Electronic cigarettes (also known as e-cigarettes, e-cigs, vapors or nicotine vaporizers) are battery-powered devices designed to mimic the smoking experience without burning tobacco.They’ve exploded in popularity as a “safer” alternative to smoking, and e-cigarettes can now regularly be seen on TV and in the media.E-cigarettes do not use tobacco, but instead heat a liquid containing nicotine, flavorings, and other chemicals until it becomes a vapor, which can then be inhaled.It’s sometimes called “vaping.” Users don’t inhale the same levels of tar and carbon monoxide that they would when smoking traditional cigarettes, but e-cigarettes are far from being a healthy alternative to smoking.Nicotine is a highly addictive drug and toxic in high doses.It affects the brain, nervous system, and heart—raising blood pressure and causing an abnormal heart rate.Over time, nicotine use can lead to heart disease, blood clots, and stomach ulcers.Withdrawal from nicotine may make people feel depressed, tired, and irritable.

All of these dangers apply to users of e-cigarettes.Nicotine is not the only dangerous chemical found in e-cigarette liquid.According to a 2009 announcement, the U.S.Food and Drug Administration (FDA) found diethylene glycol, a chemical used in antifreeze and “detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed.” These are relatively new products often sold with misleading claims, such as: CLAIM: E-cigarettes help smokers quit.TRUTH: There is no scientific evidence that using e-cigarettes can help you quit smoking and they are not approved by the FDA as a smoking cessation tool.Because e-cigarettes are marketed with flavors like chocolate and strawberry, they may actually encourage nonsmokers (especially kids) to try vaping.CLAIM: E-cigarettes can be used anywhere, even in “non-smoking” areas.TRUTH: Laws vary from state or state (or even within some states).In general, e-cigarette use is NOT permitted in the same places where smoking is prohibited.

CLAIM: There is no “secondhand” risk with e-cigarettes.TRUTH: For smokers, the term “secondhand” refers to smoke coming from tobacco being smoked by another person or exiting the lungs of someone smoking.For e-cigarettes, “secondhand” would similarly refer to someone inhaling vapors because they are near people using the device.There has not been enough research conducted on e-cigarette use to determine whether secondhand vapors are harmful or to what extent.Yet, a 2012 study did find that exhaled vapors contained measurable amounts of carcinogens.CLAIM: You can get “nicotine-free” e-cigarettes.TRUTH: The FDA’s initial analysis of e-cigarettes in 2009 found low levels of nicotine in products labeled as “nicotine free.” The FDA regulates tobacco products including cigarettes, cigars, pipe tobacco and smokeless tobacco as well as approved products for quitting smoking (gums, patches, medications).However, it does NOT currently regulate e-cigarettes.Manufacturers are not required to disclose the chemicals in its liquids or in what amount these are inhaled and exhaled by the user.

In April 2014, the agency proposed a series of regulations for the e-cigarette market, but nothing had been passed as of early 2015.e cigarette rhylTakeaways E-cigarettes are not a healthy alternative to smoking.ecigarette lyon part dieuThere is no proof e-cigarettes can help you quit smoking.e cigarette mbk bangkokThere is some evidence to suggest second-hand vapors from e-cigarettes are harmful.e cigarette abingdonVolume 87, July 2017, Pages 1–8 •Assessing and managing risk for contact and respiratory allergens in e-liquid.•‘How to’ guide for a vaping contact allergy quantitative risk assessment.•Don't use respiratory allergens!.•Case study: Cocoa shell extract respiratory sensitisation risk assessment.Many flavours and fragrances are known allergens.e cigarette wetherby

Their selection and inclusion levels in e-liquids must therefore be guided by toxicological principles, taking into account the exposure pattern and inhalation route of exposure.e cigarette vgoFor contact sensitisation, a general, agreed quantitative risk assessment approach to prevent dermal sensitisation exists.Here we propose exposure parameters and safety factors to apply this approach to e-liquid ingredients.Additionally, as a risk management approach for pre-sensitised individuals, we derive a threshold of 0.1% for indicating the presence of a contact sensitiser in e-liquid.Risk assessment for respiratory sensitisation is not well established.Occupational exposure limits that protect against respiratory allergy are generally very low.Cocoa shell extract is used as a case study to discuss the issues.A tolerable exposure level is derived and estimates of consumer exposure are presented, leading to the practical risk management approach of excluding respiratory sensitisers as e-liquid ingredients.

Related to this, if natural extracts are used as flavourings in e-liquids, we recommend only protein-free versions are used.Additionally, we recommend the presence of any potential food allergens should be noted on the product information.The use of various flavours in e-cigarettes and e-liquids can lead to concerns over the potential for allergic responses from the use of these vaping products.Different types of allergy can be relevant to vaping exposures.Skin or contact sensitisation, also known as type IV delayed cell-mediated type hypersensitivity, needs to be considered due to the use of flavours or fragrances, and sometimes other compounds, such as preservatives, many of which are known potential contact sensitisers.Dermal quantitative risk assessment for contact sensitisation is well established (Api et al., 2008), and this paper proposes the details for an analogous approach for vaping exposures.Early thinking in this area has been briefly described in a poster presentation elsewhere (Costigan, 2014).Because the main intended exposure from vaping products is via inhalation, respiratory allergy (also referred to as type I immediate IgE-mediated hypersensitivity) also requires consideration.

Although chemical respiratory allergy is much less common than contact sensitisation, the potential adverse effects are much more severe.We have previously introduced respiratory sensitisation as an exclusion criterion for ingredient selection (Costigan and Meredith, 2015).In this Position Paper, we expand upon that by discussing cocoa shell extract as a case study to illustrate the risk assessment process and related challenges, and include some practical resources for identifying type I allergies.Additionally, we propose to extend this exclusion criterion to risk management of ingredients associated with IgE-mediated food allergies and discuss various food immunological responses.Vaping transforms e-liquid into an aerosol that enters the consumer's mouth and respiratory tract.E-liquid formulations generally contain nicotine, solvents and flavourings, and might contain other ingredients, such as preservatives.Some flavour ingredients, whether natural extracts or synthetic, can induce contact sensitisation.

Thus, a hazard identification approach is needed to decide whether an intended ingredient has that potential.And if it does, whether the risk of allergy responses from the expected exposures is acceptably low.Sensitisation has two basic phases, induction and elicitation of a reaction (OECD, 2012).Induction ‘primes’ an individual's immune system to a specific substance by inducing specialised immunological memory on exposure to an allergen.Induction might take weeks to years of exposure to develop and, after induction, further exposure can elicit the classic inflammatory reaction associated with allergic contact dermatitis.Both induction and elicitation are threshold mechanisms.The threshold for elicitation, however, is typically lower than that for induction.The network of Langerhans cells in oral tissue, means that oral exposure is also relevant.However, contact sensitisation reactions are not known to extend into the respiratory tract.Typical types of compounds with contact sensitisation potential are flavourings and preservatives.

Flavourings often contain natural flavours, which are effectively mixtures of constituents.To assess the risks associated with single ingredients and constituents of naturals, three questions should be addressed:1.Does the ingredient/constituent have any sensitisation potential?2.If yes, is the sensitiser present at a sufficiently low level that it is not expected to elicit reactions even in pre-sensitised individuals?3.If present at higher levels, are the levels expected or not expected to induce sensitisation?In this article, we derive a risk assessment approach specific to vaping products.1 summarises the resultant practical process for assessment of contact sensitisation of e-liquid ingredients.The main toxicological test for determining sensitisation potential of a substance is the local lymph node assay (OECD, 2010).This test measures the concentration needed to stimulate a threefold increase in lymph node cell proliferation in mice.Other classic animal methods are the Buehler and guinea pig maximisation tests.

The classic clinical study, which shows an absence of sensitisation induction in humans at specific levels, is the human repeat insult patch test (Basketter, 2008).Good progress has been made with in silico and in vitro methods for contact sensitisation hazard identification.The OECD has published two new in vitro test guidelines (442C and 442D) that address key events in the adverse outcome pathway for contact sensitisation and, therefore, can be part of a weight of evidence approach to hazard assessment.No in vitro test is validated to assess the relative potency of sensitisers.The QRA methodology for contact sensitisation is well established and has been adopted by industry (e.g.International Fragrance Association and Research Institute for Fragrance Materials) and regulators (e.g.The method is based on defining a no expected sensitisation induction level (NESIL) and applying appropriate uncertainty factors to establish a level where the risk is acceptably low—the acceptable exposure level (AEL) (Api et al., 2008).

The consumer exposure level (CEL) is then estimated and compared against the AEL.If AEL/CEL=>1, the proposed use of the compound is deemed supportable.NESILs can be derived from animal and/or human data and are quantitative measures of the potency of the sensitiser.Compilations of appropriate sensitisation data for NESILs derived from flavours and fragrances have been published (Gerberick et al., 2005 ;  Kern et al., 2010).Although elicitation is also of some interest, the main interest of the QRA is in avoiding sensitising consumers at all.The usual approach to protecting pre-sensitised consumers is to define levels above which consumers should be informed of the presence of known sensitisers, so they may decide whether to use the product if they know of, or suspect a sensitivity.This approach is analogous to that taken in the EU Cosmetics Directive 76/768/EEC which requires known sensitisers at concentrations greater than 0.001% in leave-on products and 0.01% in rinse-off products to be mentioned on the label (European Commission, 1976).