Vitamin E acetate was associated with lung injuries in people who smoked electronic cigarettes or liquid e-cigarettes, a study showed.
The New England Journal of Medicine on Friday published a paper titled, “Vitamin E Acerate in Bronchoalveolar-Lavage Fluid Associated with EVALI.”
EVALI, short for e-cigarette, or vaping, product use associated lung injury, was named by the U.S. Centers for Disease Control and Prevention. The U.S. health authorities received 1,479 reports of EVALI cases including 33 deaths until Oct. 15
As the cause of the recent outbreak of EVALI in the U.S. has not been found, detecting toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI could provide direct information on exposure within the lung, the researchers explained.
In the study, the researchers collected BAL fluids from 51 patients with EVALI in 16 states and from 99 healthy people who were in an ongoing smoking-related study that started in 2015. They analyzed the fluids and measured several key toxicants such as vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes.
The results showed that 48 (94 percent) out of 51 EVALI patients had vitamin E acetate in BAL fluid, versus none in the healthy group. The researchers could not detect vitamin E acetate in the BAL fluid obtained from three patients because they were with probable EVALI.
“The EVALI case definition is intentionally sensitive, which raises the likelihood that a patient’s illness could be misattributed to EVALI,” the study said.
Vitamin E acetate has been commonly used as a dietary supplement and in skin creams, and the ingestion and dermal application of vitamin E acetate have not generally been associated with adverse health effects, the researchers noted.
However, people have paid little attention to the safety of inhaling vitamin E acetate, they noted.
Vitamin E acetate is a compound of vitamin E (α-tocopherol) and acetic acid. The changes that occur when vitamin E acetate is converted from a gel to a liquid could generate a possible mechanism by which vitamin E causes respiratory dysfunction, the researchers noted.
The researchers concluded that vitamin E acetate was associated with EVALI, as vitamin E acetate was detected in 48 among 51 EVALI patients in 16 states, while the substance was absent in the healthy comparison group.
In Korea, the Ministry of Food and Drug Safety on Dec. 12 said it detected vitamin E acetate in 13 products after analyzing substances of 153 liquid e-cigarettes.
The 13 e-cigarettes that contained vitamin E acetate were Juul Pod Crisp (Juul Labs), Siid Tobac (KT&G), X Pod Peach, X Pod Menthol (Monsters), Staroar Peach Paradise (My Vaper), Ignis Ice Peach (Lasal Korea), Swidn Ice Demon Green (unknown manufacturer), Alchemaster Mango Slush (Alchemaster), Soo Liquid 2 Snow Peach (WPN), I Love Aloe (JR Food), Cake Hazelnut Milk Tobacco (Cake Paper), ziri9 jmt Mix Melon (unknown manufacturer), and Labit Real Mango (Sinyoung Labit).
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