WHEN OIL MEETS AIR: A NEW CAUSE OF HYPERSENSITIVITY PNEUMONITIS

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Essential oil diffusers have become popular devices used in homes and at workplaces to create relaxing environments by enriching the air with essential oils. Essential oils are not regulated by any government entity, and their health benefits and risks are controversial. Here, we present a case of hypersensitivity pneumonitis secondary to peppermint and eucalyptus essential oils. CASE PRESENTATION: A 41-year-old African American woman with a history of autoimmune cirrhosis and group 1 pulmonary arterial hypertension secondary to portopulmonary hypertension without previous tobacco use presented to clinic for worsening cough, shortness of breath, and dyspnea on exertion despite adherence to furosemide and ambrisentan. Her six minute walk test had decreased from 439 to 384 meters over the course of 10 months, and her physical exam was benign. A computed tomography of the chest showed diffuse, punctated centrilobular nodules concerning for respiratory bronchiolitis interstitial lung disease. Bronchoscopy with bronchoalveolar lavage showed macrophage predominance (64%) and occasional inflammatory cells. On biopsy she had mild lymphocytic inflammation of the bronchial wall of the right lower lobe. Autoimmune workup was negative. Further history revealed she had been diffusing peppermint and eucalyptus oil via an essential oils diffuser for the last 3 months at work. She was advised to stop using the diffuser as there was concern it may be the cause of her symptoms. Follow up questioning 3 months after abstinence from diffusing showed significant improvement in her symptoms. Her cough had improved, and her dyspnea had returned to baseline. DISCUSSION: Essential oil diffusers work by heating or using electronic vibrations to turn water and oils into a mist. The composition of the oil is not standardized, and they can contain a myriad of chemicals at varying concentrations. This fine mist is easily inhaled, however the consequences of frequent use is unknown. Hypersensitivity pneumonitis is caused by inflammation of the alveoli in the lung due to hypersensitivity to certain environmental antigens. Inhaling small particles is known to cause hypersensitivity and lung disease, and a similar mechanism is likely present with essential oils. Previous studies have shown hypersensitivity when oils are placed topically, but little work has been done to determine if aerosolization leads to increased sensitivity. Although the case appears to have resolved with the discontinuation of the essential oils, it is unknown if persistent use may lead to more permanent lung pathology. CONCLUSIONS: This case demonstrates the importance of obtaining a good social history of exposures in the setting of new or worsening lung disease. Furthermore, more research needs to be done in the area of essential oils and the potential consequences of their use with or without a diffuser. Reference #1: Braden, Rebecca, Susan Reichow, and Margo A. Halm. "The use of the essential oil lavandin to reduce preoperative anxiety in surgical patients.” Journal of Perianesthesia Nursing 24.6 (2009): 348-355. Reference #2: Buckle, Jane. "Clinical aromatherapy and AIDS.” Journal of the Association of Nurses in AIDS Care 13.3 (2002): 81-99. DISCLOSURES: No relevant relationships by Bindu Akkanti, source=Web Response No relevant relationships by Kara Calhoun, source=Web Response No relevant relationships by Jennifer Duke, source=Web Response No relevant relationships by NEAL GEORGE, source=Web Response