2793 Nettle-induced urticaria treatment study (NUTS): a research training exercise

<h3>Aims and Objectives</h3> Treatment of nettle stings with dock is a well-known folk remedy, however has never been scientifically evaluated. We designed the Nettle-induced Urticaria Treatment Study (NUTS); a randomised, double-blind active placebo-controlled trial, as a research training exercise. <h3>Method and Design</h3> Emergency Department doctors each acted as their own control. Intervention was defined as two dock leaves rubbed for 60 seconds on the affected area, and placebo as two lettuce leaves. Nettle stems were brushed ten times over participants’ forearms. Blindfolded, participants rolled a die - for odd numbers intervention was applied to the right forearm, placebo to the left, and vice-versa for even numbers. Participants rated discomfort in each arm on a scale of 0-5 at minutes 1-5, 10, 15 and 20. This score was tracked until complete resolution, giving the Insult to Complete Healing (ITCH) score. Primary outcome was absolute reduction in ITCH at 5 minutes. Secondary outcomes included absolute reduction in ITCH at 10 and 20 minutes, and the Observable Urticaria/Count of Hives (OUCH) score: number of discrete wheals visible at 5, 10, 15 and 20 minutes. <h3>Results and Conclusion</h3> Nine individuals participated. Absolute reduction in ITCH did not differ between dock and lettuce arms (p=1) (figure 1). Whilst there was a statistically significant decrease in ITCH with time across both study arms (p=0.0056), there was no significant difference between dock and lettuce arms (p=0.391). Median peak OUCH was 27 in the dock arm and 20 in the lettuce (p=0.739). Median time to peak OUCH was 5 minutes in both arms (p=0.654). The main goal of this study was to open discussion about research in Emergency Medicine, exploring key areas such as blinding, placebo and measurement. We conclude that dock may work for nettle stings; lettuce may be just as good; relief comes quickly either way and research training in EM can be made extremely entertaining.