• Dr. Lawrence Afrin, Dr. Tania Dempsey

Mast cell activation syndrome and vaping

Is vaping better than smoking? How harmful is vaping?


Are e-cigs/vapes “better" than regular cigarettes? If not, why were people so eager to think so?

E-cigarettes or Vapes are, unfortunately, no better than cigarettes, and in fact could be a lot worse. Early on when electronic cigarettes were introduced to the market, they were touted as a safer alternative to smoking as well as a means to quit smoking.

The thought was that this was a purer way to get nicotine into the body than smoking tobacco, given the thousands of chemicals that burning tobacco contains. It turns out that vaping nicotine releases volatile organic compounds and particulate matter that when breathed in can damage the lungs.

E-cigarette cartridges also contain carcinogens and toxic chemicals. Research has also shown that the majority of people who switch to e-cigarettes to help them with smoking cessation continue to be addicted to nicotine, and thus never really quit.

E-cigs/vapes are more diverse than regular cigarettes. Cartridges for e-cigs can contain THC or nicotine or just flavorings, which might be more appealing in some ways to people compared to regular cigarettes.

Unfortunately, all of those products have side effects and are potentially very dangerous, particularly to young people.


What are the side effects of e-cigs/vaping? How does this vary from regular cigarettes? Are these long-term effects?

The side effects of e-cigs/vaping are extensive. Some overlap of side effects can be seen with regular cigarettes. Nicotine addiction is a real concern, especially in teens and young adults, because of nicotine’s effects on the developing brain.

Young people are at risk for escalation of addictive behavior once they are exposed to nicotine because it can make certain drugs more pleasurable to the developing brain. One study on high school students showed that after 6 months of e-cigarette use, students were more likely to have progressed to smoking cigarettes than those who didn’t use e-cigs.

E-cigs also cause significant respiratory issues, due to the inhalation of the abundant toxic chemicals that are either added to the e-liquids or that are produced during the heating and vaporization process. These chemicals can also lead to cancer and can affect reproductive health.

Some of the long-term inflammation seen with regular cigarette smoking including bronchitis, emphysema, and heart disease is also seen with e-cigs because of the presence of some of the same toxic chemicals in both.

Even though e-cigs do not produce smoke, they are contributing to poor air quality around the user from the release of volatile organic compounds and other particulate matter. This is akin to second-hand smoke, but in this case, it is second hand vapor.

Is there a difference between e-cigs/vapes? Is one worse?

It is not clear if there is one brand or type of e-cig/vape that is better than another. There are some studies showing that e-liquids from certain brands of e-cigarettes contain high levels of heavy metals, such as cadmium, which is also found in cigarette smoke, and can lead to serious complications in the lungs, heart, kidneys and bones.

In a study done at Johns Hopkins in February 2018, they found that e-liquid exposed to heating coils had higher amounts of lead, chromium, nickel and manganese, all of which are toxic when inhaled. In fact, 50 percent of the samples they tested had lead concentrations higher than the limits set by the Environmental Protection Agency.

Can you talk about the new lung disease associated with vaping? Are there any precautions users can take aside from quitting?

We are in the middle of an outbreak of a severe lung disease associated with e-cig/vaping use. As of January 7, 2020, there have been a total of 2,602 hospitalized EVALI ( E-cigarette or Vaping Product Use-Associated Lung Injury) cases and 57 deaths reported to the CDC in the U.S. The CDC has found that most of the cases reported using e-cigarettes with THC, many reported using nicotine and THC and some used nicotine cartridges only.

While the actual cause of the lung damage that we are seeing has not been determined, there are some leading hypotheses. One hypothesis is that the nicotine, flavorings and other ingredients set up the lung with inflammation and THC oil that is aerosolized adds fuel to the fire. Heated e-liquids that contain oil and glycerol, form droplets that get inhaled and can cause lipoid pneumonia, which is essentially the collection of oil in immune cells in the lungs.

Some early reports seem to indicate that one additive in particular, Vitamin E acetate, which is found in THC containing e-cigarette or vaping products, is closely associated with EVALI.

It is important to note that there seems to be some variability in how patients seem present with lung involvement. Some of the cases developed acute respiratory distress syndrome (ARDS) which is severe inflammation in the lungs that leads to fluid build-up and decreased oxygen levels.

Many of these patients needed to be intubated. It is important to note that while some of the cases developed lipoid pneumonia, not all did. Some cases have significant inflammation without the fat deposits, so it is still somewhat unclear what this exact illness is and what exactly is causing it.

Those who vape are urged to stop. If they continue vaping, they should be on alert for symptoms that can suggest that they are developing this lung disease. These symptoms include cough, shortness of breath, fever, chest pain, weight loss and abdominal discomfort.

Mast cell activation syndrome and e-cigarettes


Can smoking e-cigarettes trigger MCAS?

Smoke of any sort (tobacco-based, wood-based, etc.) has long been recognized to be a potent trigger of mast cell activation (MCAS) in some people. Along similar lines, some mast cell patients seem to be highly sensitive, too, to exposures to organic chemicals of a wide variety of sorts, as found not only in smoke but also in petroleum-based chemicals, such as fuels, perfumes/fragrances, plastics, and some textiles.

Thus, though a few chemicals sometimes found in certain types of smoke (e.g., the cannabidiol (CBD) found in marijuana smoke, but not the tetrahydrocannabinol (THC) can be helpful in controlling mast cell activation in some people, overall the risks of exposure to the harmful chemicals found in *every* type of smoke likely significantly outweighs any benefits from exposure to any helpful chemicals in combustion-produced smoke. Vaping does not involve actual combustion, but it does involve heating a liquid chemical concoction until the liquid becomes a vapor which can be inhaled. As such, whatever chemicals are in the concoction one chooses to vape -- whether those chemicals are known by the manufacturer to be present in the concoction or not -- will be inhaled.

ECIGS AND MCAS At present, the actual cause of the emerging epidemic of (occasionally fatal!) vaping-related pulmonary illness is unclear. It is unclear what specific chemical(s) are being inhaled which is/are triggering the illness, and it is unclear what the molecular and cellular mechanisms of the illness are, though in general the mechanisms seem to be rooted in an "inflammatory" reaction (at least in the lungs, possibly also elsewhere in the body, too), and very recently it has emerged that this inflammatory response to the provocative chemical(s) may be rooted in activation of the immune cells called macrophages.

There is no association known at present between mast cells (let alone MCAS) and vaping-related pulmonary illness. Only time -- and much more research -- will tell whether mast cells (and possibly MCAS) are involved in any fashion in this public health problem or not. Lungs, of course, are meant (i.e., evolved) to inspire oxygen and expire carbon dioxide. That's it. That's all they're supposed to do. Inhalation of anything other than oxygen serves no known purpose in normal human biology, and thus it should not be surprising if inhalation of *anything* other than oxygen (and the other inert elemental gases naturally found in our atmosphere) were to have *potential* for actually *harming* our lungs.

Yes, a relatively few substances -- i.e., certain drugs -- have also been found helpful to inhale in certain disease conditions, but only the drugs approved for inhalation have been found helpful, and only after a lot of research. Everything else? Prudence would seem to dictate not inhaling everything else. Breathing for the rest of your life with somebody else's (i.e., transplanted) lungs, even if such are accessible should yours fail, is obviously far less desirable than breathing for the rest of your life with the lungs you were born with. As such, in the same fashion in which the medical profession has long been strongly counseling against smoking tobacco, it would seem that similar strong recommendations against vaping (of *anything*, legal or illegal) would be most appropriate, too. We learned decades (actually, centuries) ago that chronic inhalation of smoke was terrible for human health, and yet a worldwide epidemic of smoking ensued anyway thanks largely to the addicting properties of the nicotine found naturally in tobacco. With extraordinary effort, the human race is finally beginning to turn the corner on the tobacco smoking epidemic.

And now there is vaping, with a humongous assortment of addictants (nicotine, THC, etc.) in the various products -- legal and illegal -- being widely vaped. As of this writing on January 15, 2020, fifty-seven people have died from vaping so far just in the U.S. Do we need to repeat with vaping the deaths of millions of people seen in the past from smoking? Nobody is forced to start vaping. It's a choice. If you're not already doing it, then don't do it. And if you're already vaping, stop. If you need help stopping, talk to your doctor about it.


Interview on eCigs in aSweatLife "Everything you need to know about E-Cigarettes"

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