Vitamin E acetate as a possible cause in vaping lung injury

Nov. 12, 2019

Recent CDC laboratory testing of bronchoalveolar lavage (BAL) fluid samples (or samples of fluid collected from the lungs) from 29 patients with EVALI (e-cigarette, or vaping, product use associated lung injury) submitted to CDC from 10 states found vitamin E acetate in all of the BAL fluid samples.

Vitamin E acetate is used as an additive in the production of e-cigarette, or vaping, products. This is the first time that the CDC detected a potential chemical of concern in biologic samples from patients with these lung injuries. These findings provide direct evidence of vitamin E acetate at the primary site of injury within the lungs.

The CDC announced the following laboratory findings: (1) Analyses of bronchoalveolar lavage (BAL) fluid samples of patients with e-cigarette, or vaping, product use associated lung injury identified vitamin E acetate, an additive in some THC-containing products and (2) Recent CDC laboratory test results of BAL samples from 29 patients submitted to CDC from 10 states identified vitamin E acetate in all BAL fluid samples. THC was identified in 82 percent of the samples and nicotine was identified in 62 percent of the samples.

CDC tested for a range of other chemicals that might be found in e-cigarette, or vaping, products, including plant oils, petroleum distillates like mineral oil, MCT oil and terpenes. None of these potential chemicals of concern were detected in the BAL fluid samples tested.

These findings complement the ongoing work of FDA and some state public health laboratories to characterize e-liquid exposures and inform the ongoing multistate outbreak.

As of November 5, 2019, 2,051 cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 1 U.S. territory. Thirty-nine deaths have also been confirmed in 24 states and the District of Columbia.

While it appears that vitamin E acetate is associated with EVALI, evidence is not yet sufficient to rule out contribution of other chemicals of concern to EVALI. Since the specific compound or ingredient causing lung injury are not yet known, the only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products.

CDC continues to work closely with FDA, states, public health partners and clinicians on this investigation. CDC continues to recommend that people should not use e-cigarette, or vaping, products that contain THC, particularly from informal sources like friends, or family, or in-person or online dealers.

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