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Insect Repellents

The Bottom Line

Protection against disease transmission from insect bites is an important worldwide public health issue. DEET has been the most widely used and most effective insect repellent for 60 years. Newer repellents such as picaridin, IR3535, and plant-derived oils may be somewhat safer but are not more effective than DEET.

The Full Story

As warm weather arrives in the US, the number of insect bites and stings reported to poison control centers increases dramatically. More than just an annoyance, insect bites can spread disease. The growing concern about the mosquito-borne Zika virus emphasizes this danger.

An insect repellent (IR) is defined as a chemical that makes the air within about 1.5 inch above human skin obnoxious enough to insects that they are less likely to land and bite. Current guidelines require IRs to provide at least a 50% repellency rate to make a reliable claim that they repel mosquitoes. IRs are divided into two chemical classes: synthetic chemicals such as DEET (N,N-diethyl-3-methylbenzamide), picaridin and IR3535; and plant-derived oils such as oil of lemon eucalyptus and oil of citronella.

Picaridin is a relatively new IR. Compared with DEET, its advantages include lack of chemical odor, non-greasy consistency, and non-damaging to clothing and plastics. Its vapor is noxious to mosquitoes, flies, chiggers, and ticks. Picaridin 20% spray has been shown to be comparable to DEET 20% for protection against Aedes, Anopheles, and Culex mosquito species. 

US Environmental Protection Agency (EPA) registration data indicate that picaridin at a concentration of 20% is effective against mosquitoes and ticks for 8-14 hours. The 10% concentration is effective for 3.5-8 hours. It is recommended by the Centers for Disease Control and Prevention (CDC) for use in malaria-endemic areas. Some studies have shown a shorter protection time for picaridin compared to DEET. Picaridin is not known to produce the same nervous system toxicity as DEET but has not been subjected to as much long-term testing. Human and animal studies of picaridin have not demonstrated skin, internal organ, or reproductive toxicity. Picaridin is not recommended for use in children under 2 years of age.

IR3535 (ethyl butylacetylaminopropionate) was first marketed in the US as a skin moisturizer but, when noted to be as effective as DEET against biting midges or "no-see-ums", it was adopted for use as an IR. IR3535 has also shown greater effectiveness against black fly and sand fly bites than DEET, with a longer duration of protection. IR3535 20% offers protection against Aedes and Culex mosquitoes for 7-10 hours but only 3.8 hours of protection against Anopheles in some studies. Therefore, IR3535 is not recommended for use in malaria-endemic areas. It is a serious eye irritant but otherwise has a good safety profile. It can melt some plastics and damage some fabrics.

IR3535 is found in some combination sunscreen/IR products. This is a problem because most sunscreens should be reapplied about every 2 hours. Following those instructions could overexpose the user to the IR. Animal studies have not demonstrated developmental toxicity, but there are no specific recommendations for use or avoidance of IR3535 in children or pregnant women.

Oil of lemon eucalyptus (OLE) is an extract of the leaves of the lemon eucalyptus tree, Corymbia citriodora. The leaf extract is refined to increase the concentration of a naturally occurring substance, para-menthane-3,8-diol, also known as PMD. Commonly available products have a concentration of 30% OLE and 20% PMD. Some studies have suggested that concentrations of 20-26% PMD may be as effective as 15-20% DEET against both mosquitoes and ticks. However, the EPA believes that PMD’s maximum protection time against mosquitoes and ticks is shorter than DEET’s. When used at concentrations of 30%, PMD offers complete protection for 4-6 hours against ticks and several Aedes, Anopheles, and Culex species of mosquitoes. It is recommended by the CDC for use in malaria-endemic areas but it requires more frequent application than DEET.

OLE with enhanced PMD concentration is considered the most effective botanical IR but it can cause allergic skin reactions. Synthetic PMD can be found in some repellent products at a concentration of 10%. These products provide only a few hours of protection. They have less risk of allergic skin reactions than natural PMD. The US Food and Drug Administration has recommended that PMD not be used in children younger than 3 years.

Pure oil of lemon eucalyptus, an essential oil not formulated for use as an IR, has not undergone testing for safety and effectiveness and is not registered by the EPA as an IR.

Citronella is a natural plant oil obtained from several species of Cymbopogon lemongrasses. Citronellol and geraniol are major components of oil of citronella. Citronella is available as a lotion, oil, solid wax, and as a component of candles and flame pots. Citronella has a short duration of action. A 4.2% concentration provides 1 hour of mosquito and tick protection. Citronella in candle form used indoors or citronella incense diffusers used outdoors do not reduce mosquito bites to a degree acceptable to the EPA.

Citronella is ineffective against Asian tiger mosquitoes (the Asian tiger mosquito is now found in more than 20 states). The pests have been found to be infected with LaCrosse encephalitis viruses and West Nile virus, which can cause encephalitis (inflammation of the brain). Citronella is not effective against flies, fleas, or ticks. Oil of citronella can be mildly irritating to the skin and eyes. It can also cause skin allergies for some people with prolonged or frequent exposure.

Botanical blend IRs have not been adequately tested and don’t repel aggressive species such as the Asian Tiger mosquito. Some that contain geranium oil and soybean oil mixtures might provide some insect repellency but frequent reapplication is necessary. These can cause allergic skin reactions.

Bug zappers are not effective and might actually attract mosquitoes while killing insects that are beneficial.

Clip-on IRs or fans are an inhalation concern especially for those with allergies to ragweed or chrysanthemums. They can contain insecticides such as metofluthrin and allethrin that are more toxic than IRs.

For other ways to help prevent mosquito and insect bites and stings, read the article on mosquitoes in The Poison Post®.

If insect repellent is swallowed or gets in the eyes:

  • If you suspect someone has swallowed an insect repellent, immediately check the webPOISONCONTROL® online tool for guidance or call Poison Control at 1-800-222-1222.
  • When an IR gets in the eyes, irritation and redness are common. Serious eye injury is not likely. The eyes should be rinsed immediately. Remove contact lenses. Use lots of room temperature water. For children, pour water onto the bridge of the nose and let it gently run into the eyes. Encourage blinking. Then check with Poison Control after rinsing.

Mary Elizabeth May, RN, BA, MPH
Certified Specialist in Poison Information


For More Information

Centers for Disease Control and Prevention Yellow Book, Chapter 2: The Pre-Travel Consultation

Choosing and Using Insect Repellents, National Pesticide Information Center

Environmental Working Group Guide to Bug Repellents in the Age of Zika: Repellent Chemicals  


References

Alpern JD, Dunlop SJ, Dolan BJ, Stauffer WM, Boulware DR. Personal protection measures against mosquitoes, ticks, and other arthropods. Med Clin North Am 2016;100:303-16.

Antwi FB, Shama LM, Peterson RK. Risk assessments for the insect repellents DEET and picaridin. Regul Toxicol Pharmacol 2008;51:31-6.

Diaz JH. Chemical and plant-based insect repellents: efficacy, safety, and toxicity. Wilderness Environ Med 2016;27:153-63.

Katz TM, Miller JH, Hebert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol 2008;58:865-71.

Kongkaew C, Sakunrag I, Chaiyakunapruk N, Tawatsin A. Effectiveness of citronella preparations in preventing mosquito bites: systematic review of controlled laboratory experimental studies. Trop Med Int Health 2011;16:802-10.

Muller GC, Junnila A, Butler J, et al. Efficacy of the botanical repellents geraniol, linalool, and citronella against mosquitoes. J Vector Ecol 2009;34:2-8.

Robb-Nicholson C. By the way, doctor. DEET makes a mess of my fly fishing gear. I've heard there are some new mosquito repellents that don't contain DEET. Are they any good? Harv Womens Health Watch 2005;12:8.

Roberts JR, Reigart JR. Does anything beat DEET? Pediatr Ann 2004;33:443-53.

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • Read the label instructions before using any insect repellent; do not over apply.
  • Check the container for an EPA-approved label and registration number; never use an insect repellent that has not been approved by the EPA.
  • Make sure that the repellent label lists the specific insect that you wish to repel; some repellents are not formulated for certain insects.
  • Avoid combination sunscreen/insect repellent products. More frequent application can lead to over-exposure to the insect repellent.
  • Do not use essential plant oils that are not formulated as insect repellents; they can cause skin irritation or an allergic response and are not effective insect repellents.

This Really Happened

Case 1. A 50-year-old man was applying an insect repellent spray containing picaridin while vacationing in the Caribbean. Some of the spray flew back into his eye. It took a while for him to get to fresh water but he rinsed the eye well for about 45 minutes and then called Poison Control. At that time, his eye felt a little dry. Poison Control advised placing a cool compress over the eye and resting for a short period. He did not experience any further symptoms.

Case 2. A 6-year-old boy was at summer camp. Someone applied an insect repellent containing oil of lemon eucalyptus to his face. Two hours later his face was red and swollen. His face was washed with soap and water and his mom called Poison Control, which recommended application of a cool compress to his face and provided guidelines for the use of nonprescription antihistamine and anti-inflammatory medications. He was given the antihistamine and the next day he was able to participate in camp activities despite a slight rash on his face.

Case 3. A 2-year-old girl with asthma tried to blow out a citronella insect repellent candle. Shortly thereafter, she vomited and complained of trouble breathing and a sore throat. Her mom gave the child her asthma inhaler and called Poison Control, which recommended close observation for persistent airway irritation. When Poison Control checked back an hour later, the child was doing better. However, when Poison Control followed up again the next day, the child continued to have throat irritation and she had vomited again. Her pediatrician examined her and said her lungs were clear. Shortly after leaving the doctor’s office the child was playful and fine.