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December 23, 1988, Vol 260, No. 24 >
ARTICLE | December 23, 1988

Evaluation of the Health Hazard of Clove Cigarettes FREE

[+] Author Affiliations

This is Report A, adopted by the House of Delegates at the American Medical Association's Annual Meeting, June 1988.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all of the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the views of scientific literature as of June 1988.

Reprint requests to Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (William R. Hendee, PhD).


JAMA. 1988;260(24):3641-3644. doi:10.1001/jama.1988.03410240111042
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References

Resolution 43 (1987 Annual Meeting), adopted by the House of Delegates, resolved that the American Medical Association study the dangers associated with clove cigarettes, that policy recommendations regarding regulation of clove and other tobacco additives be developed, and that this information be made available to physicians and the public. Clove cigarettes are tobacco products. They therefore possess all the hazards associated with smoking all-tobacco cigarettes. In addition, inhaling clove cigarette smoke has been associated with severe lung injury in a few susceptible individuals with prodromal respiratory infection. Some individuals with normal respiratory tracts have apparently suffered aspiration pneumonitis as the result of a diminished gag reflex induced by a local anesthetic action of eugenol (the active component of cloves), which is volatilized into the smoke. The American Medical Association has an existing policy vigorously opposing the use of any tobacco product; no exemption from this policy is made for clove-containing cigarettes.

(JAMA 1988;260:3641-3644)

REFERENCES

1 +
Schröder V, Vollmer H:  Über die Ausscheidung von Thymol, Carvacrol, Eugenol und Guaiacol und die Verteilung dieser Substanzen im Organismus . Naunyn Schmiedebergs Arch Exp Pathol Pharmakol 1932;;168:331-353.
2 +
Weinberg JE, Barbag H, Nahas G, et al:  In-vivo and in-vitro metabolism of C eugenol in the rat , abstracted. Int Assoc Dent Res 1972;, p 177.
3 +
Klungsøyr J, Scheline RR:  Metabolism of safrole in the rat . Acta Pharmacol Toxicol 1983;;52:211-216.
4 +
Delaforge M, Janiaud P, Levi P, et al:  Biotransformation of allylbenzene analogues in vivo and in vitro through the epoxide-diol pathway . Xenobiotica 1980;;10:737-744.
5 +
Swanson AB, Miller EC, Miller JA:  Side-chain epoxidation and hydroxylation of the hepatocarcinogens safrole and estragole and some related compounds by rat and mouse liver microsomes . Biochim Biophys Acta 1981;;673:504-516.
6 +
Purser DA, Anderson A, Maxwell G, et al: Comparison of the Response of Rats Exposed to Equivalent Concentrations of Smoke From American or 100% Clove Bud Cigarettes: Comparative 14 Day Toxicity , report FPA/4. Huntingdon (England) Research Centre, 1987;.
7 +
Jenner PM, Hagen EC, Taylor JM, et al:  Food flavourings and compounds of related structure: I. Acute oral toxicity . Food Chem Toxicol 1964;;2:327-343.
8 +
Sticht FD, Smith RM:  Eugenol: Some pharmacologic observations . J Dent Res 1971;;50:1531-1535.
9 +
LaVoie EJ, Adams JD, Reinhardt J, et al:  Toxicity studies on clove cigarette smoke and constituents of clove: Determination of the LD50 of eugenol by intratracheal instillation in rats and hamsters . Arch Toxicol 1986;;59:78-81.
10 +
Clark GC, Lewis DJ, Gopinath C: Eugenol: Acute Inhalation Study in Rats, 4-Hour Exposure , report FPA 3/86101. Huntingdon (England) Research Centre, 1986;.
11 +
Vishteh A, Thomas I, Imamura T:  Eugenol modulation of the immune response in mice . Immunopharmacology 1986;;12:187-192.
12 +
NTP Technical Report on the Carcinogenesis Studies of Eugenol (CAS No. 97-53-0) in F344/N Rats and B6C3F1 Mice (Feed Studies) , publication 84-1779. Bethesda, Md, National Institutes of Health, 1983;, pp 1-154.
13 +
 Allyl compounds, aldehydes, epoxides and peroxides . IARC Monogr Eval Carcinog Risk Chem Hum 1985;;36:75-97.
14 +
 Illnesses possibly associated with smoking clove cigarettes . MMWR 1985;;34:297-299.
15 +
Guidotti TL, Binder S, Stratton JW, et al:  Clove cigarettes: Development of the fad and evidence for health effects , in Hollinger MA (ed): Current Topics in Pulmonary Pharmacology and Toxicology . New York, Elsevier Science Publishing Co Inc, 1987;, vol 2, pp 1-23.
16 +
Food and drugs. 21CFR §184.1257,1980 A.
17 +
Food and drugs. 21 CFR §177.2800,1980 B.
18 +
Drug products for the relief of oral discomfort for over-the-counter use: Establishment of a monograph. 21 CFR §354,1982.
19 +
External analgesic drug products for the relief of oral discomfort for over-the-counter use: Tentative final monograph. 21 CFR §348,1983.
20 +
 Twenty-third report of the joint FAO/WHO expert committee on food additives . WHO Tech Rep Ser , No. (648) , 1980;.
21 +
Itoh M:  Sensitization potency of some phenolic compounds with special emphasis on the relationship between chemical structure and allergenicity . J Dermatol 1982;;9:223-233.
22 +
Opdyke DLJ:  Monographs on fragrance raw materials: Eugenol . Food Chem Toxicol 1975;; 13( (A) ):545-547.
23 +
Opdyke DLJ:  Monographs on fragrance raw materials: Clove bud oil . Food Chem Toxicol 1975;;13( (B) ):761-763.
24 +
Rothenstein AS, Booman KA, Dorsky J, et al:  Eugenol and clove leaf oil: Survey of consumer patch-test sensitization . Food Chem Toxicol 1983;;21:727-733.
25 +
Webb JG Jr, Bussell NE:  Comparison of the inflammatory response produced by commercial eugenol and purified eugenol . J Dent Res 1981;;60:1724-1728.
26 +
Kozam G, Mantell GM:  Effect of eugenol on oral mucous membranes . J Dent Res 1978;;57:954-957.
27 +
Niinimäki A, Hannuksela M:  Immediate skin test reactions to spices . Allergy 1981;;36:487-493.
28 +
Sternberg L:  Contact dermatitis: Cases caused by oil of cloves and by oil of camomile tea (Anthemis cotula) . J Allergy 1937;;8:185-186.
29 +
Göransson K, Karltorp N, Ask H, et al:  Några fall av eugenolöverkänslighet . Svenska Tandl Tidskr 1967;;60:545-549.
30 +
Koch G, Magnusson B, Nyquist G:  Contact allergy to medicaments and materials used in dentistry: II. Sensitivity to eugenol and colophony . Odont Revy 1971;;22:275-289.
31 +
Barkin ME, Boyd JP, Cohen S:  Acute allergic reaction to eugenol . Oral Surg Oral Med Oral Pathol 1984;;57:441-442.
32 +
McCarter RF:  An unusual allergy . Midwest Dentist 1966;;42( (April) ):20.
33 +
Wise MB, Guerin MR:  Chemical analysis of the major constituents in clove cigarette smoke , in Hoffmann D, Harris CC (eds): Banbury Report 23: Mechanisms of Tobacco Carcinogensis; Conference, September 5, 1985 . Cold Spring Harbor (NY) Laboratory, 1986;, pp 151-162.
34 +
Clark GC, Anderson A, Klawitter P, et al: Comparison of the Response of Rats Exposed to Equivalent Concentrations of Smoke From American or Kretek Cigarettes: Comparative Acute Toxicity , report FPA1/851513. Huntingdon (England) Research Centre, 1986;.
35 +
Clark GC, Anderson A, Klawitter P, et al: Comparison of the Response of Rats Exposed to Equivalent Concentrations of Smoke From American or Kretek Cigarettes: Comparative 14-Day Toxicity , report FPA 2/86238. Huntingdon (England) Research Centre, 1986;.
36 +
Robinson TN, Killen JD, Taylor CB, et al:  Perspectives on adolescent substance use: A defined population study . JAMA 1987;;258:2072-2076.
37 +
Hackett PH, Rodriguez G, Roach RC:  Clove cigarettes and high-altitude pulmonary edema . JAMA 1985;;253:3551-3552.
38 +
McLellan D:  Death sparks concern over clove cigarettes . Los Angeles Times , (Dec 4) , 1984;, pp V1-V2.

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1 +
Schröder V, Vollmer H:  Über die Ausscheidung von Thymol, Carvacrol, Eugenol und Guaiacol und die Verteilung dieser Substanzen im Organismus . Naunyn Schmiedebergs Arch Exp Pathol Pharmakol 1932;;168:331-353.
2 +
Weinberg JE, Barbag H, Nahas G, et al:  In-vivo and in-vitro metabolism of C eugenol in the rat , abstracted. Int Assoc Dent Res 1972;, p 177.
3 +
Klungsøyr J, Scheline RR:  Metabolism of safrole in the rat . Acta Pharmacol Toxicol 1983;;52:211-216.
4 +
Delaforge M, Janiaud P, Levi P, et al:  Biotransformation of allylbenzene analogues in vivo and in vitro through the epoxide-diol pathway . Xenobiotica 1980;;10:737-744.
5 +
Swanson AB, Miller EC, Miller JA:  Side-chain epoxidation and hydroxylation of the hepatocarcinogens safrole and estragole and some related compounds by rat and mouse liver microsomes . Biochim Biophys Acta 1981;;673:504-516.
6 +
Purser DA, Anderson A, Maxwell G, et al: Comparison of the Response of Rats Exposed to Equivalent Concentrations of Smoke From American or 100% Clove Bud Cigarettes: Comparative 14 Day Toxicity , report FPA/4. Huntingdon (England) Research Centre, 1987;.
7 +
Jenner PM, Hagen EC, Taylor JM, et al:  Food flavourings and compounds of related structure: I. Acute oral toxicity . Food Chem Toxicol 1964;;2:327-343.
8 +
Sticht FD, Smith RM:  Eugenol: Some pharmacologic observations . J Dent Res 1971;;50:1531-1535.
9 +
LaVoie EJ, Adams JD, Reinhardt J, et al:  Toxicity studies on clove cigarette smoke and constituents of clove: Determination of the LD50 of eugenol by intratracheal instillation in rats and hamsters . Arch Toxicol 1986;;59:78-81.
10 +
Clark GC, Lewis DJ, Gopinath C: Eugenol: Acute Inhalation Study in Rats, 4-Hour Exposure , report FPA 3/86101. Huntingdon (England) Research Centre, 1986;.
11 +
Vishteh A, Thomas I, Imamura T:  Eugenol modulation of the immune response in mice . Immunopharmacology 1986;;12:187-192.
12 +
NTP Technical Report on the Carcinogenesis Studies of Eugenol (CAS No. 97-53-0) in F344/N Rats and B6C3F1 Mice (Feed Studies) , publication 84-1779. Bethesda, Md, National Institutes of Health, 1983;, pp 1-154.
13 +
 Allyl compounds, aldehydes, epoxides and peroxides . IARC Monogr Eval Carcinog Risk Chem Hum 1985;;36:75-97.
14 +
 Illnesses possibly associated with smoking clove cigarettes . MMWR 1985;;34:297-299.
15 +
Guidotti TL, Binder S, Stratton JW, et al:  Clove cigarettes: Development of the fad and evidence for health effects , in Hollinger MA (ed): Current Topics in Pulmonary Pharmacology and Toxicology . New York, Elsevier Science Publishing Co Inc, 1987;, vol 2, pp 1-23.
16 +
Food and drugs. 21CFR §184.1257,1980 A.
17 +
Food and drugs. 21 CFR §177.2800,1980 B.
18 +
Drug products for the relief of oral discomfort for over-the-counter use: Establishment of a monograph. 21 CFR §354,1982.
19 +
External analgesic drug products for the relief of oral discomfort for over-the-counter use: Tentative final monograph. 21 CFR §348,1983.
20 +
 Twenty-third report of the joint FAO/WHO expert committee on food additives . WHO Tech Rep Ser , No. (648) , 1980;.
21 +
Itoh M:  Sensitization potency of some phenolic compounds with special emphasis on the relationship between chemical structure and allergenicity . J Dermatol 1982;;9:223-233.
22 +
Opdyke DLJ:  Monographs on fragrance raw materials: Eugenol . Food Chem Toxicol 1975;; 13( (A) ):545-547.
23 +
Opdyke DLJ:  Monographs on fragrance raw materials: Clove bud oil . Food Chem Toxicol 1975;;13( (B) ):761-763.
24 +
Rothenstein AS, Booman KA, Dorsky J, et al:  Eugenol and clove leaf oil: Survey of consumer patch-test sensitization . Food Chem Toxicol 1983;;21:727-733.
25 +
Webb JG Jr, Bussell NE:  Comparison of the inflammatory response produced by commercial eugenol and purified eugenol . J Dent Res 1981;;60:1724-1728.
26 +
Kozam G, Mantell GM:  Effect of eugenol on oral mucous membranes . J Dent Res 1978;;57:954-957.
27 +
Niinimäki A, Hannuksela M:  Immediate skin test reactions to spices . Allergy 1981;;36:487-493.
28 +
Sternberg L:  Contact dermatitis: Cases caused by oil of cloves and by oil of camomile tea (Anthemis cotula) . J Allergy 1937;;8:185-186.
29 +
Göransson K, Karltorp N, Ask H, et al:  Några fall av eugenolöverkänslighet . Svenska Tandl Tidskr 1967;;60:545-549.
30 +
Koch G, Magnusson B, Nyquist G:  Contact allergy to medicaments and materials used in dentistry: II. Sensitivity to eugenol and colophony . Odont Revy 1971;;22:275-289.
31 +
Barkin ME, Boyd JP, Cohen S:  Acute allergic reaction to eugenol . Oral Surg Oral Med Oral Pathol 1984;;57:441-442.
32 +
McCarter RF:  An unusual allergy . Midwest Dentist 1966;;42( (April) ):20.
33 +
Wise MB, Guerin MR:  Chemical analysis of the major constituents in clove cigarette smoke , in Hoffmann D, Harris CC (eds): Banbury Report 23: Mechanisms of Tobacco Carcinogensis; Conference, September 5, 1985 . Cold Spring Harbor (NY) Laboratory, 1986;, pp 151-162.
34 +
Clark GC, Anderson A, Klawitter P, et al: Comparison of the Response of Rats Exposed to Equivalent Concentrations of Smoke From American or Kretek Cigarettes: Comparative Acute Toxicity , report FPA1/851513. Huntingdon (England) Research Centre, 1986;.
35 +
Clark GC, Anderson A, Klawitter P, et al: Comparison of the Response of Rats Exposed to Equivalent Concentrations of Smoke From American or Kretek Cigarettes: Comparative 14-Day Toxicity , report FPA 2/86238. Huntingdon (England) Research Centre, 1986;.
36 +
Robinson TN, Killen JD, Taylor CB, et al:  Perspectives on adolescent substance use: A defined population study . JAMA 1987;;258:2072-2076.
37 +
Hackett PH, Rodriguez G, Roach RC:  Clove cigarettes and high-altitude pulmonary edema . JAMA 1985;;253:3551-3552.
38 +
McLellan D:  Death sparks concern over clove cigarettes . Los Angeles Times , (Dec 4) , 1984;, pp V1-V2.

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