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Jason Boyce

Jason’s report that highly diluted nebulized hydrogen peroxide rapidly improved his health sparked concerns.

A recent blog featuring Jason’s near recovery from a 16-year bout of ME/CFS reported that nebulized hydrogen peroxide (2%) was one of two treatments that he credited with playing the greatest role in his improvement. Within a week of nebulizing 2-3% food-grade hydrogen peroxide, Jason reported he was feeling 80% better.

Decades earlier – after nothing had worked – an alternative health M.D. tried intravenous hydrogen peroxide on me. It failed, like everything else, to effect any change – positive or negative. That was the extent of my experience with hydrogen peroxide therapy.

Jason’s Eclectic Mix of Treatments Returns Him to Near Normal Health After 16 Years with ME/CFS

I didn’t realize, though, what a hornet’s nest I was stepping into with Jason’s report and how controversial the treatment had recently become. A 2021 warning by the Asthma and Allergy Foundation of America about the dangers of using hydrogen peroxide in any form had pervaded the media. I was accused – not surprisingly – of promoting a dangerous treatment without much forethought.

This blog is an attempt to rectify that situation. I dug into what I could find on the use of nebulized hydrogen peroxide to treat infections and other illnesses.

The Study

Our cells use hydrogen peroxide to kill pathogens but highly concentrated forms of it can be dangerous when used improperly.

The controversy may have had its genesis in a July 2021 case series, “Hydrogen Peroxide as an Adjuvant Therapy for COVID-19: A Case Series of Patients and Caregivers in the Mexico City Metropolitan Area“, published in the Evidence-Based Complementary and Alternative Medicine journal.

Citing the prevalence of COVID-19, and the need for “easily and cheaply obtained” over-the-counter alternatives in Mexico, the authors noted that hydrogen peroxide (H202) therapy had been first used over a hundred years ago and that exactly a hundred years ago, a Lancet article described how intravenous hydrogen peroxide had cut mortality in half in a set of soldiers during the Spanish Flu pandemic.

The paper reported that nebulized hydrogen peroxide (0.2%) or H2O2, taken by mouth (PO, at a concentration of 0.06%) or oral rinse (mouthwash, 1.5%) was taken by 23 patients over 16 days. The participants were given instructions on how to prepare the hydrogen peroxide:

“Given the risk of misuse because of the oxidizing corrosive nature of the concentrated H2O2 solution, precise instructions on preparing the dilutions were given both verbally and in writing (described in Table 1).”

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Hydrogen Peroxide Instructions

Instructions for the use of hydrogen peroxide in the Mexican study.

The authors reported that “Most of our patients reported immediate relief of respiratory symptoms and documented improved oxygenation as measured by their pulse oximeter with the nebulization. In addition to the reduction in the duration (compared to clinical progress and outcomes for Mexican patients), we observed a possible reduction in the severity of the disease and a perceived reduction in symptoms by most patients.” They concluded that the application was safe in the group of patients tested (none of which had asthma).

Note that there was no control group and that it was possible that the coronavirus infection resolved itself naturally.

The authors reported that “many positive effects on the immune response have been described” and asserted that “hydrogen peroxide is a simple, well-studied, and useful molecule for a range of medical and sanitary applications”, and that “an abundance of scientific knowledge” exists, including “sufficient documentation” for its use as a therapeutic modality.

Noting that the body produces its own H202 and that H2O2 decomposes into water (H2O) and oxygen (O−), the authors asserted that “in appropriate doses, it is relatively safe for animal and human uses, as well as relatively nontoxic.”

The Farr Paper

Dr. Charles Farr – the “father of oxidative medicine” – advocated for the use of intravenous hydrogen peroxide in the mid-1980s.

The authors’ documentation, however, was slim, relying mostly on a few older studies, several of which focused on using hydrogen peroxide as a mouthwash. One of the works cited was a self-published 1986 work, “The Therapeutic Use of Intravenous Hydrogen Peroxide“, by Dr. Charles Farr, MD., Ph.D., known as “the father of oxidative medicine”.

Farr claimed that he had given over 500 IV infusions of H202 (0.15%) without harmful effect and noted that immune cells called granulocytes produce H2O2 “as a first line of defense against bacteria, yeast, virus, parasites, and most fungi”. He reported that the infusions had produced “rapid improvements” in people with infections, allergies, flu syndromes, “and other toxic phenomena”. He ended the paper by stating that:

“We feel the evidence presented should stimulate a new appreciation in the study of the potential therapeutic application of bio-oxidative mechanisms.”

In 1993, he produced a paper, “The Protocol for the Intravenous Administration of Hydrogen Peroxide”. Farr’s report appears to have triggered new interest in hydrogen peroxide therapy in some corners of the alternative health world but did not trigger the kind of rigorous study he was apparently looking for.

By 1996, enough people were apparently drinking high strength hydrogen peroxide – something Farr warned against – for the FDA to publish a warning in 1996 “not to purchase or use high-strength hydrogen peroxide products for medicinal purposes, including a product marketed as “35 Percent Food Grade Hydrogen Peroxide.”

A 2007 rejoinder to Farr’s work, “Charles H. Farr and the purported scientific and medical rationale for intravenous hydrogen peroxide“, noted the very thin scientific citation record for hydrogen peroxide use and concluded, “There is no growing body of support from basic science, animal models or human studies. Specifically, there would need to be systemic animal studies showing real promise, followed by phase I, II and III human trials.”

While many studies exist on the pros and cons of hydrogen peroxide as an antiseptic agent, very few have explored the use of low concentrations of H202 in IVs or in nebulized form.

Most published admonitions against the use of H202 that I found use case reports of damage from high concentrations of H202 to argue against any applications of it. A 2009 paper, “Oxygen Therapies”, for instance, used several reports of death or injury from the ingestion or IV use of 30-40% hydrogen peroxide to conclude that “0xygen therapies are expensive, unproven, and harmful”.

The Asthma and Allergy Foundation of America Message

AAFA Hydrogen Peroxide

The Asthma and Allergy Foundation of America issued a blunt warning about using hydrogen peroxide in a nebulizer.

More recently, in September 2021, the Asthma and Allergy Foundation of America responded to what it called a “concerning and dangerous trend” on social media platforms … regarding people using nebulized hydrogen peroxide to fight COVID-19.

Its message was brief and succinct and allowed no gray areas. “Nebulized hydrogen peroxide in any form is dangerous, was the message.

“DANGER! Don’t Nebulize Hydrogen Peroxide and Breathe It to Try to Treat or Prevent COVID-19”

“Hydrogen peroxide can be used as a cleaner and stain remover, and can cause tissue damage if you swallow it or breathe it.”

It reported that, according to the Agency for Toxic Substances and Disease Registry:

“Hydrogen peroxide can be toxic if ingested, inhaled, or by contact with the skin or eyes. Inhalation of household strength hydrogen peroxide (3%) can cause respiratory irritation. Exposure to household strength hydrogen. peroxide can cause mild ocular irritation. Inhalation of vapors from concentrated (higher than 10%) solutions may result in severe pulmonary irritation.”

The warning ended by stating:

“Only use asthma medicine prescribed by your doctor in your nebulizer. Other chemicals can be harmful to your lungs.”

The Gist

  • Jason reported that nebulized hydrogen peroxide returned him to 80% of health within a couple of weeks. Questions came up, though, regarding its safety – hence this blog. 
  • A small Mexican study suggested that nebulizing or ingesting highly diluted hydrogen peroxide might be a cheap and effective way of treating COVID-19. The study reported rapid relief of respiratory and other symptoms with minimal side effects but lacked a control group and it was possible that the patients might have recovered naturally.
  • After doctors and patients on social media outlets promoted the use of nebulized hydrogen peroxide, the Allergy and Asthma Foundation of America issued a stern warning about using hydrogen peroxide in any form in a nebulizer. 
  • The warning was picked up by numerous media outlets and amplified. The message was clear: using hydrogen peroxide in any concentration was dangerous. 
  • Media reports regarding the dangers of hydrogen peroxide use exploded. They and the doctors they quoted, however, often didn’t differentiate between the clearly dangerous high concentrations of H202 found and concentrations that are 10x or more lower than some alternative health practitioners assert are safe.
  • Given that highly diluted H202 therapy has been used by at least some alternative health practitioners for decades, one would have thought that reports of damage would be easy to find but the opposite was true. Two reports from poison control centers produced little evidence of harms from low concentrations of hydrogen peroxide. Little other evidence was found. 
  • On the other hand, the evidence for the efficacy and safety of low concentrations of nebulized H202 is almost entirely anecdotal. No animal studies or phase I, II, or III clinical trials and only one study were found. Highly diluted hydrogen peroxide has been almost totally ignored as a possible research subject.
  • The evidence regarding the efficacy and safety of using diluted hydrogen peroxide to combat infections comes entirely from doctor and patient reports. 
  • It’s not clear how widespread the use nebulized hydrogen peroxide is. While it’s clearly used in many alternative health centers, I couldn’t find evidence of any ME/CFS/FM experts recommending it.

Media Reports

That put H202 therapy on the map big time. The warning was immediately picked up by dozens of media outlets. Most media reports warning about the use of hydrogen peroxide noted the dangers of using industrial-strength hydrogen peroxide – which was not being advocated – making the subject confusing.

Others simply didn’t address the concentration issue. Forbes, for interest, ridiculed people who’d tried hydrogen peroxide therapy stating that:

“Don’t hit your head repeatedly with a trash can lid. Don’t eat spaghetti and hot dogs that you randomly find splattered on the sidewalk. And don’t inhale hydrogen peroxide to try to prevent or treat Covid-19. These three things should be obvious. Nevertheless, the Asthma and Allergy Foundation of America (AAFA) has had to issue a warning about one of them. Take a wild guess as to which one.”

Healthline blankly stated, “Inhaling Hydrogen Peroxide Will Hurt Your Lungs and Won’t Prevent COVID-19“. The expert it cited, Dr. Len Horovitz, stated, “There is ‘never’ a good reason to inhale hydrogen peroxide. It concluded that, “Experts say that hydrogen peroxide should never be inhaled or ingested, as the health consequences could be severe.”

Dr. Gregory Schrank, infectious disease specialist at the University of Maryland School of Medicine, told USA Today. “The concern for using it in a nebulized form is severe irritation to the airways with a lot of additional inflammation,” but never addressed the concentration question. (Ironically, the Mexican study reported that low-dose hydrogen peroxide provided relief from respiratory conditions.)

Dr. Mercola – who advocates the use of nebulized hydrogen peroxide and has produced videos promoting it – responded to an article in the Washington Post, stating:

 “The solution you are referring to is primarily saline, with highly diluted hydrogen peroxide. It is important to ensure that people use saline to dilute the hydrogen peroxide to .1%; 30X lower concentration than standard peroxide found at the local pharmacy. High concentrations of hydrogen peroxide should not be used.”

In response to Mercola’s comment, Melanie Carver from the Allergy and Asthma Foundation of America side-stepped Mercola’s claim about the safety and efficacy of low-dose hydrogen peroxide, and instead focused on the possibility that some people might be using higher concentrations:

“There are different concentrations available for purchase, and people may be using dangerous concentrations of hydrogen peroxide in an attempt to protect themselves from COVID-19,”

Harms Caused by the Use of Low Concentrations of Hydrogen Peroxide

It was hard to find reports of injury due to the use of low-dose (1-3%) hydrogen peroxide in its nebulized form. (Several case reports cite the dangers of hydrogen peroxide enemas.) One case report concluded that a 50-year-old woman with a history of asthma had brought on lung difficulties through her 5-year use of nebulized hydrogen. It noted that she had recently increased her use of the nebulizer.

The report noted that “hydrogen peroxide use as an alternative and complimentary form of medicine is advocated for use in multiple disease processes including COPD, asthma, pneumonia, and bronchitis” but were aware of only one case report of interstitial lung disease that was associated with it.

One of the few actual studies involved a 1994 3-year review of hydrogen peroxide exposures at a regional poison center which found that most of the 325 exposures (which made up less than .4% of all exposures) “resulted in a benign outcome (no effect or minor effect)”. A statistically insignificant trend (p<0.11) toward more severe outcomes was found in people ingesting a concentration greater than 10% – which is 3-10x’s the concentrations used in alternative health practices.

Similarly, a much-cited 2004 Toxicology Review, “Hydrogen Peroxide poisoning“, pointed out the potentially dire effects (stroke) of taking in concentrated hydrogen peroxide (35%) and noted that “highly concentrated solutions… can cause severe irritation and inflammation of mucous membranes, with coughing and dyspnoea (shortness of breath) but was mostly silent on the effects of much smaller doses stating that “most inhalational exposures cause little more than coughing and transient dyspnoea (shortness of breath).”

While it didn’t state what it considered “diluted” Medical News Today at least contrasted the effects of ingesting concentrated hydrogen peroxide (severe stomach upset, tissue burns, in rare cases embolism) to ingesting diluted forms (mild gut irritation, throat irritation, vomiting). It still treated all nebulized treatments the same stating that they could lead to nose, throat, and lung irritation and pulmonary edema.

While ample evidence shows that higher dose hydrogen peroxide (30-40%) is quite toxic, I could find little evidence of harms produced by highly diluted H202. A 1994 poison control center study, for instance, found a statistically insignificant trend towards harm in exposure to doses greater than 10% – 3x higher than the maximum dose recommended. Two years later, a review of 670 exposures to 3% hydrogen peroxide over a three-year period at a different poison control center found that most exposures involved children, that 86% of the exposures did not produce symptoms, and all except one exposure – to a small child, were benign. (The small child developed bloody bowels and gastric ulcers).

In conclusion, evidence of damage done by the use of highly diluted forms of hydrogen peroxide was hard to come by.

Use in the Alternative Health Field

It’s not clear how often nebulized hydrogen peroxide is used by alternative health practitioners. I didn’t find any reference to it by prominent ME/CFS/FM practitioners such as Dr. Teitelbaum, Dr. Holtorf, Dr. Murphree or Dr. Nathan. Jon Kaiser – one of the few alternative health M.D.’s to do clinical trials in ME/CFS – prescribes it.

A search of nebulized hydrogen peroxide therapy brought up a variety of alternative health clinics in the U.S. that use it including the Riordan Clinic, Dr. David Brownstein, East Valley Naturopathic, the Integrative Medicine Center of Western Colorado, RegenIV Wellness, Dr. Sean Ceaser, Auburn Naturopathic Medicine, KOIWellBeing, Innovative Medicine, BrioMedical, and others. It’s clearly used regularly in quite a few practices.

Thomas E. Levy, MD, JD is one of the more vocal proponents of using diluted hydrogen peroxide. In a Townshend Letter article, “Curing Viruses with Hydrogen Peroxide – Can a Simple Therapy Stop the Pandemic?“, Levy called H202 a “straightforward and quite elegant way to augment the body’s natural expression of HP to combat infection and inflammation” and goes so far as to say that, “The search for an effective, nontoxic, available, and inexpensive respiratory virus therapy could end with HP.”

At the low doses used, he asserts that “the only ‘toxic’ effects of inhaled HP consist of minor degrees of nasal and throat irritation that rapidly resolve upon termination of the nebulization.” People who experience irritation at 3% H202 can easily drop the concentration further.

Levy recommended (a runny nose or slightly sore throat) 5 to 15-minute nebulization sessions be undertaken several times daily or until symptomatic relief is realized for mild colds. He reported that many individuals report significant improvement only a few hours after the first one or two treatments.

Conclusion

Help or harm? Hydrogen peroxide

Despite the warnings little evidence of harm caused by nebulizing highly diluted hydrogen peroxide was found. On the other hand, the evidence for its efficacy and safety is almost all anecdotal as well.

Jason reported that nebulized hydrogen peroxide returned him to 80% of health within a couple of weeks. Questions came up, though, regarding its safety.

Not long after a small Mexican study suggested that nebulizing or ingesting highly diluted hydrogen peroxide might be a cheap and effective way of treating COVID-19 the Allergy and Asthma Foundation of America issued a stern warning about using hydrogen peroxide in any form in a nebulizer.

Media reports regarding the dangers of hydrogen peroxide use exploded. They and the doctors they quoted, however, often didn’t differentiate between the clearly dangerous high concentrations of H202 found and concentrations that are 10x’s or more lower that some alternative health practitioners state are safe.

Given that H202 therapy has been used by at least some alternative health practitioners for decades, one would have thought that reports of damage would be easy to find but the opposite was true. Two reports from poison control centers produced little evidence of harms from low concentrations of hydrogen peroxide.

On the other hand, the evidence for low concentrations of nebulized H202 is almost entirely anecdotal. No animal studies or phase I, II, or III clinical trials and only one study were found. Highly diluted hydrogen peroxide has been almost totally ignored as a possible research subject.

It’s not clear how widespread the use nebulized hydrogen peroxide is. While alternative health centers that use it can pretty readily be found, I couldn’t find evidence of any ME/CFS/FM experts recommending it.

Aside for some doctors and patient reports that it’s helpful with infections and causes only mild irritation at best, we lack any other evidentiary basis regarding optimal dosing, duration, effectiveness, and safety.

 

 

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