Coltsfoot as a Potential Cause of Deep Vein Thrombosis and Pulmonary Embolism in a Patient also Consuming Kava and Blue Vervain

How Do Herbal Cigarettes Compare To Tobacco? A Comprehensive Review of Their Sensory Characters, Phytochemicals, and Functional Properties

Herbal cigarettes, known as tobacco-free or nicotine-free cigarettes, are those recognized as being-tobacco free, being composed of a mixture of various herbs claimed to lessen the smoking habit hazards. However, controversial data regarding its properties occur in the literature with no comprehensive overview or analysis of its effects. Like herbal smokeless tobacco, they are often used to substitute for tobacco products (primarily cigarettes) regarded as a "nonsmoking" aid. This review capitalizes on herbal cigarettes with regard to their quality characteristics, sensory attributes, chemical composition, and health properties to rationalize their choice as a nonsmoking aid. Furthermore, the impacts of heat and/or pyrolysis that occur during smoking on its chemical composition are presented for the first time. Some herbal smokes may produce notable metabolic problems that increase the risk of several chronic metabolic diseases. In general, burning substances from plants can have a variety of negative effects on the body attributed to toxic chemicals such as carbon monoxide, polyaromatics, nicotine, and N-nitrosamines. This review compiles and discusses the phytochemical compositions detected in various herbal cigarettes alongside sensory and quality attributes and health effects.

A systematic review and quality assessment of case reports of adverse events for borage (Borago officinalis), coltsfoot (Tussilago farfara) and comfrey (Symphytum officinale)

Symphytum officinale (comfrey), Tussilago farfara (coltsfoot) and Borago officinalis (borage) have long histories of therapeutic use, but their safety has been questioned due to the presence of unsaturated pyrrolizidine alkaloids (PAs). The evidence base underlying these concerns relies in part on case reports. This systematic review assesses these case reports for their reliability to inform this debate.

METHOD

Study selection was restricted to case reports describing possible pyrrolizidine alkaloid related harm and ingestion of comfrey, coltsfoot or borage. An extensive search of academic databases was conducted. Papers meeting the criteria were critically appraised.

RESULTS

The search resulted in 11 appropriate case reports, none of which involved borage. Nine reports were assessed for causality and indicated some degree of association between the material ingested and the adverse event. Lack of unequivocal identification of the species ingested compromised attribution and was a significant source of uncertainty. Three levels of identity confusions were found; misidentification or substitution at the level of the whole herb; omission of appropriate botanical identification and attribution of a specific PA to either comfrey or coltsfoot when it is a constituent found in other plants of established toxicity.

CONCLUSION

These cases are an unreliable body of evidence on which to draw conclusions about the safety of the oral consumption of Symphytum officinale and Tussilago farfara. Toxicological studies based on oral ingestion of phytochemically-complex preparations of these herbs may be the most accurate methodology for assessing clinical risk.