Three additional deaths were confirmed last Friday in Indiana, Minnesota and California, following the ones reported in Illinois and Oregon, as the number of reported cases reaches 450. “While this investigation is ongoing, people should consider not using e-cigarette products,” says Dr. Dana Meaney-Delman, incident manager of the CDC’s response to the vaping-related lung injuries.

Vapers should refrain from purchasing and using unlicensed products off the street, where they are untested, unregulated and therefore possibly unsafe.

“People who do use e-cigarette products should monitor themselves for symptoms, for example, cough, shortness of breath, chest pain, nausea and vomiting — and promptly seek medical attention for any health concerns.”

After advising vapers to just stop using e-cigarettes for weeks, the CDC, FDA, and HHS, are finally advising consumers to avoid using unlicensed products and refrain from purchasing e-liquids off the street where they are untested, unregulated and therefore possibly unsafe.

Most of the cases are occurring amongst youth or young adults, and the acute disease appears to be lipoid pneumonia, acute respiratory distress syndrome, and/or chemical pneumonitis.

Vitamin E oil (tocopheryl-acetate)

Despite getting closer to an answer, the cause is still unknown, but New York health authorities have confirmed that vitamin E oil (tocopheryl-acetate) was found in most seized vaping products in that state. Additionally, the FDA has received about 120 samples for testing, and 10 of the 18 THC samples contained the vitamin E oil.

New York health authorities have confirmed that vitamin E oil (tocopheryl-acetate) was found in most seized vaping products in that state

Amongst the tainted products were ones under the brand names Chronic Carts, Dank Vapes, and West Coast Carts, however the disease has been linked to multiple other illicit market brands across multiple states.

Last week, an article on Leafly reported that a new diluent known as Honey Cut entered the illicit vape market in late 2018. The product, dilutes THC oil without thinning it, and pen makers are known to use vitamin E oil as it’s a cheap thickener. When officials at the terpene manufacturer True Terpenes, tested Honey Cut earlier this year, they found it contained Vitamin E oil.

Pulmonary Lipid-Laden Macrophages

Meanwhile, a study published in the New England Journal of Medicine last week, has identified a previously unrecognized characteristic of the vaping-related respiratory illness. Within the lungs of these patients, doctors found large immune cells containing numerous oily droplets, called lipid-laden macrophages.

Within the lungs of these patients doctors found large immune cells containing numerous oily droplets, called lipid-laden macrophages.

“A notable and consistent feature of the cases we report is the presence of lipid-laden macrophages seen with oil red O staining in BAL samples that are not attributable to aspiration of exogenous lipoid material. In addition, the diffuse parenchymal opacities seen on CT scans did not have low attenuation (in Hounsfield units) consistent with classic lipoid pneumonia. Although the pathophysiological significance of these lipid-laden macrophages and their relation to the cause of this syndrome are not yet known, we posit that they may be a useful marker of this disease,” read the study Abstract.

This finding may assist doctors in diagnosing the condition quicker, and also provide clues into the causes. “While it is too soon to be sure, these lipid-laden macrophages may turn out to be useful to confirm or rule out this disease,” said lead study author Scott Aberegg, M.D., a critical care pulmonologist at U of U Health. “They may also be helpful in understanding what is causing this illness,” he added.

Read Further: Huffpost; MedicalXpress

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