injury, abdominal surgery, and liver transplantation. Other studies have shown no such reduction in elective abdominal surgery and critical care patients.More research is needed in this area before a conclusion can be drawn.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Some research suggests that self-administered reflexology may be beneficial for immune enhancement. Additional study is needed in this area.
  • Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle or with severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, kidney stones, or with a pacemaker. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose plant. It is unclear if rose hips affect immune function. More studies are needed in this area.
  • Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or anti-platelet aggregating agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.
  • Shiitake: Lentinan, a constituent of shiitake, has been shown to modulate the immune system in some studies. However, there is currently a lack of reliable human evidence supporting the use of lentinan or shiitake for immunomodulation. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Tai chi may increase the body's immune response in older adults. For example, patients receiving varicella vaccines and who practiced tai chi showed increased immune responses. Although early study is promising, more study is needed to better determine if tai chi is effective for immune system stimulation.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract increases white blood cell counts. Additional study is needed to determine if thymus extract is effective for immune system stimulation.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to the potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking hormonal therapy or immunosuppressants. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Vitamin A: Vitamin A is a fat-soluble vitamin. Vitamin A deficiency may compromise immunity, but there is no clear evidence that additional vitamin A supplementation is beneficial for immune function in patients who are not vitamin A deficient.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity may occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Vitamin B6: Major sources of vitamin B6 include: cereal grains, legumes (beans), vegetables (like carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Vitamin B6 has been shown to be important for immune system function in older individuals. One study found that the amount of vitamin B6 required to reverse immune system impairments in elderly people was more than the current recommended dietary allowance (RDA). Well-designed clinical trials on vitamin B6 supplementation for this indication are needed before a conclusion can be made.
  • Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA). Avoid if sensitive or allergic to any vitamin B6 product ingredients. Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Use cautiously if pregnant or breastfeeding.
  • Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Preliminary human evidence suggests that vitamin D and its analogues, such as alfacalcidol, may act as immunomodulatory agents. High quality clinical studies are needed to better understand the effects of vitamin D on immunomodulation.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Further research is needed before a clear conclusion can be drawn.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid doses greater than the recommended daily level in pregnant women and breastfeeding women.
  • Fair negative scientific evidence:
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. It is suggested by some textbooks and review articles that DHEA may be effective for immune system stimulation. However, current scientific evidence does not support this claim.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
  • Lycopene: Lycopene is a carotenoid found in human serum, and skin, liver, adrenal, lung, prostate, and colon tissue. It has been proposed that lycopene and other carotenoids, such as beta-carotene, may stimulate the immune system. However, several studies of lycopene supplements and tomato juice intake in humans do not report effectiveness for immune stimulation.
  • Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding

Prevention
  • There is currently no known method to prevent WAS. However, individuals can be tested to determine whether they are carriers of the disease.

Complications
  • General: In general, complications of Hashimoto's disease only develop if the condition is left untreated or if patients do not take their medications as prescribed.
  • Birth defects: If pregnant women with Hashimoto's thyroiditis do not receive treatment, their babies are more likely to have birth defects. Babies may have intellectual and developmental problems. Researchers have identified a connection between underactive thyroids during pregnancies and brain, heart, and kidney problems in infants.
  • Goiter: When a patient's thyroid is not producing enough hormones, the pituitary gland constantly stimulates the thyroid to release more hormones. As a result, the thyroid may become enlarged, causing the neck to look swollen. This condition is called a goiter. Although goiters generally do not cause pain, a large goiter can interfere with swallowing or breathing and it may affect the patient's appearance and self-esteem. In many cases, goiters will be cured once hormone replacement therapy is started. However, some patients may need to have their goiter surgically removed.
  • Heart problems: If Hashimoto's thyroiditis is not properly treated, patients may have an increased risk of developing heart disease. The patient's heart may enlarge, and in rare cases, this may lead to heart failure. Researchers have also found a connection between hypothyroidism and high cholesterol.
  • Mental functioning: Untreated Hashimoto's disease may also lead to slowed mental functioning. Patients may become confused or have trouble thinking or concentrating. Once treatment is started, these symptoms will go away.
  • Mental health: If the disease is untreated or poorly managed, patients may suffer from depression. Patients who are depressed experience sadness, low self-esteem, loss of pleasure, apathy, and sometimes, difficulty functioning. If these problems persist for two weeks or more for unknown reasons, patients should consult their healthcare providers.
  • Some males and females may experience a decrease in sexual desire (libido).
  • Myxedema: In rare cases, long-term Hashimoto's thyroiditis that has not been treated may lead to a life-threatening condition called myxedema. This condition causes swelling of the skin and other tissues, especially near the eyes and cheeks. Symptoms may include drowsiness followed by extreme tiredness and unconsciousness. Patients who experience symptoms of myxedema should seek immediate medical treatment at the emergency department of a nearby hospital.

Types of insect bites
  • Bed bugs:
  • Overview: Bedbugs are small, brown, flattened insects that feed on the blood of animals and humans. The Cimex lectularius species is most likely to affect humans.
  • Adult bedbugs are about 1/4 inch long and reddish brown, with flat oval bodies. The nymphs (immature bedbugs) look similar to the adults, but they are smaller and lighter in color. While bedbugs cannot fly, they can crawl quickly.
  • Female bedbugs lay up to five eggs a day in secluded areas. These whitish-colored eggs are difficult to see without magnification. Bedbugs molt (shed their skin) five times before reaching adulthood. Before each molt, the bugs eat a blood meal.
  • Bedbugs are able to withstand harsh living conditions. Nymphs can survive months without food, while adults can survive for more than a year without eating. If a home becomes infested with these insects, extermination by a professional is almost always necessary.
  • The feces of bedbugs will appear as dark spotting and staining. Bloodstains may also appear on bed linens after they feed on the host.
  • Since bedbugs are active during the night, most bedbug bites occur while people are sleeping. Once the bugs pierce the skin, they become engorged (full) in about 3-10 minutes. Bites are typically painless, and most hosts do not even realize they are being bitten.
  • Symptoms vary among individuals. Many people develop an itchy red welt or localized swelling, which may develop a day or two after the bite. Others have little or no reaction. Bedbugs feed on any bare skin that is exposed while sleeping. Bedbugs are generally unlikely to transmit diseases to humans, and they are not considered a serious health threat.
  • Bedbug infestations were common in the United States before World War II. Improvement in hygiene and widespread use of DDT (Dichloro-Diphenyl-Trichloroethane, an insecticide that is no longer available in the United States) during the 1940s and 1950s led to a drastic decline of infestations. However, bed bugs are starting to become more prevalent the United States, especially in apartments, homes, hotels, motels, dormitories, and shelters. The bugs are commonly found in other parts of the world including Africa, Asia, Central and South America, and Europe.
  • Symptoms: Bedbugs feed on any bare skin that is exposed, including the face, neck, shoulders, feet, arms, and hands. Many people develop an itchy red welt or localized swelling, which may appear a day or two after the bite. Others experience little or no reaction.
  • Diagnosis: A healthcare provider can diagnose bedbug bites after a physical examination and confirmation of the bugs' presence. Patients should look for specks of blood on bed linens and behind wallpaper. Fecal stains may also be visible. Areas of high infestation may also have an intense sweet odor that is caused by bedbugs' oil secretions.
  • Treatment: Treatment focuses on alleviating symptoms. Bedbugs will need to be exterminated in order to prevent symptoms from recurring. A professional exterminator should be consulted when there is a bedbug infestation. Bed linens should be washed in hot water to kill the insects. Oral antihistamines like diphenhydramine (Benadryl®) have been used to relieve the itching associated with bedbug bites. Hydrocortisone cream or ointment may also be applied to the skin to relieve itching and irritation.
  • Black widow spider:
  • Overview: Out of the approximately 20,000 species of spiders found in North, South and Central America, only 60 can bite humans. Black widow spiders are about a half-inch long. The two species that commonly inhabit the United States are the southern black widow and northern black widow. The southern black widow has a shiny, black abdomen with a red hourglass shape on the underside. The northern black widow has red, yellow, or white spots on the upper and underside surface of its abdomen. Some spiders also have red legs.
  • Black widow spiders are nocturnal (active at night) and they are typically found in dark areas. Only female black widows can bite humans; they only bite when they feel threatened, disturbed, or provoked, according to researchers.
  • The black widow spider venom affects the victim's nervous system. Some people experience mild symptoms while others may have a severe reaction.
  • Symptoms: A black widow spider bite is painful. The severity of symptoms after the bite depends on the age and overall health of the victim. Children and elderly individuals are more likely to experience more serious symptoms than healthy adults. Individuals may experience pain at the bite site, which is often followed by severe muscle cramps, weakness, abdominal pain, and tremors. Severe reactions may cause lightheadedness, dizziness, chest pain, difficulty breathing, increased heart rate, increased blood pressure, nausea, and vomiting. Patients who experience severe symptoms should seek medical attention immediately.
  • Diagnosis: A diagnosis can only be confirmed after a physical examination and medical history. The healthcare provider will also consider the likelihood of a bite, which depends on whether the spider lives in the area of the country where the patient was bitten.
  • Treatment: Treatment is not generally needed because symptoms will resolve on their own. Severe cases may be treated with narcotics and antivenin (antitoxin to counteract the effects of the spider venom).
  • The antivenin used to treat black widow spider bites is made from horse serum (clear fluid portion of blood). The antivenin is produced from a horse that has developed antibodies and is immune to the spider's venom.Some experts suggest that antivenin be used in any severe bite because one dose of the antivenin quickly relieves symptoms. However, others only suggest antivenin in children, the elderly, and in those with severe underlying medical conditions.
  • Patients who receive antivenin may experience allergic reactions to the horse serum. Therefore, patients should be skin-tested for a possible allergy prior to treatment.
  • Since antivenin may not be readily available at most hospitals, there may be some delay in obtaining it.
  • Brown recluse spider:
  • Overview: Brown recluse spiders are found in the Midwestern and Southeastern United States.
  • Brown recluse spiders have a violin pattern on the back of their cephalothoras (body part to which the legs attach). These spiders may range in color from yellowish-tan to dark brown. The name of the genus, Loxosceles, means six eyes. Unlike most other spiders, which have eight eyes, the brown recluse has six.
  • The spiders live in large numbers, and they are commonly found in dark, warm, dry environments, such as attics, closets, and basements. These spiders only bite humans when they feel threatened, disturbed, or provoked. Bites are most likely to occur during the summer.
  • The brown recluse venom is more potent than rattlesnake venom. However, the spider's venom causes less severe reactions than a rattlesnake because much smaller quantities are injected into its victims.
  • The venom is made of enzymes that destroy the tissues of its victims. This allows the spider to suck up and ingest the body parts of the insects it preys on. When the spider bites a human, the venom causes tissue death in the areas immediately surrounding the bite site.
  • The venom also causes an immune response in humans. The immune system releases inflammatory chemicals such as cytokines, histamines, and interleukins. These chemicals signal white blood cells to flood to the bite site. However, in rare but severe cases, the inflammatory chemicals may cause serious adverse reactions in the human, including the destruction of red blood cells and platelets, blood clots in capillaries, kidney failure, coma, and death. Death has only been reported in children younger than seven years old.
  • Symptoms: Initially, the bite site becomes red and fang marks might be visible. The bite mark typically has a "bull's-eye" appearance (red ring around the site, which often becomes blistered). Symptoms usually develop two to eight hours after the bite. Some patients may experience a minor burning sensation at the bite site. Patients may experience severe pain at bite site, as well as severe itching, fever, muscle pain, nausea and vomiting. After about 12-48 hours, the blistered bite mark may turn bluish and then black in color, as the skin tissue dies.
  • Diagnosis: Reliable clinical tests to diagnose a brown recluse spider bite are lacking. A diagnosis can only be confirmed after a physical examination and medical history. The healthcare provider will also consider the likelihood of a bite, which depends on whether the spider lives in the area of the country where the patient was bitten.
  • Treatment: There is no antivenin available in the United States to treat brown recluse spider bides. Controversial therapies include steroids and the antibiotic dapsone (Avlosulfon®). These therapies are controversial because they have little proven benefit. These are typically reserved for patients with severe systemic diseases (such as certain types of anemia, blood clotting problems, and kidney failure). Most wounds, especially necrotic lesions (dead tissue), will need to be monitored by a healthcare provider every day for at least three to four days. The doctor may remove dead tissue to reduce the likelihood of secondary bacterial infections.
  • Oral antihistamines like diphenhydramine (Benadryl®) may be used to decrease the histamine reaction. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®), may be used to decrease the pain and inflammation at the bite site.
  • Chiggers:
  • Overview: Chiggers are the parasitic larvae of the harvest mite. While the adults are harmless to humans, the larvae are parasites to many animals, including birds, livestock, reptiles, and humans. Chigger bites only occur during the late summer and early autumn because this is when the larvae are active.
  • Chiggers are found in many parts of the world, including the southern United States. Chiggers typically live in brush and grassy areas. Females lay up to 400 eggs in damp areas on the ground.
  • Once the eggs have developed into larvae (chiggers), they move to the tips of grasses. When a potential host, such as a rodent or human passes by, the chigger latches on. The chiggers then move to protected areas on the host, such as under socks or under belts.
  • Chiggers pierce the skin, especially near hair follicles. When they pierce the skin, they secrete digestive enzymes from their saliva and then they suck up and ingest the liquefied host tissues. The rash and intense itching that develops after a chigger bite is an allergic reaction to their salivary secretions. Once the larva is fully fed, it drops off the host.
  • These insects generally do not transmit diseases, but they are known to carry "scrub typhus" in certain parts of Asia.
  • Symptoms: After a chigger is fully fed, it will drop off the individual. Three to six hours after a bite, patients develop a red, itchy welt that has a white center. The welt may develop into dermatitis (dry, itchy, flaky skin). Some patients may also experience fever and swelling. Depending on the sensitivity of the patient, symptoms may last for weeks. Patients should not scratch the bite mark because it may break the skin and potentially lead to secondary infections.
  • Diagnosis: A qualified healthcare provider can diagnose chigger bites after examining the patient's rash. Chiggers cause a distinctive red welt, with a hard central area on the skin that itches.
  • Treatment: Hydrocortisone cream has been applied to the affected area to temporarily relieve itching. Hydrocortisone 1% cream, which is available over-the-counter, has anti-inflammatory effects, and relieves swelling and redness in addition to itching. Antipruritic agents like calamine lotion (Calamox®) have been applied to the skin to relieve itching.
  • Mosquitoes:
  • Overview: Mosquitoes have long, slender bodies, and long, thin legs. The males, and occasionally, the females, eat nectar and other plant juices. However, the females of most mosquito species need to have a blood meal to mature their eggs, which are laid on the surface of water.
  • The female mosquito inserts a thin proboscis (tubular, feeding, and sucking organ) into the victim's skin. The mosquito injects saliva into the host. This prevents the victim's blood from clotting as it is sucked into the insect's abdomen. Mosquitoes feed until they are full or brushed away by the victim.
  • The mosquito's saliva causes an allergic reaction in humans that causes the bite site to itch and swell.
  • Mosquitoes are potentially dangerous because they can carry diseases such as malaria and the West Nile Virus (WNV). The Anopheles mosquito can transmit malaria. Malaria is an infectious disease of the red blood cells. The disease is most common in tropical and subtropical areas, such as Africa, Asia, the Middle East, South America, and Central America.
  • The WNV causes a viral infection of the brain called encephalitis. The infection is considered a seasonal epidemic in Northern America. Outbreaks typically occur during the summer and fall months.
  • Eastern equine encephalitis (EEE) is a virus found in freshwater swamp birds and mosquitoes. It is occasionally transmitted to horses, and very rarely, to people. EEE affects the brain and central nervous system. The risk of contracting EEE is highest in mid to late summer.
  • Symptoms: Mosquito bites usually cause swelling, itching, and burning at the bite site. A bite may take several days to heal and stop itching.
  • Symptoms of malaria include cycles of chills, fever, and sweating every one, two, or three days if the infection is not treated. Some individuals may also experience diarrhea, jaundice (yellowing of the skin and eyes), coughing, nausea, and vomiting.
  • According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 80% of patients who are infected with WNV experience no symptoms. If symptoms do develop, they typically occur three to 14 days after being bitten by an infected mosquito. Mild symptoms may include fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach, and/or back. Mild symptoms can last anywhere from a few days to several weeks. Severe symptoms may include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. Severe symptoms may last several weeks and neurological effects may be permanent.
  • Symptoms of EEE include fever, stiff neck, and headache starting between two and 10 days after infection. Encephalitis followed by coma is possible. Patients who survive suffer mild to severe neurological complications.
  • Diagnosis: Mosquito bites are harmless, unless the insect transmitted a disease such as malaria or WNV.
  • Patients who have traveled to areas of the world where malaria is common and who experience symptoms of malaria should consult their qualified healthcare providers. A diagnosis of malaria can be confirmed after a blood test. Since malaria is a cyclic virus, two samples taken at six- and 12-hour intervals can confirm the presence of malaria.
  • A diagnosis of WNV or EEE can be made after the virus is identified. A sample of blood and spinal fluid is analyzed for the viral DNA.
  • Treatment: Antipruritic agents like calamine lotion (Calamox®) have been used to relieve itching. Oral antihistamines like diphenhydramine (Benadryl®) are also commonly used to relieve the itching associated with mosquito bites.
  • Malaria is treated with one or more antimalarials including: chloroquine (Aralen®), quinine (Quinamm® or Quiphile®), hydroxychloroquine (Plaquenil®), Mefloquine (Lariam®), doxycycline (Doryx®, Vibramycin®), a combination of sulfadoxine and pyrimethamine (Fansidar®), or a combination of atovaquone and proguanil (Malarone®).
  • There is currently no cure for WNV. However, since most patients experience no symptoms, treatment is not usually necessary. Patients who experience severe symptoms may need to be hospitalized and receive intravenous (IV) fluids. Some patients may also need to have breathing tubes inserted into their airways to help them breathe.
  • There is currently no cure for the EEE virus in humans. Medical treatment focuses on treating symptoms of the infection. Treatment options may include antibiotics to treat secondary infections, anticonvulsants to treat seizures, a respirator for assisted breathing, and corticosteroids to reduce swelling in the brain.
  • Ticks:
  • Overview: Ticks are external parasites that feed on the blood of animals and humans. These arachnids (invertebrates that have four pairs of legs and simple eyes) are usually found in tall grasses or bushes. There are two main types of ticks: hard ticks and soft ticks. Hard ticks, such as the common dog tick and the deer tick, have a hard shell just behind the mouthparts, while soft ticks do not. Soft ticks rarely affect humans because they prefer to feed on birds or bats.
  • Once the tick has reached its host, it will attach firmly and draw blood until full (engorged), and then it will drop off.
  • In general, ticks do not cause serious health problems, unless they carry a disease. However, in rare cases, the tick itself can cause temporary paralysis in some patients. Symptoms include numbness, tingling, weakness, lack of coordination, and spreading paralysis. Once the tick is removed, symptoms will disappear.
  • Internationally, there are more 30 major tick-borne diseases. The most common disease transmitted by ticks is Lyme disease, which is a bacterial infection that that may lead to arthritis, as well as neurological and heart-related problems.
  • Symptoms: Some people may have a mild allergic reaction and experience symptoms such as swelling, itching, and reddening at the bite site. In rare cases, a severe and potentially life threatening allergic reaction called anaphylaxis may occur. Another rare symptom is temporary paralysis, which may occur in sensitive patients. Symptoms of tick-induced paralysis include numbness, tingling, weakness, lack of coordination, and spreading paralysis. Once the tick is removed, symptoms will subside and the patient will fully recover.
  • In the United States, Lyme disease is caused by the bacteria called Borrelia burgdorferi,which is carried by deer ticks. These ticks are brown and usually about the size of the head of a pin. Patients who have Lyme disease typically develop a rash with a bull's eye appearance at the bite site (red ring around the bite mark). Symptoms may also include flu-like symptoms, joint pain and swelling, inflammation of the meninges surrounding the brain, Bell's palsy (temporary paralysis on one side of the face), numbness or weakness in the limbs, poor muscle movement, and memory loss. Some patients may develop heart-related problems, such as irregular heartbeat, several weeks after infection. These symptoms typically only last a few days or weeks. Other less common symptoms include eye inflammation, severe fatigue, and hepatitis (inflamed liver).
  • Diagnosis: If Lyme disease is suspected, a qualified healthcare provider may conduct an enzyme-linked immunosorbent assay (ELISA) and a Western blot test to determine whether the patient has the disease. An ELISA test is used to determine whether the patient has developed antibodies to B. burgdorferi. During the procedure, a sample of the patient's blood is sent to a laboratory for testing. If antibodies to the B. burgdorferi are present in the patient's blood sample, the test solution will have an intense color reaction generated by the attached enzyme. If results are positive, a Western blot test is performed to confirm a diagnosis because ELISA may produce false-positive results.
  • Treatment: Patients should remove ticks promptly with tweezers after they are discovered. If the tick is difficult to remove, rub a petroleum jelly (Vaseline®) or paint nail polish over the tick. These products will kill the tick. Patients should consult their healthcare providers if they are unable to remove the tick. Once the tick is removed, patients should thoroughly wash the bite site and their hands with soap and water. Patients should observe the bite site for the next several days. If a bull's eye rash develops around the bite site, a qualified healthcare provider should be consulted immediately.
  • Oral antihistamines like diphenhydramine (Benadryl®) are usually taken to decrease the histamine reaction in the body.
  • Patients who have Lyme disease usually receive oral antibiotic treatment with doxycycline (Vibramycin®) for adults and children who are at least eight years old. Younger children typically receive treatment with amoxicillin (Amoxil®, Prevpac®, Trimox®) or cefuroxime axetil (Ceftin®). Treatment generally lasts 14-21 days.
  • Patients who have late-stage Lyme disease typically receive intravenous antibiotics like ceftriaxone (Rocephin®) for 14 to 28 days. Symptoms of late-stage Lyme disease include chronic joint inflammation, Bell's palsy, memory loss, and irregular heartbeat. Side effects of treatment may include low white blood cell count, gallstones, and mild to severe diarrhea.
  • According to the U.S. Food and Drug Administration (FDA), bismacine, also known as chromacine, should not be used to treat Lyme disease. Alternative medicine practitioners sometimes prescribe bismacine for the treatment of Lyme disease. Bismacine contains high amounts of bismuth, a heavy metal that is used in some medications taken by mouth to treat Helicobacter pylori (a bacteria that can cause stomach ulcers). Although bismuth is considered safe when used in some oral medications to treat stomach ulcers, it is not approved as an intravenous medication or to treat Lyme disease. Bismacine can cause bismuth poisoning, which may lead to heart and kidney failure. In March 2005, one patient was hospitalized after receiving a bismacine treatment and in 2006, one person died after treatment, according to the FDA.

Insect repellants
  • General: Many types of insect repellents are available in the United States. The U.S. Centers for Disease Control and Prevention (CDC) recommends the use of products containing active ingredients like DEET (N, N-diethyl-meta-toluamide), picaridin, permethrin, and oil of lemon eucalyptus that have been registered with the U.S. Environmental Protection Agency (EPA) for use as repellents applied to skin and clothing.
  • DEET: DEET (N, N-diethyl-meta-toluamide) is the active ingredient in many insect repellent products. According to the EPA, insect repellents containing DEET are not a health concern, as long as consumers follow the label directions and take necessary precautions.
  • DEET is used to repel biting insects like mosquitoes and ticks. On average, about one-third of Americans use DEET each year, according to the EPA. Products containing DEET are currently available to the public in many different types of liquids, lotions, sprays, and impregnated materials (such as wrist bands). DEET-containing products that are applied to the skin are made with 4-30% DEET. If used as directed (as a personal insect repellant), DEET is not likely to adversely affect aquatic or terrestrial wildlife, according to the EPA.
  • Picaridin: Picaridin, which is nearly odorless, offers protection against insect bites equal to DEET at similar concentrations. In addition, picaridin prevents mosquitoes from locating individuals who have applied the repellant.
  • Permethrin: Permethrin is primarily used to treat lice and permethrin-containing products are highly effective as insecticides and repellents, according to the EPA. Insect repellants that contain permethrin (like Permanone®) may be applied to clothing, shoes, and camping equipment to help reduce the risk of insect bites. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other arthropods (like spiders). Permethrin treated clothing is still effective after repeated washings.
  • Oil of lemon eucalyptus: Oil of lemon eucalyptus is a plant-based chemical. This ingredient, according to the EPA, may offer protection that is comparable to low concentrations of DEET.
  • Others: Shorter-acting repellents, such as the oil of geranium, lemon grass, cedar, soy, or citronella, may offer limited protection against insect bites.
  • EPA safety recommendations: Repellents should only be applied to exposed skin and/or clothing. These products should not be used under clothing. Do not apply to eyes or mouth, or to cuts, open wounds, or irritated skin. Apply sparingly around ears. Do not spray repellents directly onto the face. Instead, spray the repellant onto the hands and gently rub onto the face. Heavy application is not needed for effectiveness. After returning indoors, wash treated skin with soap and water. Patients who experience side effects or allergic reactions after exposure should wash the repellent off with mild soap and water and call a local poison control center and physician's office for further instructions. Keep repellants out of reach of children.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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