Controversies in Allergy
Electronic Cigarettes: A Pro–Con Review of the Current Literature

https://doi.org/10.1016/j.jaip.2022.07.009Get rights and content
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Electronic cigarettes (e-cigarettes, e-cigs, or electronic nicotine delivery systems) are battery-operated devices typically containing glycerol and/or propylene glycol-based solutions with varying nicotine content, known as e-liquids. Although e-cigarettes were originally developed as a potentially less harmful alternative to traditional combustible tobacco cigarette smokers, several factors have driven their popularity among smokers and nonsmokers alike, including their sleek product designs, innumerable appealing flavors, lack of combustible smoke and odor, and high potential nicotine concentrations. Furthermore, many advocates have promoted the idea that e-cigarettes are safe to use, or at least safer than conventional tobacco, despite limited longitudinal data to support these claims. Here, we examine what is known about the impacts of e-cigarette use on traditional cigarette smoking cessation, lung health, and youth and young adult tobacco product exposure. Upon review of the currently available literature, the negative effects of e-cigarette use seem to outweigh any potential benefit, because the available evidence does not confirm the use of e-cigarettes as an effective strategy for supporting traditional combustible tobacco cigarette smoking cessation, particularly given the emerging adverse effects on lung health and the potential future public health effects of e-cigarette adoption among a burgeoning new generation of tobacco product users.

Key words

E-cigarette
Nicotine
Smoking cessation
EVALI
Dual use

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Dr Crotty Alexander’s salary was supported in part by Veterans Affairs Merit Award 1I01BX004767 (Crotty Alexander), National Institutes of Health (NIH) National Heart, Lung, and Blood Institute Award K24HL155884 (Crotty Alexander), and Tobacco-Related Disease Research Program Awards T32SR5359 (Emory/Crotty Alexander) and T30IP0965 (Crotty Alexander). Dr Que’s salary is supported in part by NIH National Heart, Lung, and Blood Institute Awards R01HL146542 (Holguin/Que), R01HL153641 (Que), R01HL136917 (Dixon), NIH National Institute of Environmental Health Sciences Award R01ES027574 (Tighe), and NIH National Institute of Allergy and Infectious Diseases Award HHSN272000-TO22-Task D (Walters/Que) and the American Lung Association-Airways Clinical Research Center.

Conflicts of interest: The authors declare that they have no relevant conflicts of interest.