Tobacco Documents Online

bacco among tobacco workers and noted: that because of ".. . the smalll proportiom of exposed individuals who develop such lesions, and the: tendency for it to clear completely when contact with tobacco is avoide& and to return on reexposure, an allergic cause in, certainn instances wouId appear to be highly probable:"' Recently, case re- ports have appeared identifying tobacco smoke and tobacco smoke, residue as causes of contact derrnatitis (6, 12, 72) . Harkavy's (28) early reports of a greater number of reactors to: tobacco extract among patients with thromboangiitis obliterans. (TA% than among, controls drew attention to the cardiovascular system as a possible "susceptible"'organ for allergic reactions (15).. Harkavy continues to be a strong, proponent of the role of tobaccoo allergy in a wide range of cardiovascular abnormalities, including, coronary artery disease (21, 22, 25, 27, 31, 32). This view ono tobacco allergy as one of'the etiological factors in coronary heart disease. (CHD) has not received much attention. Silivette, et aI. (64) reviewed reports(28„ 33, 66, 68, 73)~ on t'heprevalence: of skini sensitivity in patients with TAO as compared to controls and cited possible reasons for a higher prevalence of' posi- tive skin, tests to tobacco in these patients. In general",, th~eevidencerelating, TAO, to, tobacco allergy is incon- clusive. t SUMMARY 1. Tobacco leaf,, tobacco pollen, and tobacco smoke are antigenicc ini man and animals. 2. (a) Skin sensitizing antibodies specific for tobacco antigens have been found frequently in smokers and nonsmokers. They appear to occur more often in allergic individuals. Precipit'at'ing antibodies specific for tobacco antigens have also been found ini both smokers and nonsmokers. (b) A delayed t'ype of hypersensitivity: to tobacco has been demonstratedl in man.. (c) Tobacco may exert an adverse effect on protective mecha- nisms of the imrn.une system in man and animals: 3. (a) Tobacco smoke can contribute to the discomfort of many iind'ividuals:, Itexerts, corn~plexpharmacol'ogic, irritative, and allergic effects, the clinical manifestations of which may be indistinguishable from one another. (b) E'xposure t'o tobacco smoke may produce exacerbation of allergic symptoms in nonsmokers who are suffering from allergies of diverse causes. 4.Little is known about the pathogenesis of tobacco allergy and its possibie relationship to other smoking-related diseases. irr

ALLERGY REFERENCES' (1)~ ALLISON, R; D., ROTH, G. M. Central and peripheral vascular effects during, cigarette smokings Archives of Environmental Health 19'(2) :. 189-198, August 1969: (2) ARMEN, R. N., COHEN, S. The effect of' forced' inhalation of tobacco smoke on the elect'rocardiogram of' normal and tobacco-sensitized rab- bits. Diseases of the Chest 35(6) : 663-676, June 1959, (3) AUSTEN, K. F. Disorders due to hypersensitivity and alteredl immune response. IN: Wintrobe, M. M., Thorn, G: W., Adams, R. D.,, Bennett; I. L,„Jr., Braunwald„E., Isselbacher;,K. J!.,,Petzrsdbrf;,R. G: (Editors): Harrison?'s Principles of Internal Medicine. Sixth Edition. New York,McGraw-Hi1l Book Company, 1970. pl 342. (l`), BLUE, J:, A. Cigarette; asthma and tobacco allergy. Annals of Allergy 28 ( (3) 110-115 t lYla. r c h 1970. (S) BxUNi, A. Influenza delliavvelenamentoda fumo di tabacco sulla fago- citosi. (Effect, of tobacco smoke paisoning, on~ phagocytosis.) Speri mentale 85: 523-543, 1931. (6) CHANIAL, G., JOSEPH, J., CouIN„ L,, DuctAux, C. Les dermites chez les travailleurs du tabac (a propas de 9 observations). (Dermatitis in tobacco workers. Nine observations.) Bulletinide la Sbciete Franqaise de Dermatologie et de Syphiligraphie 77 (2) : 281-283, July 1970: (7) CHL, Y. M.,, PARLE'rr, R. C., WRIGHT, G. L.,, JR. A preliminary investi-, gation, of some immunologic aspects of tobacco use. American Review of' Respiratiory Disease 102(1) : 118-123, Jialy 1970. (8) COHEN, A. B., CLrNE, M. J. The human alveolar macrophage:~ Isolatibny cultivation in vitroj and studries of' morpholagic and functional char- acteristics. The Jaurnal' of Clinical Investigation 50(7) : 1390-1398, July 1971. (9) COLTOIU, A., MAITEESCU, D., LEBE, V. Consideratii priwind, sensibilizarea la tlatun: (~Cbnsideratians concerning sensitization tb tpbacco.) Viata Medicala 16 (1) :: 29-37, January 1969: (I1'0) COOMBS, R. R. A. The basic types of'allergic reactivity producing disease. Triangle 9 (2) : 43-46; 1969. (11) CoolvlBS,, R. R: A.,, GELL, P: G, H. Classification of allergic reactions re- sponsible for clinical hypersensitivity andl disease. Chapter 20. IN:: Gel14 P.G:H., Coombs, RI.R.A. (Editors). Clinical Aspects of Immu- nalogy: Second Edition. Philadelphia, F: A. Davis Company, 196&& pp. 575-596: (22))i CORMIA, F. E., DEGARA,; P. F. Vesiculobullbus dermatitis from tobacco smoke. Journal of the American Medical Association 193 (5) : 391-392', August 2, 1965. (1:7)' DECRINIS, K., REDLSCH, W., FONTANA, V., LEWIS, A.,, SULZBERGER; M. B., STEELEy J. M. Vascular responses to smoking tobacco compared with responses to skin testing of tobacco extracts. Annals of Internal. . Medicine 52 (5)', : 1'035-1041, May: 1960. ((14) DONZELLI, F. Influenza sulle agglutinine dell'avvelenamentlo~ da~ fumoo di, tabacco. (Effect of tobacco smoke poisoning on agglutinins.) Gior- nale di Batteriologia e Immunolbgja Tli: 1012-101$, 1933. (15) FERSTL, A. Die bedeutung der tabakrauchallergie bei erkrankungen des Gafasssystems. (~The importance of allergy tio tobacco in diseases of the vascular system:) Weiner Zeitschrift fur Innere IWtedizin und Ihre Grenzgebiete 43!: :455-458 , 1962. (i1s)~. FINKLEA, J. F., HASSELBLAD, V_RIGGAN, W. B., hlELsoN,,Rl. C~.,, HAM~- ntER„ D. I., I+TEwILL„ V. A. Cigarette smoking and, hemagg)utination 1' 112,

inhibition response to influenza after natural disease and immuniza- tion. American Review of Respiratory Disease,104 (3) : 368-376, Sep- t'ember 1971.. (17) FqNmANA, V'. J. Tobacco hypersensitivity. Annals of the New York. Academy of' Sciences 90(11)I: 138-141, September 27;, 1960. (18) FoNTANA, V.,J:, REnISCFI, W., NEMIR,, R., L., S1WIIITH, M. K., DECRINIS, K., SunzBERGER; M. B. Studies in tobacco hypersensitivity. III. Reac- tions to skin tests and peripheral vascular response& Journal of Allergy 30'(3) : 241-249, May-.Iiune 1959. (19), FRIEDLANDER, M., SILBERT, Si, LASKEY, N. Toe lesions following tabaccoo injections in rats. Proceedings of the Society for Experimental Biology andl Medicine 34:,156'-1157, 1936. (20) GREEN,, G. M:,, CAROLIN, D. The depressant effect of cigarette smoke on, the in vitro antibacterial activity of' alveolar macrophages. New England Journal of Medicine 276: 422-427, February 23„ 11967. (21') HARKAVY, J. Cardiac manifestations due to hypersensitivity. Annals of. Allergy 28(6) :~ 242-251, June 1970; (22) HARKAVY, J. Cardiovascular manifestatfions due to hypersensitivity: New York State Journal of Medicine 69(21)~:, 2757-2765~ November 1, 1969.. (23) HARKAVY,, J. Hypersensitiveness to tobacco and biopsy studies of skini reactions in vaseular disease. Journal of Allergy 9:475-488, 1938'.. (24) HARKAVY,, J. Tobacco allergy. Chapter 13. IN: Vascular Allergy: andl its Systemic Manifestations. Washington, Butterworths, 1963, pp. 101-11i6 i (25) HARKAVY, J. Tobacco allergy in cardiovasculam disease:~ A review. Annals of' Allergy 26:(8) : 447-4'59, August 11968. (126:) HARxnvY,, J!. Tobacco~ allergy in vascular diseases. Review of Allergy and Applied Immunology 11: 189-212, March 1957. (27') HARKAvy„ J. Tobacco sensitiveness in, angina pectoris and coronary artery disease: Proceedings'of the Society for Experimental Biology andl Medicine 30: 683-684, 1933'., (28) HARKAVY, JI. Tobacco sensitiveness. in tlhromboangiitis~ obliterans„ mi- gratiing, phlebitis and, coronary artery disease. Bulletin of the New York Academy of Medicine 9:~ 318-322, 1933. (29) HARKAVY, J. Tobaeeo sensitization in rats. Journal of Allergy, 9: 275- 277, 1938. (30) HARKAVY,, J'. Tobacco: skin reactions and their clinical significance. The Journal of Investigatiive Dermatology 2: 257-279, 1939.. (31) HARKAvY,, J., PERLMAN, E. Tobacco allergy in coronary artery disease. Annals of the New York Academy of' Sciences 90 (1) ~: 327-332; Sep- tember 27, 1960. (3'2) HARKAVY,, Jl, PERLMAN, E. Tobacco allergy in coronary artery disease. New York State Journal of Medicine 64(11) r, 1287-1296, June 1, 1964: (33) HARKAVx,, J., ROMANOFF,, A. Skin reactions to tobacco~ and other aller= gens in normal men and women smokers. Journal ofI Allergy 6: 62r 70, 1934'. (34), HARKAVY,, J., WiTEBSKr, E. Studies of' speeificity in multiple hyper- sensitiveness by quantitative titration and absorption of' reagins. Journal of Allergy 6: 437-447, 1935. (35) HARRIS, J. 0'.,, SweNSON, E. W.,, JoHNSON, JL E. III. Human alveolar macrophages: Compari'son of' phagocytic ability, glucose utilization, and ultrastructure in smokers and nonsmokers. The Jburnal of Clini- cal Investigation 49': 2086-2096„ 1970~: 11'3 4~ J W

(36) HEISKELL, C. L., MILLER, J. N., ALDRICH,,H. J., CARPENTER;, C, M. Smok- ing and serolbgic abnormalities. Journal of the American Medlcal. Association 151(,8) : 674-fi77„ August 25, 1962.(3'7) IsR2.zAKA, K. The identification and significance of Gamma E, Hospital Practice : 70-81, , September 1969. (98) KAMESWARAN, L., KANAKAIWIBAL,, K., VIJAYASEKARA'N, V. Studies onn plasma histaminase levels in normal and allergic individuals., Indian Journal of Physiology and PhaTmacolbgy 12(4): 159-165, October 1968. (39) KREIs, B, PELTIER, A., FOURNAUD, S., DUPI;N GIROD, S+ Reaction db precipitation entre certains serums humains et des extraits solubles dle tabac. (Precipitation reaetionI between certain human sera, andd soluble tobacco extracts.) Annales de Medecine Interne: 121(4) : 437- 440, April 1970. (40)~ LEwIS, D. M., LAPP, N. LER., BURRELL, R., Quantitation of' secretory i:mmunoglobulin A in chronic pulmonary disease. American Review of' Respiratory Disease 101(YI) : 5'5-61, January 1970. (1,1) LIMA, A. 0:,, RoCHA, G. Cutaneous reactions to tobacco:antigen in aller- gic and nonallergic childrem Annals af' Allergy 7(4) : 528'-531, July- August 1949. (42) LovNSBURY, J. B,,, OuGxTERSON,, A. W. Specificity of: tobacco antigen. Yale Journal of Biology andi Medicine 7(4) : 305-316, March 1935. (43) LOWELL, F. C. t?'.llergy: IN,: Wynder, E. (Editor)~. The Biologic Effects of l Tobacco. Boston, Little,, Brown,, and Company, 11955. pp. 1i51-170.. (44) 11IAURER, M. L,, SPAIN, W. C. The allergic response to tbbacco: Journal of! the American Geriatric Society 2: 278-283, 1954. (i1,5) MAXWELL, K. Vfd'.,, MARCUS; S., RENZETrI`, A. C!, Ja, Effect of tobacco smoke: on the phagocytic and cytopeptic activity af'guinea pig alveolar macrophages. American Review of Respiratory Disease 96'(1)1: 156, 1967: (4;6) MEYER, D„ H., CROSS, C. E., IBICaHI1aI, A. B:, MUSTAFA, M. G., Nicotine effects on alveolar macrophage respiration and adenosine triphos- phatase activity. Archives of Environmental Health, 22 (3) : 362-365, March 1971. (47) PAPA, C. Mi., SHELLEY, W~. B. Menthot hypersensitivity. Diagnostic basophil response in a, patient with chronic urticaria,, flushing, and hCadaches.. Journal of the Ameriean, Medical Association 189'(7) : 546-548; August 17, 1964. (48) PATTERSON, R. Skin-sensitizing antibodies. Advances in Internal Medi- cine 16 : 351-371, 1970.. (49) Pavr-IK, L, CERMAKOVA, Z. Casna kozni rea.kee na tabakovy: extrakt uu chorob dychadel. (Early skin reaction against tobacco extract in res- piratory system disease. ), Rozhledy v Tuberkulose av Nernocech Plienich124 (9')', : 629-635, 1964. (50)~ PESHKIN, M. M., LANDAY, L. H. CutaneousI reactions totobacco antigenn in allergic and nonallergic children with the:direct andI indirect (local passive transfer) methode of testing. Journal ofI Allergy10: 241-245, 1939. (51) PIPES,, D. M. Allergy to tobacco smoke. Annals of Allergy 28 (3)~ : 277- 282', July-August 1945. ( 52) POPESCU, I. G., PAUNs R~_M'oLNER, C., OLARU, C.,GHEORGxQU, T., IOTA, Cl G:, Contributii la studfnl aiergiei, la tatun. (Contributions to the study of'tobacco allergy:)i Revue Roumaine de Medecine Interna 1(5) : 427=436, 1964. 11i4

~al Eal ion an ier de IEs ,nd 17- pry lew ~er- Dcts'. ~70. inal' ltco qlar ~56, I I Eine kios- 365; >stic ~and' 7) kiedi- I kt u r'es+ ~cech tig¢n local -245, ,277- IOTA, ~ the (5)1: (53')' REDISCH, W: Tobacco allergy and vascular responses. IN: James, G., Rosenthal, T. (Editors),. Tobacco and Health. Springfield, C: C. Thomas,, 1962'. pp. 352--359: (54) RosErrs F. L. Studies in tobacco allergy. Journal of the Medical Society of New Jersey 51(3) : 109-114, March 1954. (55) 1 ROSEN, F. L., LEVY,,A. Btonchial asthma, due to allergy to tobacco:smoke in an, infant. A case report. Journal ofl the American Medical Asso- ciation 1144 (8) : ~ 620-621, October 21, 1950: (56) ROTH, G. M., ScHICx, R!. M. The effects of smoking, on the peripheral circulation. Diseases of the Chest 37 (2) : 203-210, February 1960. (57), ROYAL CULL'EGE OF PHYSICIANS. Smoking, and Health Now. Londbn,. Pitman Medical and Scientific Publishing Company, Ltd., 1971. 148 pp. (58) SAINDELLE,, A., RUFF, F., FLAVIAN, N.,, PARROT, J.-L~ Liberation d'his- tamine par des aldehydes a courte chaine: (Liberation of histamine by: short-chain aldehydes.) Cbmptes Rendus Hebdomadaires des Seances : de l''Academie des! Sciences Paris. Series D 266 ( 2)i : 139-1!41, January 8, 1968. (59) SAVEL, H. Clinical hypersensitivity to cigarette smoke.Archives of En- vironmental Health 2Y (2) : 146-148, August 1970. (60)1 SCHOEN, I., Piz'ERy M. Eosinophilia apparently related to cigarette smok- ing: New England Journal of'Medicine 270(25)1:, 1344-1347, June 18, 1964. (6Z ) SaEI:DON,, J. M., LovELL, R'. G., MATHEWS, K. P. (Editbrs). House dust and miscellaneous allergens. IN': A Manual of Clinical Allergy. Sec- ond Edition. Philadelphia, W. B, Saunders Co:, 1967. pp. 437-455.. (62) SHERMAN, W. B, (~Editor). Agents causing atopic diseases. IN: Hyper- sensitivity. Mechanisms and Management. Philadelphia, W. B:, Saun- d'ers Company, 1968; p. 130. (63) SHURE, Nl, HARRIS, M. C: Distribution of commonplace inhalant aller- gens: Chapter 4, IN: Harris, M., C, Shure, N:(Editors). Sensitivity. Chest Di'seases. Philadelphia, F. A. Davis Company, 1964. pp. 62-97:. (64) SIwETTE, H., LARSON, P. S., H!AAG; H. B. Immunological aspects of tobacco and smoking. Ameriean~ Journal of the Medical Sciences 234(5) :, 561-589, November 1957., (65) SPEER, F. Tobacco and the nonsmoker. A study of subjective symptoms. Archives of Environmental Health 16(3) : 443-446, March 1968. (66) SULZBER.GER; M'. B. Studies in tobacco hypersensitivity., I.. A comparison betlween reactions to nicotine and to denicotinized tobacco extract. Journal of Immunology 24(1) : 85-91, L933'. (67). SULZBEItGEx, M., B',,, FEIT, E. Studies in tobacco hypersensiti'vity. II. Thromboangiitis obliterans with positive urtScarial skin reactions and negative reagin findings. Journal of' Immunology 24'(5) : 425-432, 1933. (68)' TRASOFF, A., BLUMSTEIN, G., MARKS, M. The immunologic aspect of' tobacco in thromboangiitis obliterans and coronary artery disease. Journal of Allergy 7: 250-253, 1936. (69) U.S. PUBLIC HEAi.Tx SExvICE., Smoking and Health. Report of'the A& visory Committee to the Surgeon General of the Public Health Service. Washingtony U.S. Department of Health, Education, and Welfare, Public Health Service Publication No, 1103, 1964. 387 pp. (70): U.S! PUBLI'C' HEtuLTH SERVZCn. The Health Consequences, of' Sinoking:, A Report of the Surgeon General: 1971. Washington, U.S. Depart- ment ofI Health, Education, and Welfare, DHEW Publicationi No. (HSM) 71-7513, 1971. 458 pp. 115

(71) Vos•BsAT; C., RuMKE;, P: Inxmunoglobulim concentrations, PH!A reac- tions of lymphocytes in vitro, and certain antibody titers of healthy smokers. Jaarboek Karkeronderzoek Kankerbestruding 19: 49-53, 1969. (72) VfIEasY; P.E'., WOOD, B.T: Allergic contact dermatitis from tobacco smoke residues, Journal of the American Medical' Association 208(10): 1905-1906, June 9, 1969. (78) WESTCOTT; F. H., WRIGHT, I. S. Tobacco allergy and' thromboangiitiss obliterans. Journal of Allergy 9: 555-564, 1938. (74) YEAGER, H., Js, Alveolar cells: Depressant effect of cigarette,smoke on protein synthesis. IN: Proceedings of the Society for Experimental Biology and Medicine 131: 247-250, December 26, 1968., ('75) ZussMAxts B; K Atopic symptoms caused by tobacco hypersensitivity. Southern Medical Journal 61(11)1r 1175-1179, November 1968. (76) ZusSM'Arr; B; M. Tobacco sensitivity in the allergic patient. Annals of' Allergy 28(8) : 371-377; August 19701 116

CHAPTE 8 Publ ic Exposure to Air Pollut'io!n From Tobacco Smoke 4•

Contents The Extent to which the Components of Cigarette Smoke Contaminate the Atmosphere and are Absorbedl by the The Effects of Low Levels of Carbon Monoxide on Human Health .................................................. Allergic and Irritative Reactions to Cigarette Smoke Among Nonsmokers ....................................... The Known Harmful Effects of the Passive InMalation of ry Cigarette Smoke in Animals ........................... References .............................................. LIST OF TABLES Table! 1.-Percent of COHb during and following exposure to 50 p.p:m. of C0 .................................... Tab1e 2'.-Effects of carbon monoxide ................... . Page. 1211 125 128 129 130 131 124 127 . 1,19

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PUBLIC EXPOSURE TO AIR' POLLUTION FROlVI. TOBACCO SMOKE. The purpose of this chapter is to summarize the present state of evidonce concerning the effects of exposure to an atmosphere con- taining either tobacco smoke or its constituents. Since the identifi- cation of cigarette smoking as a, serious health hazamd to1 the smoker was based on clinical and epidemioIogiical' observations that non- smokers have much Iower mortality and morbidity rates from a number of' conditions, it is obvious that cigarette smoking is nor- rna11y! a greater hazard to the smoker than is the typical levei of ex- posure to air pollutant's produced by the smoking,of cigarettes which many nonsmokers experience. This would be consistent with~ the voluminous data which show a dose-response relationship between the Ievel of exposure to smoke and the magnitude of its effect. The researchi so far reported on the nature and effects of exposure to smoke-pollutants in the atmosphere has not been as extensi've and well~controlled' as that done on, the health effects of smoking on, the smoker himself. Knowledge on this subject can be separated into four major areas of concern : T. The extent to which the components of cigarette smoke con- taminate the atmosphere and are absorbed by the nonsmoker., 2. Tlie effects of low levels of carbon monoxide on human health~. 3. AlIergic,, adverse, and irritative reactions to: cigarette smoke among nonsmokers. 4. The known harmful effects of the passive inhalation of ciga- rette smoke in animals. THE EXTENT TO' WHICH THE COlbIPO'NENTS OF CIGARETTE SMOKE CONTAMINATE THE ATMO'SPHERE. AND ARE ABSORBED BY THEI NONSMOiKER. Theoreticall modolg of this contamination have been constructed~. Owens and Rossano (44) have noted that most popular cigarettes release into t'he' atmosphere.approximat'ely 70 rngf of dry particulate matter (about 60 mg, in the sidestream and slightly over 20 mg. in the mainstream, about one-half of the latter being absorbed by the smoker and one-half expelled' into the ambient air) and 28 rng. car-