As a spate of mysterious vaping-related illnesses pop up around the United States, health officials continue to investigate ingredients in both THC and nicotine-containing devices in an attempt to determine why hundreds of people have been hospitalized after vaping.
As of September 24, 805 possible vape-related respiratory illness cases have been reported from 46 states, the Centers for Diseae Control and Prevention and the Food and Drug Administration said in a statement. Twelve of those cases have resulted in death.
“We don’t yet know the exact cause of these illnesses — whether they’re caused by contaminants, ingredients in the liquid or something else, such as the device itself,” Dr. Ann Thomas, a public health physician with the Oregon Health Authority, said on September 3 after the first person in the state died from a vape-related illness.
The ingredients in nicotine-containing vapes vary based on the flavor and brand, which has made tracking down an exact culprit for vape-related illnesses a difficult task for the FDA and CDC.
There are certain chemicals, like the oils used to suspend nicotine in vape juices, that have popped up in multiple vape illness cases. Here are the chemicals in nicotine vapes you should be aware of, along with their health risks.
Propylene glycol is a suspension ingredient that helps turn nicotine into an aerosolized form users inhale.
According to the Agency for Toxic Substances and Disease, the FDA says propylene glycol is “generally recognized as safe” when used in food, and the chemical is also used to create fog in fog machines and antifreeze.
Research has shown propylene glycol can enter a person’s bloodstream if they inhale it, but it breaks down after 48 hours.
If a person is consistently exposed to the chemical, however, it couldlead to skin or lung irritation, depending on where the chemical interacts with the body.
Vegetable glycerin, like propylene glycol, is a suspension ingredient in e-liquids.
Professor Thomas Eissenberg at the Virginia Commonwealth University Center for the Study of Tobacco Products previously told Insider he believes suspension oils like vegetable glycerin are a major culprit for vaping-related illnesses like lipoid pneumonia, a condition where liquid oil droplets get into the lung because they didn’t completely vaporize. When that liquid builds up, it can cause pneumonia.
In a 2018 BMJ case report, a 34-year-old British woman who’d been vaping for three years developed lipoid pneumonia and respiratory failure. In another case, published in 2012, a 42-year-old woman was prescribed antibiotics multiple times for her pneumonia before doctors finally told her to stop using e-cigarettes. When she did so, her condition improved.
“Vegetable glycerin is derived from vegetable oil, and to the extent that the derivation process is not complete, vegetable oil could be getting into the liquid,” Eissenberg previously told Insider. “If that’s the case, we may be seeing not the last cluster of lipoid pneumonia, but rather the first.”
Some e-cigarettes also produce formaldehyde, a chemical that can cause lung disease.
The Environmental Protection Agency classifies formaldehyde as a “probable human carcinogen,” which means inhaling the substance could increase a person’s cancer risk.
The colorless gas is also used to keeps clothes wrinkle-free in their packaging, although in undetectable amounts that can be scrubbed off with soap and water, Insider previously reported. Inhaling formaldehyde has also been linked to asthma and nausea, and wearing clothes with the chemical is associated with ashes, blisters, and itchy, dry skin.
Most e-cigs also produce acrolein, a chemical often found in weed killer.
In 2018, researchers who presented at a meeting for The American Chemical Society found that people who inhaled acrolein sustainedchanges to their DNA.
“If the cell does not repair the damage so that normal DNA replication can take place, cancer could result,” a press release on the research said.
The chemical, which is often used as a pesticide for algae and weeds and releases when gasoline is burned, has been linked to lung and gastrointestinal problems, according to the National Institutes of Health.
Nicotine can also be problematic for vape users and just as harmful as cigarettes.
“Just be aware that from the lungs’ perspective, vaping doesn’t seem to be better than smoking,” Professor Robert Tarran, who studies vaping at the University of North Carolina Marisco Lung Institute, previously told Insider.
Tarran recently conducted both human and animal studies that found vaping can contribute to the development of lung disease, just like traditional cigarette smoking can.