UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Prevention of arthropod and insect bites: Repellents and other measures

Author
Nancy L Breisch, PhD
Section Editor
David B Golden, MD
Deputy Editor
Anna M Feldweg, MD

INTRODUCTION

The approach to protection against arthropod bites is influenced by the level of protection that is needed in a specific situation. For example, a combination of chemically-treated gear and clothing and a strong chemical repellent may be necessary in areas with high concentrations of disease-carrying arthropods (Centers for Disease Control and Prevention: Protection against mosquitoes, ticks, and other arthropods). In contrast, milder repellents may be sufficient for preventing nuisance bites in areas with low levels of disease vectors. The phylum Arthropoda includes both insects and arachnids, although the terms "arthropod" and "insect" are used interchangeably in this topic review.

Repellents are variably useful in deterring mosquitoes, biting flies, fleas, midges, chiggers, and ticks.

Repellents are not effective against stinging insects, such as Hymenoptera species (yellow jackets, wasps, bees, hornets, imported fire ants, and harvester ants) or against spiders. Unlike blood-sucking arthropods, stinging insects and spiders do not seek out humans to feed. Rather, they sting/bite humans reflexively in self-defense or to defend the nest (some Hymenoptera) or egg sacs (some spiders), and it is not possible to chemically deter these extreme behaviors short of using an insecticide.

The effectiveness and safety of the leading repellents and the use of permethrin will be discussed here. Additional measures to prevent mosquito-borne illness in tropical areas are presented separately. (See "Prevention of malaria infection in travelers", section on 'Mosquito bite prevention'.)

REPELLENTS

Among repellents for which a mechanism of action has been described, some act as agonists at olfactory receptors, binding the receptors and blocking recognition of suitable prey. Others antagonize olfactory receptors and actively reverse a normally attractive scent into a deterring scent. Due to highly divergent receptors, the same compound may act as an agonist in one species and an antagonist in another [1,2].

                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Nov 17 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Bohbot JD, Fu L, LE TC, et al. Multiple activities of insect repellents on odorant receptors in mosquitoes. Med Vet Entomol 2011; 25:436.
  2. Bohbot JD, Dickens JC. Insect repellents: modulators of mosquito odorant receptor activity. PLoS One 2010; 5:e12138.
  3. Insect repellents. Med Lett Drugs Ther 2003; 45:41.
  4. Schofield S, Tepper M, Gadawski R. Laboratory and Field Evaluation of the Impact of Exercise on Performance of Regular and Polymer-Based Deet Repellents. Vector Control 2007; 44:6.
  5. Pickett JA, Birkett MA, Logan JG. DEET repels ORNery mosquitoes. PNAS 2008; 105:36.
  6. Fradin MS. Mosquitoes and mosquito repellents: a clinician's guide. Ann Intern Med 1998; 128:931.
  7. Fradin MS, Day JF. Comparative efficacy of insect repellents against mosquito bites. N Engl J Med 2002; 347:13.
  8. Katz TM, Miller JH, Hebert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol 2008; 58:865.
  9. Kasting GB, Bhatt VD, Speaker TJ. Microencapsulation decreases the skin absorption of N,N-diethyl-m-toluamide (DEET). Toxicol In Vitro 2008; 22:548.
  10. Insect repellents. Med Lett Drugs Ther 1989; 31:45.
  11. (Content expires 8/30/2011) www.aap.org/advocacy/releases/summertips.cfm/ (Accessed on April 06, 2011).
  12. Centers for Disease Control (CDC). Seizures temporally associated with use of DEET insect repellent--New York and Connecticut. MMWR Morb Mortal Wkly Rep 1989; 38:678.
  13. Koren G, Matsui D, Bailey B. DEET-based insect repellents: safety implications for children and pregnant and lactating women. CMAJ 2003; 169:209.
  14. Briassoulis G, Narlioglou M, Hatzis T. Toxic encephalopathy associated with use of DEET insect repellents: a case analysis of its toxicity in children. Hum Exp Toxicol 2001; 20:8.
  15. Morton R, Brooks M, Eid N. Hypersensitivity pneumonitis in a child associated with direct inhalation exposure of an insect repellent containing DEET. Pediatr Asthma Allergy Immunol 2006; 19:44.
  16. Garrettson L. Commentary--DEET: caution for children still needed. J Toxicol Clin Toxicol 1997; 35:443.
  17. www.cdc.gov/travel/bugs.htm (Accessed on March 15, 2007).
  18. Wylie BJ, Hauptman M, Woolf AD, Goldman RH. Insect Repellants During Pregnancy in the Era of the Zika Virus. Obstet Gynecol 2016; 128:1111.
  19. Schoenig GP, Neeper-Bradley TL, Fisher LC, Hartnagel RE Jr. Teratologic evaluations of N,N-diethyl-m-toluamide (DEET) in rats and rabbits. Fundam Appl Toxicol 1994; 23:63.
  20. McGready R, Hamilton KA, Simpson JA, et al. Safety of the insect repellent N,N-diethyl-M-toluamide (DEET) in pregnancy. Am J Trop Med Hyg 2001; 65:285.
  21. Badolo A, Ilboudo-Sanogo E, Ouédraogo AP, Costantini C. Evaluation of the sensitivity of Aedes aegypti and Anopheles gambiae complex mosquitoes to two insect repellents: DEET and KBR 3023. Trop Med Int Health 2004; 9:330.
  22. Frances SP, Waterson DG, Beebe NW, Cooper RD. Field evaluation of repellent formulations containing deet and picaridin against mosquitoes in Northern Territory, Australia. J Med Entomol 2004; 41:414.
  23. Costantini C, Badolo A, Ilboudo-Sanogo E. Field evaluation of the efficacy and persistence of insect repellents DEET, IR3535, and KBR 3023 against Anopheles gambiae complex and other Afrotropical vector mosquitoes. Trans R Soc Trop Med Hyg 2004; 98:644.
  24. Pretorius AM, Jensenius M, Clarke F, Ringertz SH. Repellent efficacy of DEET and KBR 3023 against Amblyomma hebraeum (Acari: Ixodidae). J Med Entomol 2003; 40:245.
  25. Klun JA, Khrimian A, Debboun M. Repellent and deterrent effects of SS220, Picaridin, and Deet suppress human blood feeding by Aedes aegypti, Anopheles stephensi, and Phlebotomus papatasi. J Med Entomol 2006; 43:34.
  26. Picardin--a new insect repellent. Med Lett Drugs Ther 2005; 47:46.
  27. Wahle BS, Sangha GK, Lake SG, et al. Chronic toxicity and carcinogenicity testing in the Sprague-Dawley rat of a prospective insect repellant (KBR 3023) using the dermal route of exposure. Toxicology 1999; 142:41.
  28. Astroff AB, Young AD, Holzum B, et al. Conduct and interpretation of a dermal developmental toxicity study with KBR 3023 (a prospective insect repellent) in the Sprague-Dawley rat and Himalayan rabbit. Teratology 2000; 61:222.
  29. Charlton NP, Murphy LT, Parker Cote JL, Vakkalanka JP. The toxicity of picaridin containing insect repellent reported to the National Poison Data System. Clin Toxicol (Phila) 2016; 54:655.
  30. https://www3.epa.gov/pesticides/chem_search/reg_actions/registration/fs_PC-070705_01-May-05.pdf (Accessed on November 17, 2016).
  31. U.S. Environmental Protection Agency. p-Menthane-3,8-diol (011550) Fact Sheet. www.epa.gov/oppbppd1/biopesticides/ingredients/factsheets/factsheet_011550.htm (Accessed on March 15, 2007).
  32. Carroll SP, Loye J. PMD, a registered botanical mosquito repellent with deet-like efficacy. J Am Mosq Control Assoc 2006; 22:507.
  33. Rodriguez SD, Drake LL, Price DP, et al. The Efficacy of Some Commercially Available Insect Repellents for Aedes aegypti (Diptera: Culicidae) and Aedes albopictus (Diptera: Culicidae). J Insect Sci 2015; 15:140.
  34. Insect repellents: which keep bugs at bay? Consum Rep 2006; 71:6.
  35. Frost AC. Oil of lemon eucalyptus as an insect repellent. Alt Med Alert 2005; 8:85.
  36. Barnard DR, Bernier UR, Posey KH, Xue RD. Repellency of IR3535, KBR3023, para-menthane-3,8-diol, and deet to black salt marsh mosquitoes (Diptera: Culicidae) in the Everglades National Park. J Med Entomol 2002; 39:895.
  37. Xue RD, Qualls WA, Smith ML, et al. Field evaluation of the Off! Clip-on Mosquito Repellent (metofluthrin) against Aedes albopictus and Aedes taeniorhynchus (Diptera: Culicidae) in northeastern Florida. J Med Entomol 2012; 49:652.
  38. Centers for Disease Control and Prevention. Updated information regarding mosquito repellents. www.cdc.gov/travel/yellowBookCh2-InsectsArthropods.aspx (Accessed on April 27, 2009).
  39. Witting-Bissinger BE, Stumpf CF, Donohue KV, et al. Novel arthropod repellent, BioUD, is an efficacious alternative to deet. J Med Entomol 2008; 45:891.
  40. The results are depicted graphically at www.homs.com/pdf/UofG_Graph.PDF (Accessed on April 28, 2009).
  41. Bissinger BW, Apperson CS, Sonenshine DE, et al. Efficacy of the new repellent BioUD against three species of ixodid ticks. Exp Appl Acarol 2009; 48:239.
  42. Cilek JE, Petersen JL, Hallmon CE. Comparative efficacy of IR3535 and deet as repellents against adult Aedes aegypti and Culex quinquefasciatus. J Am Mosq Control Assoc 2004; 20:299.
  43. Carroll SP. Prolonged efficacy of IR3535 repellents against mosquitoes and blacklegged ticks in North America. J Med Entomol 2008; 45:706.
  44. Girgenti P, Suss L. [Repellent activity against Aedes aegypti (L.) of formulas based on natural vegetable extracts or synthetic active agents]. Ann Ig 2002; 14:205.
  45. Ritchie SA, Williams CR, Montgomery BL. Field evaluation of New Mountain Sandalwood Mosquito Sticks and New Mountain Sandalwood Botanical Repellent against mosquitoes in North Queensland, Australia. J Am Mosq Control Assoc 2006; 22:158.
  46. Bissinger BW, Roe RM. Tick repellents: Past, present, future. Pestic Biochem Physiol 2010; 96:63.
  47. Maia MF, Moore SJ. Plant-based insect repellents: a review of their efficacy, development and testing. Malar J 2011; 10 Suppl 1:S11.
  48. Day JF. Repellent Wars. BuzzWords 2003; 3:4. http://entomology.ifas.ufl.edu/pestalert/arbovirus/repellentwars.pdf (Accessed on April 27, 2009).
  49. Enayati AA, Hemingway J, Garner P. Electronic mosquito repellents for preventing mosquito bites and malaria infection. Cochrane Database Syst Rev 2007; :CD005434.
  50. Kasai S, Komagata O, Itokawa K, et al. Mechanisms of pyrethroid resistance in the dengue mosquito vector, Aedes aegypti: target site insensitivity, penetration, and metabolism. PLoS Negl Trop Dis 2014; 8:e2948.
  51. Schreck CE, McGovern TP. Repellents and other personal protection strategies against Aedes albopictus. J Am Mosq Control Assoc 1989; 5:247.
  52. Gupta RK, Rutledge LC, Reifenrath WG, et al. Effects of weathering on fabrics treated with permethrin for protection against mosquitoes. J Am Mosq Control Assoc 1989; 5:176.
  53. Frances SP, Sferopoulos R, Lee B. Protection From Mosquito Biting Provided by Permethrin-Treated Military Fabrics. J Med Entomol 2014; 51:1220.
  54. Miller NJ, Rainone EE, Dyer MC, et al. Tick bite protection with permethrin-treated summer-weight clothing. J Med Entomol 2011; 48:327.
  55. Miot HA, Ferreira DP, Mendes FG, et al. Efficacy of topical permethrin as repellent against Aedes aegypti's bites. Dermatol Online J 2008; 14:1.
  56. Kuehn BM. CDC: new repellents for West Nile fight. JAMA 2005; 293:2583.
  57. Interlandi J. Insect Repellents in the Age of Zika. Our new tests identify what works and what doesn't against the bugs that can spread the virus and other serious diseases. Consum Rep 2016; 81:40.
  58. Alzogaray RA, Fontan A, Zerba EN. Repellency of deet to nymphs of Triatoma infestans. Med Vet Entomol 2000; 14:6.