A systematic review of tick removal techniques: relationship to outcomes of tick-induced allergic reactions and tick-borne illnesses

Australia has the highest prevalence worldwide of tick-induced allergies (mammalian meat and tick allergy/anaphylaxis). Inappropriate tick removal techniques are known to trigger tick anaphylaxis. This study aimed to ascertain the evidence for the effectiveness of tick removal methods and their relationship to the outcomes of tick-induced allergies and tick-borne illnesses. The design involved is a systematic literature review. Scopus, Embase, and Medline were searched (September 20, 2023) for studies of tick removal techniques and for outcomes of tick-induced allergic reactions and tick-borne illnesses. Two reviewers reviewed abstracts and full texts. Included studies were appraised (Joanna Briggs Institute critical appraisal tools), and data were extracted, tabulated, and evaluated. Six studies investigated a relevant outcome, all of low or moderate quality. Tick-killing in situ before removal resulted in allergic reactions in only 3/61 patients and no anaphylaxis. 23/28 who presented to the Emergency Department following removal with tweezers had allergic reactions (one anaphylaxis). When those with known tick anaphylaxis killed ticks in situ before removal there was no subsequent anaphylactic reaction. A significant decrease in disease transmission and/or seropositivity (B. burgdorferi and/or R. conorii) was shown with crushing ticks or gentle pressure before removal with fine-tipped forceps, forceps alone, and surgical tweezers. Manipulation before removal with tweezers made no difference to B. burgdorferi seropositivity. Few studies worldwide have examined outcomes of tick removal techniques. Tick-killing in situ reduces recurrent tick anaphylaxis in Australians. Early removal with forceps may be effective where tick-borne disease is of greater concern. Further studies of tick-killing in situ focusing upon disease transmission should be prioritized.