Assessing the Efficacy of First-Aid Measures in Physalia sp. Envenomation, Using Solution- and Blood Agarose-Based Models

Toxins (Basel). 2017 Apr 26;9(5):149. doi: 10.3390/toxins9050149.


Stings from the hydrozoan species in the genus Physalia cause intense, immediate skin pain and elicit serious systemic effects. There has been much scientific debate about the most appropriate first aid for these stings, particularly with regard to whether vinegar use is appropriate (most current recommendations recommend against vinegar). We found that only a small percentage (≤1.0%) of tentacle cnidae discharge during a sting event using an ex vivo tissue model which elicits spontaneous stinging from live cnidarian tentacles. We then tested a variety of rinse solutions on both Atlantic and Pacific Physalia species to determine if they elicit cnidae discharge, further investigating any that did not cause immediate significant discharge to determine if they are able to inhibit cnidae discharge in response to chemical and physical stimuli. We found commercially available vinegars, as well as the recently developed Sting No More® Spray, were the most effective rinse solutions, as they irreversibly inhibited cnidae discharge. However, even slight dilution of vinegar reduced its protective effects. Alcohols and folk remedies, such as urine, baking soda and shaving cream, caused varying amounts of immediate cnidae discharge and failed to inhibit further discharge, and thus likely worsen stings.

Keywords: Portuguese man o’ war; bluebottle; cnidaria; first aid; hydrozoa; jellyfish; marine envenomation; sting.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acetic Acid / therapeutic use
  • Animals
  • Bites and Stings / therapy*
  • Cnidarian Venoms / adverse effects*
  • Erythrocytes
  • Ethanol / therapeutic use
  • First Aid / methods*
  • Hemolysis
  • Humans
  • Hydrozoa*
  • Sepharose
  • Sodium Bicarbonate / therapeutic use
  • Solutions
  • Treatment Outcome
  • Urine


  • Cnidarian Venoms
  • Solutions
  • Ethanol
  • Sodium Bicarbonate
  • Sepharose
  • Acetic Acid