Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers: a retrospective data analysis

Abstract

BackgroundThe use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS).MethodsA retrospective analysis of exposures associated with e-cigarettes reported to national poison centers was performed covering incidents from 2012 to March 2015 from 10 EU MS. De-identified and anonymous raw data was acquired.ResultsIn total, 277 incidents were reported. Unintentional exposure was the most frequently cited type of exposure (71.3%), while e-cigarette refill vials were responsible for the majority of the reported incidents (87.3%). Two-thirds of all exposures (67.5%) occurred as ingestion of e-liquids, which was more frequent among children (≤ 5 years, 6–18 years) compared to adults (87.0% vs. 59.3% vs. 57.6%, p < 0.001 respectively), exposure via the respiratory (5.4% vs. 22.2% vs. 22.2%, p < 0.001) were more frequent among paediatric patients while ocular routes (2.2% vs. 3.7% vs. 11.4%, p = 0.021) were more frequent among adults. Logistic regression analyses indicated that paediatric incidents (≤ 5 years) were more likely to be through ingestion (adjusted Odds Ratio [aOR] = 4.36, 95% Confidence Interval [C.I.]: 1.87–10.18), but less likely to have a reported clinical effect (aOR = 0.41, 95% C.I.: 0.21–0.82).ConclusionsOur study highlighted parameters related to e-cigarette exposure incidents in 10 EU MS, the results of which indicate that consideration should be given to the design features which may mitigate risks, thereby protecting users, non-users and especially children.

An epidemiologic and clinical description of e-cigarette toxicity

“…This study prospectively described e-cigarette exposures reported to a regional Poison Center over a 42-month period. Current knowledge of e-cigarette exposures and their associated toxicity is based on case reports, small case series, and retrospective poison center data [2,3,7,[9][10][11]. Several published reports have described e-cigarette exposures causing topical irritation [8,12], GI symptoms [5,7,13,14], myocardial infarction [15], and severe nicotine toxicity manifesting as respiratory arrest [1,7,16], and even death [16][17][18][19][20][21].…”

“…The majority of exposures in these datasets resulted in minor or no effects [11,23]. Commonly reported adverse effects were vomiting, nausea, eye irritation, and dizziness [2,10].…”

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

“…In Texas, Poison Centers received 225 calls between 2009-2014 [165], while in Utah 52 cases were reported to have been poisoned by a synthetic cannabinoid in 2017-2018 [166]. Between 2012-2015, 277 calls were made to 10 European Countries' Poison Centers [12], while in the UK, between 2008-2016, 278 calls were made to the National Poisons Information Service (NPIS) regarding children under 16 years old [167]. Between 2012-2018, 148 cases of acute exposure to e-cigarettes were reported to Czech Toxicological Information Centre [69].…”

“…The first case of e-cigarette-related lung injury was a case of lipoid pneumonia published in 2012 [11], furthermore from 2012 to 2015, 277 incidents of poisoning have been reported to National Poison Centers of 10 EU MS [12] and similarly increased poisoning incidents have been reported by US poison centers [13].…”

E-Zigaretten: gesundheitliche Bewertung und potenzieller Nutzen für Raucher

“…Es vergiften sich v. a. Kinder bis zum Alter von 5 Jahren infolge einer oralen Aufnahme von Liquids. Diese Vergiftungsgefahr lässt sich durch kindersichere Verpackungen, eine eindeutige Kennzeichnung der Behälter und eine kindersichere Lagerung minimieren [3,8].…”