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Bugs!
They are such a nuisance when you want to be out enjoying nature! If you are a bug magnet like I am, this is a real problem! The running joke among my friends is that no one else needs bug spray when I am around because the bugs will be all over me and will leave everyone else alone. I love spending time outside but have had to literally run for shelter on more than one hike. Ending an outdoor adventure as a bloody, welted mess is no fun! Itching and aesthetics aside this can be a real problem as bugs can carry disease. This route of disease transmission is known as vector-borne disease. Did you know that vector-borne diseases account for 17% of all infectious diseases in the world and cause over 700 000 deaths annually (primarily in developing nations) ⁽¹⁾. Here in Canada the most common vector-borne diseases include Lyme disease (carried by the black legged ticks (Ixodes scapularis or Ixodes pacificus)) and West Nile Virus (carried by the Culex species of mosquitoes) ⁽²,³⁾. However, with rising temperature, there is concern that we will see more vector-borne diseases above the 49th parallel in the coming years ⁽⁴⁾. Vector-borne illnesses can be difficult to diagnose and treat but there are options. Speak with your ND should you feel this may be a concern for you.
There are a number of things to consider when trying to avoid these bug bites. If you would like to know more about options to help deal with your bug bites, let us know and we can write about this in the future. Quickly, I do want to reiterate what you have heard a million times… if you do get a tick bite, ensure you remove the tick properly! Here is a good resource from the CDC to help you out:
Now, let’s dive in and talk about some prevention options!
Prevention
Cover up
Super simple right?! Simple but often forgotten! Wearing thicker, long sleeved and legged clothing can make a big difference. However, this can be difficult on hot days, and we all know that mosquitos will often still bite through clothing. It is important to note that ticks love the creases on our clothing also so check these and your neckline after and during your hikes. One way to help prevent tick bites is to tuck your socks over your pants (such a fashion statement).
Nets, screens and/ or fans
Netting is a great option over outdoor eating areas, infant carriers and outdoor sleeping areas and there are many options to choose from. Also, don’t forget to use screens over open windows and ensure you repair any holes in screens.
Fans are often forgotten but are a great option to keep you cool and make it difficult for mosquitos to land.
Break the cycle
Mosquitos lay eggs near standing water. Dumping out, scrubbing, covering, turning over containers such as pots, tires, bird baths, watering cans etc. on a regular basis to prevent standing water can help prevent mosquitoes from hatching.
Insect Repellent
This is a big topic and is really why you are reading this right? Let’s spend some time here. The most widely known and most widely researched of the insect repellents is DEET (N, N-Diethyl-meta-toluamide). I know, I know you are asking but do I really want to be using this?? You are not alone. A 2018 consumer report surveyed 2,025 Americans and found that 25% of them avoided using DEET. Well, you might be surprised by its safety profile! ⁽⁵⁾. I have compiled a table including DEET and other insect repellents that have shown some efficacy in research studies. Let’s explore each further in the table below:
⁽⁶⁻¹⁹⁾
Phew! That was a lot! Still confused, here are some of my thoughts:
First, I think it is important to note that research is lacking to show the efficacy of other botanicals not included in the table above including citronella! I know I was surprised too! So, it seems that while they may smell nice, they should not be considered if you are trying not to get insect bites. You may be interested to know that the EPA has classed essential oils as “minimum risk” as they may still cause an allergic reaction and/ or irritation to the skin and eyes.
Here are some things you do want to consider before choosing the right insect repellent for you:
Who is using the product?
What are the insects you are most concerned about in the area you will be visiting?
Who is using the product (age, allergies, etc)?
How long will you be outdoors?
When it comes to efficacy, it seems that DEET is the repellent that all others are measured against as it has the longest history of use and is thought to be as potent ⁽¹⁸⁾. Picaridin has been shown to have a comparable efficacy profile to DEET ⁽¹¹,¹⁸⁾ but has a better safety profile ⁽⁷,¹⁸,²⁰⁾. So, in my opinion, Picaridin comes out on top at least for now. I say “at least for now” because Picaridin does not have near as much research or history of use compared to DEET.
I would also like to say that I was surprised to learn of the amount of research that has been done on DEET and while it does not have a squeaky-clean profile it is not nearly as harmful as I originally thought. When I looked at the Centers for Disease Control and Prevention, the World Health Organization, the American Academy of Pediatrics, the Environmental Protection Agency, and Health Canada all approve of the use of DEET and do not see that it presents a risk to the general population when used as directed. Further, it is the only repellent that has been studied in pregnant women! So, all of this said I would still consider DEET a good option if you are planning a trek in insect territory.
Next up, I have a list of important notes and tips for insect repellent use.
Other Tips and Important Repellent Notes
If you have sensitive skin:
Do a patch test! Apply a small amount to a small area of your inner wrist and wait 15 min to watch for a reaction before applying to larger areas.
There is a higher allergic potential with botanical repellants – use caution when you are first using these.
If you would prefer not to have repellant on your skin:
Consider layering with long pants and sleeves and applying the bug repellant to your clothing instead. This will leave your hands and face exposed; consider using a fan near your face to help prevent bites.
For children:
Picaridin is less irritating and might be a better choice.
Oil of Lemon Eucalyptus and PMD are not recommended for children under the age of 3.
If you are pregnant or breastfeeding
The CDC confirms that EPA- registered insect repellents have been proven safe for pregnant and breastfeeding women ⁽²⁰⁾.
If you are traveling outside the country where there is a risk of Zika virus, know that the risk of this virus far outweighs the risk from any EPA - registered insect repellants. Please also remember a mosquito net when traveling!
The Government of Canada states that there is insufficient evidence that Lyme disease causes adverse effects to a fetus ⁽²¹⁾ This is good news, however dealing with Lyme disease while pregnant or a new mom will add a whole new level of challenge to an already challenging time so avoiding tick bites is still very important.
Note: lemon eucalyptus oil is not the same as theil of Lemon Eucalyptus!
Do not apply any repellants over cuts, wounds, or irritated skin
Avoid the use of DEET in concentrations over 30% and restrict applications to 1x/ day
ALWAYS carefully check for ticks when you have been in an area known to have ticks!
Don’t forget to wash your hands after applying bug spray.
NEVER apply any repellant directly to your face! Instead, spray the repellent in your hands and rub it over your face avoiding your mouth and eyes.
If you have been wearing bug spray all day, take a shower before going to bed.
When purchasing bug repellants, stick to EPA registered items.
If you have been out in an area known to have ticks always check for ticks when you come indoors and be sure to remove them properly.
Insect repellant candles are not generally effective and often contain chemicals that can be harmful to inhale.
Use caution when using sprays, aerosolized or not, as many insect repellants are not meant to be inhaled and can cause lung irritation. Cover your mouth, nose, and eyes when using these products.
Avoid the use of sunscreens with insect repellants. Sunscreens should be reapplied every couple of hours, and this can lead to overdosing on the insect repellant.
Don’t forget about the other prevention methods such as netting, fans, clothing, etc.
DIY Bug Spray Recipe
Ok, all of this said, if you are still looking to DIY yourself a bug spray, here is a little recipe you can try. Enjoy!
Oil
25ml soybean oil
30 drops oil of lemon eucalyptus
OR
Spray
50ml witch hazel
30 drops oil of lemon eucalyptus
**Optional: with either formula a few drops of your favorite essential oils for smell.
Directions:
Mix and apply directly to your skin. The spray can also be applied to clothing. I suggest trying a test patch on your inner wrist before applying to your whole body.
Precautions:
The oil preparation will stain your clothing, do not apply it to your clothing. The same precautions as with other repellents apply here as well. Use caution to avoid ingesting, inhaling, and contact with your mouth and eyes.
*Disclaimer: While there is some research looking at the efficacy of the ingredients above, there is no research on these formulas and therefore one cannot make any claims of efficacy. Further, commercially available oil of lemon eucalyptus does not list the % PMD, making it impossible to consider how well this might work according to this concentration. In short, you might consider this for “light use” i.e. in your backyard, in the city, but not if you are looking for an insect repellent with proven repellent properties.
References:
1. World Health Organization. Vector-borne diseases. Mar 2020. https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases
2. Canadian Public Health Association. Climate change and vector-borne illness. Policy and Advocacy Blog, July 2017. https://www.cpha.ca/climate-change-and-vector-borne-illness#:~:text=Two%20well%2Dknown%20vector%2Dborne,introduced%20into%20Canada%20in%202001
3. Government of Canada. Vector-borne diseases in Canada: Emerging challenges of vector-borne diseases and cities. Canada Communicable Disease Report. Oct 2016, 42-10. https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2016-42/ccdr-volume-42-10-october-6-2016/ccdr-volume-42-10-october-6-2016-emerging-challenges-vector-borne-diseases-cities-2.html
4. Githeko A et al. Climate change and vector-borne diseases: a regional analysis. Bulletin of the World Health Organization. 2000. https://www.scielosp.org/article/bwho/2000.v78n9/1136-1147/
5. Interlandi J. How safe is DEET? Despite assurances about the chemical, consumer concerns persisit. Is there a reason to worry? Consumer Reports. April 2019. https://www.consumerreports.org/insect-repellent/how-safe-is-deet-insect-repellent-safety/
6. United States Environmental Protection Agency. Reregistration eligibility decision (RED) DEET. 1998. https://www3.epa.gov/pesticides/chem_search/reg_actions/reregistration/red_PC-080301_1-Apr-98.pdf
7. Public Health Statement for DEET (N,N-Diethyl-meta-toluamide). Agency for Toxic Substances and Disease Registry, 2015. Available at www.atsdr.cdc.gov/phs/phs.asp?id=1447&tid=201
8. Agency for Toxic Substances and Disease Registry. DEET (N,N-Diethyl-meta-toluamide) toxicological profile. 2018. www.atsdr.cdc.gov/toxprofiles/tp.asp?id=1451&tid=201
9. Abdel-Rahman A., et al. Subchronic dermal application of N,N-diethyl m-toluamide (DEET) and permethrin to adult rats, alone or in combination, causes diffuse neuronal cell death and cytoskeletal abnormalities in the cerebral cortex and the hippocampus, and purkinje neuron loss in the cerebellum. Experimental Neurology. 2001. 172(1):153-171. doi.org/10.1006/exnr.2001.7807
10. Corbel V, et al., Evidence for inhibition of cholinesterases in insect and mammalian nervous systems by the insect repellent DEET. BMC Biology. 2009. doi.org/1186/1741-7007-7-47
11. Goodyer L. and Schofield S., Mosquito repellents for the traveller: Does picaridin provide longer protection than DEET? Journal of Travel Medicine, May 2018, 25:S10–S15. doi.org/10.1093/jtm/tay005
12. Government of Canada. Personal insect repellents. June 2021. https://www.canada.ca/en/health-canada/services/about-pesticides/insect-repellents.html
13. Environmental Working Group. EWG’s 2018 Guide to Bug Repellents. Consumer Guides. July 2018. https://www.ewg.org/consumer-guides/ewgs-2018-guide-bug-repellents?_ga=2.116510278.1945940480.1534131935-2087774720.1519666723#Picaridin
14. Charlton N.,et al., The toxicity of picaridin containing insect repellent reported to the national poison data system. Clinical Toxicology. February 2016. 655-658. doi.org/10.1080/15563650.2016.1186806
15. American Academy of Pediatrics. Repellents part of arsenal in war against insects., June 2013, 34(6). www.aappublications.org/content/34/6/16.1
16. United States Environmental Protection Agency. Methyl nonyl Ketone. R.E.D. Facts. July 1995. https://www3.epa.gov/pesticides/chem_search/reg_actions/reregistration/fs_PC-044102_1-Jul-95.pdf
17. United States Environmental Protection Agency. Biopesticides Fact Sheet for p-menthane-3,8-diol. Apr 2000. https://www3.epa.gov/pesticides/chem_search/reg_actions/registration/fs_PC-011550_01-Apr-00.pdf
18. Tavares M., et al. Trends in insect repellent formulations: A review. Int. J. Pharm. March 2018. 539:1-2(190-209). doi.org/10.1016/j.ijpharm.2018.01.046
19. United States Environmental Protection Agency. Biopesticides Fact Sheet for 3-(N-butyl-N-acetyl)-aminopropionic acid, ethyl ester (IR3535). January 2000. https://www3.epa.gov/pesticides/chem_search/reg_actions/registration/fs_PC-113509_01-Jan-00.pdf
20. United States Environmental Protection Agency. New pesticide fact sheet: Picaridin. May 2005. https://www3.epa.gov/pesticides/chem_search/reg_actions/registration/fs_PC-070705_01-May-05.pdf
21. Centers for Disease Control and Prevention. Zika virus: Prevent mosquito bites. https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html
22. Government of Canada. Lyme disease and pregnancy. July 2019. https://www.canada.ca/en/public-health/services/diseases/lyme-disease/pregnancy.html