Incorrect And Dangerous Use Of EPI Pens With Box Jellies
Courtesy of WOWSA, Huntington Beach, California. Angel A. Yanagihara, Ph.D. of the Asia Pacific Institute of Tropical Medicine and the University of Hawaii is considered the foremost expert on box jellyfish and their treatment.
Treatment of jellyfish stings has long been discussed among lifeguards and swimmers and generally misunderstood by the general public.
In case of being stung by box jellyfish, one of the world’s most venomous marine creatures, Dr. Yanigahara explains,
“The response to the sting is not an allergic reaction. It is not at all like a bee sting. The venom of the box jelly contains ancient pore-forming proteins structurally similar to anthrolysin O and streptolysin O, the pore-forming toxins of anthrax and strep.
People are not allergic to these pathogenic bacteria either. Our blood cells are uniquely vulnerable to box jelly porins and to bacterial porins. There is no immunity or resistance – it is a question of the dose delivered.
Unfortunately, thinner skin areas of the body will allow a greater dose to be delivered. Women and children have thinner skin. So if an adult man is stung over thicker skin a smaller amount of venom will reach the blood stream than a sting of a child over a thinner skin region, such as face or neck.”
Some of the most persistently repeated treatments of jellyfish stings, and box jellies in particular, are with EPI pens. But Dr. Yanagihara who has carefully researched the chemistry of the jellyfish venom strongly advises against use of EPI pens. “EPI pens are absolutely contraindicated. I cannot stress this enough.
I am conducting studies now involving box jelly venom injection into piglets. The data clearly show as our human whole blood studies show that the venom itself causes a massive rise in plasma catecholamines – EPI and NorEPI. This is well reported in the clinical literature as a “catecholamine surge”. Adding an EPI injection on top of that situation is like adding fuel to a fire.”
She even reports a shocking revelation regarding use of EPI pens to alleviate the pain of a box jellyfish sting. “In fact, the losses of life that have occurred from box jelly sting have almost always involved well intentioned EPI administration. My studies are not yet published, but please be advised that the use of EPI pen is an extremely dangerous practice and yields no therapeutic benefit whatsoever.
I am happy to share my unpublished data with local medical decision-makers. A Japanese tourist recently died after a sting from the same influxing box jellyfish species we have here (Alatina alata) in Saipan. Emergency treatment included EPI administration.”
Copyright © 2014 by World Open Water Swimming Association
Southern California native, born 1962, is the creator of the WOWSA Awards, Oceans Seven, Openwaterpedia, Citrus Corps, World Open Water Swimming Association, Daily News of Open Water Swimming, Global Open Water Swimming Conference. He is Chief Executive Officer of KAATSU Global and KAATSU Research Institute. Inductee in the International Marathon Swimming Hall of Fame (Honor Swimmer, Class of 2001) and Ice Swimming Hall of Fame (Honor Contributor - Media, Class of 2019), recipient of the International Swimming Hall of Fame's Poseidon Award (2016), International Swimming Hall of Fame's Irving Davids-Captain Roger Wheeler Memorial Award (2010), USA Swimming's Glen S. Hummer Award (2007, 2010) and Harvard University's John B. Imrie Award (1984). Served on the FINA Technical Open Water Swimming Committee and as Technical Delegate with the 2011 Special Olympics World Summer Games, and 9-time USA Swimming coaching staff. Note: WOWSA only recommends products or services used or recommended by the community. WOWSA does not receive compensation for links or products mentioned on this site or in blog posts. If it does, it will be indicated clearly on that specific post. See WOWSA's privacy policy for more information.
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