Abstract
The health risks associated with electronic cigarettes (ECs) are largely unknown. The purpose of this systematic review was to evaluate published case reports that deal with health effects attributed to EC use. An Internet search was conducted to identify case reports dealing with the effects of EC use on health. Twenty-six case reports representing 27 individuals (one study contained reports for two individuals) were published between April 2012 and January 2016, and these were grouped into categories of effect according to their health outcomes.Of the 27 individuals, 25 had negative effects subsequent to use or exposure to ECs and their refill fluids, while two reported improvement in chronic immune and gastrointestinal conditions. Three categories of negative health effects were identified: systemic effects, nicotine poisoning, and mechanical injury. Thirteen cases reported EC effects on different systems including: respiratory (6), gastrointestinal or developing intestine of an infant (3), cardiovascular (2), neurological (1), and immune (1). Twelve cases involved nicotine poisoning resulting from accidental (N = 3), misuse/abuse (N = 1), or suicidal/intentional ingestion (N = 8); four of these involved children and three resulted in adult fatalities. Two cases reported mechanical injury caused by an EC battery explosion. Most case reports show that the health of children and adults can be negatively affected by EC products and that if death does not occur, negative effects can be reversed. Data further indicate that EC use can cause negative health effects in previously healthy individuals and exacerbate pre-existing conditions.
Highlights
Electronic cigarettes (ECs) are battery-operated devices that heat a liquid containing propylene glycol and/or glycerin, nicotine, and flavorings to produce an aerosol which users inhale (Trtchounian and Talbot, 2011; Grana et al, 2014)
In vitro studies have shown that cytotoxic effects vary among EC refill fluids (Bahl et al, 2012), some flavor chemicals have toxicity at the concentrations used in EC (Behar et al, 2014a,b; Lerner et al, 2015), and stem cells are more sensitive than differentiated adult lung cells to EC products (Bahl et al, 2012; Behar et al, 2014a)
Of case reports for individuals identified in the Internet search, 25 individuals experienced negative health effects and 2 reported positive or improved outcomes attributed to EC usage (Table 1)
Summary
Electronic cigarettes (ECs) are battery-operated devices that heat a liquid containing propylene glycol and/or glycerin, nicotine, and flavorings to produce an aerosol which users inhale (Trtchounian and Talbot, 2011; Grana et al, 2014). In spite of their rapid rise in popularity and worldwide sales, the effects of EC use on short and long-term human health are poorly understood. Information linking EC use to health effects has been gained mainly from short-term in vitro studies with cultured cells and in vivo experiments with human subjects (Pisinger and Døssing, 2014). Many of these flavors are considered safe for ingestion by the Flavor Extracts Manufacturers Association (FEMA), their inhalation safety has not been established by FEMA (Hallagan, 2015)
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