Shift of HIV tropism in stem-cell transplantation with CCR5 Delta32 mutation.

To the Editor: Bassett et al. (June 5 issue)1 describe a case of a child who was poisoned by e-cigarette refill liquid. In California, we have also seen a dramatic increase in telephone calls to poison control centers because of exposures to nicotine solution; there were 35 total cases of exposure in the period from 2010 through 20122 and 105 cases in 2013 alone. In 2013, exposure to nicotine refill solution was involved in 18% of all cases. Reported exposure to this solution in 10 children resulted in hospital evaluation in 7 and mild nicotine poisoning in 3. Children were not the only victims; 4 adults mistakenly instilled nicotine refill solution into their eyes instead of eyedrops, resulting in considerable but transient irritation in each case. In addition, systemic symptoms of nicotine poisoning developed in 3 adults after they spilled nicotine refill solution on their skin. There is currently no federal legislation with respect to labeling or packaging of nicotine refill solution. Given the high toxicity of nicotine and the widespread availability of nicotine refill solution, perhaps these products should fall under the umbrella of the Poison Prevention Packaging Act and thus be sold in child-resistant packaging. F. Lee Cantrell, Pharm.D. Richard F. Clark, M.D.