Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Pain, Palliative and Supportive Care Group produced more than 300 reviews across a very wide range of topics. These include a review of the treatment of jelly fish stings, which was updated in June 2023. We asked lead author, Richard McGee from the Department of Paediatrics in Gosford Hospital in Australia to tell us more and he used an AI voice from elevenlabs.io to make the recording.

Richard: Jellyfish are found in oceans all around the world and, as most people prefer to swim in warmer waters, that's where they most often interact with jellyfish. Anyone who has been stung by a jellyfish will know how much it hurts when the specialised stinging cells on the jellyfish, called nematocysts, fire a barb with venom into the skin. The stings of different species produce symptoms of varying severity, with milder symptoms including pain, redness, and itching at the sting site. However, reactions to some jellyfish species can be more serious, and very occasionally cause something called Irukandji syndrome, which may lead to death.
Because jellyfish stings are so common globally, there are many suggested folk remedies and much interest in the best way to treat stings; and we looked at the available evidence to try to better understand the benefits and harms of various treatments.
We found nine studies with 574 participants from Australia, Malaysia, and the United States.  Each study had only a small number of participants and each also had problems related to its methods. These included participants being aware of the type of treatment they received and a large proportion leaving the study before the end. This severely limits our confidence in the evidence base, but it's still interesting to take you through the studies that have been done.
Firstly, we found four studies that compared hot or cold treatments for treating pain. In two of these, people had been stung accidentally by bluebottle jellyfish in Australia, while the other two studies were in people stung accidentally by Hawaiian box jellyfish or major box jellyfish in Australia and Hawaii, who were treated on the beach or in hospital. Heat was applied to the sting site using a hot pack or hot water with showers, baths, buckets, or hoses. Cold was applied using ice packs or cold packs. Unfortunately, though, we're not able to tell whether applying either heat or cold to a jellyfish sting reduces or stops pain within one hour of treatment; reduces the need for retreatment or switching to the alternative treatment; reduces skin reactions in the first 24 hours; or causes any harms.
Four studies compared topical treatments that were applied to the skin on and around the sting site. In one study, people were treated on the beach after accidental stings by Hawaiian box jellyfish in Hawaii but, in the other three studies, people volunteered to be stung in a laboratory setting. A whole range of treatments were tested, including fresh water, seawater, a commercial product called Sting Aid, Adolph's meat tenderiser, isopropyl alcohol, ammonia, heated water, acetic acid, and sodium bicarbonate. Again, our low confidence in the available evidence means that we cannot tell whether applying any of these treatments reduces or stops pain within six hours of treatment or causes harm. And, in fact, one participant actually suffered a chemical burn after ammonia application.
Finally, the ninth study involved people being treated in hospital after accidental stings by box jellyfish that cause Irukandji syndrome, with either intravenous magnesium sulfate or a placebo. However, this study didn't measure pain relief in a way that could be included in our review, and did not measure any of the other outcomes that we were interested in.
In conclusion, it remains unclear whether any of the evaluated treatments reduce or stop pain or provide other benefits after people have been stung by the jellyfish species that were included in these studies. In addition, because our findings are only relevant to stings from this small number of jellyfish species in Australia, Malyasia and Hawaii, they should not be used to decide treatment options for any other type of jellyfish.

Mike: If you would like to read more about the jellyfish species and the types of treatment that have been tested, the full review is available online. If you visit Cochrane Library dot com and simply search 'jellyfish' as one word, you'll get a link to it.