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Study on e-cigarettes: In Germany so far no life-threatening poisoning by e-cigarette use ("vaping")

51/2019, 06.12.2019

Two severe cases after ingestion of refill solutions (e-liquids), according to an evaluation by the Federal Institute for Risk Assessment of Inquiries to German Poisons Centres.

In the USA, the use of electronic cigarettes (e-cigarettes) has resulted in more than 2000 cases with partially severe lung damage and 47 deaths (as of 20 November 2019). As a comprehensive evaluation of the inquiries to all poisons centres in Germany by the German-speaking Society for Clinical Toxicology (GfKT) and the German Federal Institute for Risk Assessment (BfR) showed that the majority of inquiries in Germany concerned the unintentional swallowing of refill solutions ("e-liquids") mostly containing nicotine. In most cases children are involved. Two cases were classified as life-threatening. Therefore, BfR recommends childproof storage of e-cigarettes and e-liquids. Cases with shortness of breath or lung injury after inhalation (as reported from the USA) were not registered in the study. "Despite the results available now, we must remain vigilant with regard to the use of e-cigarettes," says BfR President Professor Dr. Dr. Andreas Hensel. "Above all, we strongly advise against self-mix of e-liquids."

According to the American Centers for Disease Control (CDC), one possible cause of severe lung disease in the USA is vitamin E acetate, an oily liquid detected in e-liquids used by poisoned patients and in these patients' lung fluid.

In the "PiMont" study in Germany (PiMont stands for "Pilot Project Monitoring of Poisonings"), 851 poisonings and suspected poisonings after contact with e-cigarettes or e-liquids were registered. In 8 % of cases intended use was reported (inhalation). Non-intended swallowing of liquids is the most frequent reason for inquiries about e-cigarettes to poisons centres, accounting for 82 % of cases. Infants are often affected. Nicotine, which is usually contained in E-Liquids, can lead to moderate symptoms, such as prolonged vomiting, even if swallowed in small amounts. The intake of large amounts of nicotine can lead to life-threatening poisonings. E-Liquids should therefore always be stored in suitable, correctly labelled containers with child-resistant seal.

Between May 2018 and February 2019, a subgroup of 167 poisonings and cases of suspected poisoning were recorded in a comprehensive way: After inhalation of the vapour, the patients showed no symptoms or only mild symptoms in more than 90 % of the cases. Seven cases were assigned a moderate degree of severity, six of them after ingestion and one case with repeated vomiting after inhalation. Two patients were poisoned in a life-threatening way; in these two cases, they suffered from severe impairment of consciousness and additional symptoms after swallowing an e-liquid.

The case collection on e-cigarettes is one of eight sub-projects in the PiMont study of the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety. BfR, the German-speaking Society for Clinical Toxicology and all eight German poisons centres were involved. Data was collected retrospectively from January 2015 to November 2017 and prospectively with more comprehensive case reports for May 2018 to February 2019. Results will soon be published in a final project report.

The BfR keeps in close contact with poisons centres after completion of the project’s case collection prepared to update the evaluation if new case reports would become available.

About the BfR

The German Federal Institute for Risk Assessment (BfR) is a scientifically independent institution within the portfolio of the Federal Ministry of Food and Agriculture (BMEL) in Germany. It advises the German federal government and federal states on questions of food, chemical and product safety. The BfR conducts its own research on topics that are closely linked to its assessment tasks.

This text version is a translation of the original German text which is the only legally binding version.

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