Abstract
Kreteks are tobacco cigarettes containing clove, imported into North America from Indonesia. Health effects, including severe pulmonary toxicity, are suspected to be associated with kretek use among adolescents and young adults. The most likely candidate for a specific toxic effect among the chemical constituents of kreteks is eugenol. Eugenol is a natural compound found in high concentrations in clove buds and is the active ingredient that distinguishes kreteks from conventional cigarettes. It is a potent and valuable topical anesthetic, as well as a pungent spice constituent. Until kretek use became a fad in North America in the early 1980s, the toxicity of eugenol by routes of exposure involving the respiratory tract had not been considered because human exposure had been predominantly oral and topical. Concern over the possible pulmonary toxicity of kretek smoke has stimulated studies on the smoke, eugenol itself, and other chemical constituents of kreteks. Two sets of studies are now available for review, one series conducted by La Voie et al. of the American Health Foundation and another conducted by Clark et al. of the Huntingdon Research Centre in the United Kingdom. Their methods and findings are very different. Common problems include low statistical power, methods of exposure that do not duplicate human exposure, and failure of the models to replicate the circumstances of the extant clinical reports, which suggest that aspiration, idiosyncratic or allergic reactions, or impaired host defense mechanisms may be involved. The available toxicologic studies must be considered preliminary. Contrary to the implied claims of an industry association, the inconsistency in findings and the generally negative results of most inhalation studies does not refute clinical evidence for human toxicity. Animal studies are an important resource in the evaluation of this and other products but are part of a much larger picture.
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References
Aviado DM, Salem H (1987) Respiratory and bronchomotor reflexes in toxicity studies. In: Salem H (ed) Inhalation toxicology. Marcel Dekker, New York, pp 135–151
Barkia M, Boyd JP, Cohen S (1984) Acute allergic reaction to eugenol. Oral Surg 57: 441–442
Clark GC (1986) Concerning the article “Toxicity studies on clove cigarette smoke and constituents of clove: Determination of the LD50 of eugenol by intratracheal instillation in rats and hamsters” by La Voie et al. (1986). Arch Toxicol 59: 296–297
Clark GC, Anderson A, Klawitter P, Chanter DO, Fish LE, Gopinath C, et al. (1986a) Comparison of the response of rats exposed to equivalent concentrations of smoke from American or kretek cigarettes: Comparative acute toxicity. Huntingdon UK, Huntingdon Research Centre, Report No. FPA 1/851513, 7 March 1986. Distributed by the Specialty Tobacco Council, 8066 North Point Blvd, Suite 204, Winston-Salem, NC 27106, USA
Clark GC, Anderson A, Klawitter P, Street AE, Chanter DO, Gopinath C (1986b) Comparison of the response of rats exposed to equivalent concentrations of smoke from American or kretek cigarettes: Comparative 14-day toxicity. Huntingdon, UK, Huntingdon Research Centre, Report No. FPA 2/86238, 4 June 1986. Distributed by the Specialty Tobacco Council, 8066 North Point Blvd, Suite 204, Winston-Salem, NC 27106, USA
Clark GC, Lewis DJ, Gopinath C (1986c) Eugenol acute inhalation toxicity in rats: 4-hour exposure. Huntingdon, UK, Huntingdon Research Centre, Report No. 3/86101, 18 April 1986. Distributed by the Specialty Tobacco Council, 8066 North Point Blvd, Suite 204, Winston-Salem, NC 27106, USA
Guidotti TL (1985) Oxidant gas injury to the lung: a discussion on the functional implications. J Appl Toxicol 5: 320–326
Guidotti TL, Binder S, Strattoh JW, Schechter FG, Jenkins RA (1987) Clove cigarettes: development of the fad and evidence for health effects. Curr Topics Pulm Pharmacol Toxicol 2: 1–23
Guidotti TL, Laing L, Prakash UBS (1989) Clove cigarettes: The basis for concern regarding health effects. West J Med (in press)
Henry CJ, Kouri RE (1987) Specialized test article administration: nose-only exposure and intratracheal inoculation. In Salem H (ed) Inhalation toxicology. Marcel Dekker, New York, pp 121–134
IARC Monographs (1985) Evaluation of the carcinogenic risk of chemicals to humans, Vol. 36. IARC, Lyon, 1985, pp 75–89
La Voie EJ, Adams JD, Reinhardt J, Rivenson A, Hoffman D (1986a) 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 59: 78–81
La Voie EJ, Adams JD, Reinhardt J, Rivenson A, Hoffman D (1986b) Comments on the toxicity of constituents in clove cigarette smoke. Arch Toxicol 59: 298–299
Morbidity and Mortality Weekly Report (1985) Illnesses possibly associated with smoking clove cigarettes. Vol. 34, pp 297–299
Phalen RF (1984) Inhalation studies: foundations and techniques. CRC Press, Boca Raton FL, pp 141, 218–236
Registry of Toxic Effects of Chemical Substances (1987) US National Institute for Occupational Safety and Health, DHHS (NIOSH) Pub. No. 84-101-8, Microfiche edition, Cincinnati
Sticht FD, Smith RM (1971) Eugenol: some pharmacologic observations. J Dent Res 50: 1531–1535
Vishteh A, Thomas I, Imamura T (1986) Eugenol modulation of the immune response. Immunopharmacology 12: 187–192
Wise MB, Guerin MR (1986) Chemical analysis of the major constituents in clove cigarette smoke, In Hoffman D, Harris CC (eds) Banbury Report No. 23. Mechanisms of tobacco carcinogenesis (Conference, 5 September 1985). Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, pp 151–162
Wu T-C, Tashkin DP, Djahed B, Rose JE (1988) Pulmonary hazards of smoking marijuana as compared to tobacco. N Engl J Med 318: 347–351
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Guidotti, T.L. Critique of available studies on the toxicology of kretek smoke and its constituents by routes of entry involving the respiratory tract. Arch Toxicol 63, 7–12 (1989). https://doi.org/10.1007/BF00334626
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DOI: https://doi.org/10.1007/BF00334626