We thank Stangl and Voigt for reminding us of the indoor carbon monoxide concentrations in shisha bars, which are potentially hazardous to health.
It is our view too that the risk potential is substantial, especially for the staff working in such establishments. The symptoms of chronic carbon monoxide poisoning include neurological (polyneuropathy), psychiatric (depression), and gastrointestinal (diarrhea) symptoms (2, 3); the indoor threshold of carbon monoxide concentration that would cause such symptoms is not known and depends on diverse comorbidities and factors of influence.
Because of the known risk potential of carbon monoxide, and the fact that measuring concentrations is fairly simple when using CO alarms, we support the call for further systematic studies and would make a plea for the compulsory fitting of suitable carbon monoxide alarms in shisha bars.
Footnotes
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
References
- 1.von Rappard J, Schönenberger M, Bärlocher L. Case report: Carbon monoxide poisoning following use of a water pipe/hookah. Dtsch Arztebl Int 2014. 111:674–679. doi: 10.3238/arztebl.2014.0674. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Pepe G, Castelli M, Nazerian P, Vanni S, Panta MD, Gambassi F, Grifoni S. Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department A retrospective study. Scandinavian Scand J Trauma Resusc Emerg Med. 2011;19 doi: 10.1186/1757-7241-19-16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med. 2009;360:1217–1225. doi: 10.1056/NEJMcp0808891. [DOI] [PubMed] [Google Scholar]
