A 49-year-old woman
has written to tell us that her husband is
giving her a holiday in Kenya to celebrate her
birthday. Although appreciative of the kindly
thought, she is worried because insects seem to
be attracted to her — and when she last went to
a malarial zone she found that she was allergic
to DEET. Which anti-malarials and repellents
should she use?
Unfortunately the
reader hasn’t told us when she is going but she
should bear in mind that the pattern of
resistance to anti-malarial drugs is constantly
changing and so she should check with a travel
health clinic before she packs her bags.
The first precaution to take against malaria
is to avoid mosquitoes. No antimalarial is 100
per cent reliable.
DEET (diethytoluamide) is the repellent of
choice. I am interested in the reader’s apparent
sensitivity to DEET. The occasional case of
hypersensitivity, of a generalised allergy or
even anaphylactic shock, to DEET have been
reported, but usually the skin troubles are a
local sensitivity to it rather than an allergic
response. There is, therefore, sometimes a need
to avoid applying it to soft skin such as is
found under the arms, behind the knees, in the
elbow, around the genitalia, near the eyes or
lips. It may well be that if the reader avoids
applying DEET to these sensitive sites all will
be well.
There have been also occasional cases in
which people have responded to DEET with a
severe physical or even psychiatric reaction.
Children are thought to be more sensitive to
DEET than adults, but the extent to which this
occurs is debatable.
Solutions of DEET may be of a strength of
anything from 30 to 50 per cent. It needs to be
applied frequently, and the stronger the
solution the more effective, but the more likely
it is to cause local skin irritation. Mosiguard,
another repellent, is based on eucalyptus
(available from most chemists). It smells better
than DEET and is a natural product that is about
as efficient as a 30 per cent DEET solution.
Recently an anti-insect and anti-mosquito
cloth that smells rather deliciously of lavender
has been marketed by Arnywear (http://www.arnywear.co.uk/). It
is claimed that it will keep insects at a
distance of 50cm (about 20in) from whatever part
of the body on which it is being worn. The cloth
comes in various sizes that can be worn as a
sarong, scarf, belt, anklet, wristband or
bandana (it can also be wrapped around a pillow
or neck rest). Arnywear cloth is recommended as
a mosquito repellent by the London School of
Medicine and Tropical Hygiene. It is also useful
against insects when fishing, walking or
gardening. I intend to try it against midges in
the Scottish Highlands.
Mosquitoes in malarial zones should also be
avoided by wearing, especially after dusk, long
buttoned-up sleeves, long trousers and ankle
boots. A potential danger is resting during the
day in the shade, and sometimes damp, of a tree.
Windows should be screened against mosquitoes.
Antimalarials are essential and are as
important for those born abroad, but who have
been living in England for some years, as they
are for those who have never ventured further
afield than Eastbourne. There is now widespread
resistance to the standard anti-malarial mixture
of chloroquine and paludrine. Lariam is
effective but not recommended for anyone with
any history of psychiatric troubles, including
depression, severe reactions to so-called
recreational drugs or any suggestion of
neurological troubles and seizures. I recommend
Malarone to my former patients and now use it
myself rather than Larium.
Two musts for travellers are Travellers’
Health: How to Stay Healthy Abroad, by Dr
Richard Dawood (OUP), and the pocket-sized
Traveller’s Healthbook, by Jonathan
Lorie and Nicholas Beeching (Wexas).
ASK DR STUTTAFORD
Send your questions to drstuttaford@thetimes.co.uk
or to times2, The Times, 1 Pennington Street,
London E98 1TT. Please include the following:
the symptoms (and how long they have been
present), the person’s age, sex and marital
status. Dr Stuttaford’s replies cannot apply to
individual cases but should be taken in a
general context.
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