The "cinnamon challenge" -- a party trick among youths who accept a dare to swallow a spoonful of ground cinnamon -- has led to a surge in calls to poison control centers with reports of spice-induced choking and aspiration, according to a new report.
Calls to the American Association of Poison Control Centers (AAPCC) related to cinnamon increased from 51 in 2011 to 178 calls in the first 6 months of 2012, wrote Steven Lipshultz, MD, of University of Miami's Leonard M. Miller School of Medicine in Florida, and colleagues, online in a Perspective in Pediatrics.
Of the 178 calls, 122 (69%) were classified as intentional misuse or abuse "consistent with the cinnamon challenge," the authors wrote, and about (17%) required medical attention.
The challenge requires a person to swallow a tablespoon of the dry, ground spice in 60 seconds without drinking fluids.
The authors pointed to 51,000 YouTube video clips -- one viewed 19 million times -- as of August 2012 that showed adolescents watching someone coughing and choking as the cinnamon triggers a severe gag reflex. They said the popularity of the Internet coupled with peer pressure instigated too many cinnamon challenges.
According to the Florida Poison Information Center–Miami, there were 26 calls regarding cinnamon exposure between July 2011 and June 2012 and 13 cases, all youths ages 8 to 18, involved the cinnamon challenge. Symptoms included coughing and burning of the mouth, nose, and throat, severe coughing, vomiting, nosebleed, and chest tightness.
"Possible aspiration and pulmonary symptoms were limited to adolescents, all of whom had ingested dry powder from the cinnamon challenge. Although the known health risks of the challenge are relatively low, they are unnecessary and avoidable," the authors wrote.
Finally, they cited in Akron, Ohio, where the patient required hospitalization and ventilator support for collapsed lungs.
"Cinnamon is a caustic powder composed of cellulose fibers, which are bioresistant and biopersistent; they neither dissolve nor biodegrade in the lungs," Lipshultz and colleagues explained.
While most of the adverse effects of the challenge have been temporary, inhaling cinnamon can cause pulmonary inflammation and predispose airways to epithelial lesions and scarring, the authors wrote. Aspirated powder in the upper airways can lead to aspiration pneumonia, they added.
For those with cinnamon allergies or with broncho-pulmonary diseases, including asthma, the challenge may be of greater threat, they wrote.
"I think the cinnamon challenge is something that has been around for some time; however, I don't think we've really appreciated what the potential medical implications may be," commented Kent Pinkerton, PhD, director of the University of California Davis Center for Health and the Environment.
Based on the current reports, most patients required little more than dilution, irrigation, and washing the affected area, with no follow-up, the authors said. In some cases that required follow-up, symptoms resolved in 1 to 2.5 hours.
Lipshultz's group said they found no studies of the effects of cinnamon inhalation in humans, but cited results from animal studies.
In one study, mild multifocal granulomatous inflammation was observed 2 to 30 days after cinnamon exposure in rats. Granulomata, interstitial fibrosis, alveolar histiocytosis, alveolar lipoproteinosis, and alveolar cell hyperplasia occurred 3 to 6 months later. Granuloma and thickened interalveolar septa with worsened inflammation and fibrotic lesions were apparent 1 year later.
In a second study, rats receiving single intratracheal doses of 15 mg (7 mm particle size) of cinnamon dust and cellulose dust showed damaged lung elasticity and alveobronchiolitis at days 1 and 7, and fibrotic changes at 1 month.
"Thus, cellulose is not inert and is in fact the component of cinnamon responsible for inducing pulmonary fibrosis," the authors stated.
While Pinkerton pointed out the limitations of results from animal studies, the authors acknowledged that they could not make a "strong statement" on documented pulmonary sequelae in humans. But they stated that it was reasonable to say that the cinnamon challenge has a high likelihood of damaging the lungs.
"Given the allure of social media, peer pressure, and a trendy new fad, pediatricians and parents have a 'challenge' of their own in counseling tweens and teens regarding the sensibilities of the choices they make and the potential health risks of this dare," they concluded.
Disclosures
The authors reported no conflicts of interest.
Primary Source
Pediatrics
Source Reference: Lipshultz, S, et al "Ingesting and aspirating dry cinnamon by children and adolescents: the 'cinnamon challenge'" Pediatrics 2013; DOI: 10.1542/peds.2012-3418.