Evidence supporting the use of: Hyaluronidase
For the health condition: Bites and Stings

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Hyaluronidase is an enzyme that breaks down hyaluronic acid in the extracellular matrix, thereby increasing tissue permeability. Its use as an adjunct in the management of bites and stings—most notably from venomous insects such as bees, wasps, and spiders—has scientific basis. The rationale is that hyaluronidase can facilitate the dispersion of injected fluids, including antivenoms or local anesthetics, by enhancing their absorption into tissues. Additionally, some venoms naturally contain hyaluronidase to promote the spread of toxins. Clinical studies and case reports from the mid-20th century onward have documented its use, especially in combination with other therapies to reduce local swelling, pain, and tissue damage. However, the overall quality of evidence is moderate, with a paucity of large randomized controlled trials directly comparing outcomes with and without hyaluronidase. Its use is more established in the context of extravasation injuries and as an adjuvant to local anesthetics, but it is still cited in toxicology and emergency medicine references for bites and stings. Modern guidelines may mention it as an adjunct in selected cases rather than a primary treatment. Thus, its use is scientifically justified, but the evidence base is not robust, warranting a score of 3.

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