Cigarettes with ultralow nicotine levels are now being called the game-changer in the fight against smoking. If you are having trouble in quitting smoking, then, it is for you, that soon the Biden White House is expected to formally propose a plan that will order cigarette nicotine levels to be reduced, reports The Washington Post. For now though, it has been a failure, as these cigarettes, also known as VLN cigarettes that stands for very low nicotine are only available in 5,100 stores in 26 states. This is a very small fraction of the overall market for cigarettes. The company that makes it, 22nd Century, is struggling not because of the low supply, but also from the advocates who have long believed slashing nicotine levels altogether.

The Advent and ideation

Nicotine is a chemical that is produced naturally from tobacco that makes the cigarette and also keeps people hooked. While it is believed that it makes people alert, and get the "hit" to keep them going, it exposes the users to harmful substances, carcinogens, and increases the risk of heart disease, lung cancer, and other illness.

Ultralow-nicotine cigarettes, like the VLN brand, contain about 95% less nicotine than the regular cigarettes. The idea is quite simple: without the addictive grip of nicotine, smokers will find it easier to quit. Research too has shown some promise. For instance, the studies funded by the National Institute on Drug Abuse revealed that very low nicotine cigarettes reduced addiction potential significantly without having users to increase their smoking frequency. However, the problem is, why would anyone choose for a low-nicotine that does not make them feel the same way, when the high-nicotine cigarette is right next to it, making them feel the same way, with the same alertness, sold at the same price.

“It’s very hard to imagine someone actively choosing to continue to use a low-nicotine product for the same price when a high-nicotine product is right next to it,” said Eric Donny, a Wake Forest University School of Medicine nicotine researcher.

No wonder, the experiment with low nicotine product by Philip Morris' Next cigarettes in the 1980s and Vector Tobacco's Quest brand in the early 2000s, flopped.

FDA's Role in the Push

The Food and Drug Administration (FDA) has supported the development of such products, even allowing VLN cigarettes to be marketed as lower-risk options. However, these products remain a niche market, available in only a fraction of U.S. stores.

Recently, the Biden administration has considered a bold step—mandating a dramatic reduction in nicotine levels for all cigarettes sold in the United States. Supporters believe this move could save millions of lives, while critics, including tobacco companies, warn of potential unintended consequences.

What Could Be The Challenges?

Resistance from Big Tobacco Companies: They could argue that slashing nicotine levels could backfire. Their claim is, smokers will turn to black markets or smoke more to satisfy their cravings, which may lead to greater exposure to harmful substances.

Consumer Reluctance: History is proof to the instances of smokers being hesitant to embrace the low-nicotine products.

Political Hurdle: It may face political roadblocks, as under the Trump administration, plans to cut nicotine were shelved.

Could Low-Nicotine Cigarettes Be The Solution?

Advocates believe that ultralow-nicotine cigarettes could be a game-changer, comparing them to decaf coffee or non-alcoholic beer—products that reduce harm while offering a similar experience.

Some experts warn that a black market for traditional cigarettes could undermine these efforts. They also stress the need for safer alternatives, such as vaping products, to support smokers transitioning away from traditional cigarettes.

Days after the death of Darya Shipilova, a 28-year-old laboratory technician in Irkutsk's Anti-Plague Research Institute, sparked global headlines about a possible pneumonic plague outbreak, reports of a suspected second case instilled concern in global health bodies and citizens.

Russia responded to the reports of the second plague case in Siberia, while the World Health Organization (WHO) says it still lacks enough information to determine what caused the death of the laboratory worker.

Initial reports suggested she could have contracted pneumonic plague following a possible laboratory exposure, although Russian authorities have not confirmed that diagnosis.

Russia Denies Second Plague Case

Also read: Second Plague Death Reported As Russia Denies Outbreak

Local media reported the second death after Baikalsk authorities issued a Telegram warning on October 3 about “unofficial information” of a confirmed plague case in Shelekhov, The Daily Mail reported.

“Due to unofficial information about a confirmed case of plague in a person in the city of Shelekhov, we ask you to limit visits to Shelekhov and nearby settlements until the circumstances surrounding this threat are clarified,” the administration said.

The post was deleted about two hours later, according to local media Lyudi Baikala. There is no official confirmation that the person had plague or died from Yersinia pestis.

Russia's public health watchdog, Rospotrebnadzor, however, has maintained that Shipilova died from pneumonia of unknown or undetermined origin, rather than plague.

The agency said nearly 5,000 laboratory tests conducted among people connected to the incident had found no dangerous pathogens. More than 90% of the people who were placed under medical observation had completed monitoring.

Rospotrebnadzor also said Shipilova had been vaccinated and had immunity against the dangerous infections she worked with. It said there was no epidemic risk in the region.

The Kremlin has also rejected reports of a second suspected case. Kremlin spokesman Dmitry Peskov said the majority of media reports surrounding the incident were false and urged people to rely on official statements from Rospotrebnadzor.

According to Reuters, “There is a great deal of media coverage, and the vast majority of what the media are reporting about this situation is false information,” Peskov said.

WHO Investigates Lab Worker's Death

Also read: Russia Tells WHO No Plague Cases In Irkutsk, But Lab Worker's Death Remains Unexplained

Despite Russia's reassurances, the WHO says important questions about the lab worker's death still remain unanswered. WHO Director-General Tedros Adhanom Ghebreyesus said the organisation has requested details of the laboratory testing carried out on Shipilova and her contacts, the reasons behind the public-health measures and the current health status of those monitored.

The WHO has also asked Russia to verify reports that a second employee developed pneumonia of undetermined cause.

“As we don’t yet have the full picture of this event, we are not able to conduct a full risk assessment,” Tedros said. He stressed that timely, complete and transparent information is necessary to establish what happened and assess any potential public-health risk.

Maria Van Kerkhove, WHO director of epidemic and pandemic management, said the agency does not yet know the causative agent behind Shipilova's death.

“Right now, we don't know the causative agent of how this woman died. And that's really what we want to better understand,” she said.

Bioweapon Claims

There's also uncertainty which has prompted questions in the US about whether the incident could involve a biological weapon.

US President Donald Trump was asked on October 7 whether he believed the Russian lab worker's death was linked to a bioweapon, US President Donald Trump said: “We don't think so. We're going to find out soon enough, but we don't think so.”

He also said his administration was in “very deep discussions” about the incident and that he had a call with Russian President Vladimir Putin scheduled.

US officials, meanwhile, have continued monitoring the situation. CDC Director Erica Schwartz said the agency was prepared to monitor and screen travellers.

Secretary of State Marco Rubio said Washington was monitoring reports of possible plague but said they were not a “cause for alarm”. “There’s very limited travel between the US and Russia, obviously, but like anything else, something like that gets out, it could quickly spread,” Rubio said.

“So we're watching and monitoring it closely. I don't think it's cause for alarm – but it is cause for focus and a cause to just keep an eye on it. And we're doing that.”

Meanwhile, neighboring countries including Mongolia, Kyrgyzstan and Uzbekistan have reportedly tightened border health measures.

Novartis’ drug remibrutinib can now also be used for adults with symptomatic dermographism, according to the US Food and Drug Administration (FDA).

Marketed as Rhapsido, it is the first FDA-approved treatment specifically for symptomatic dermographism in adults whose symptoms do not sufficiently respond to H1 antihistamines.

Symptomatic dermographism is a condition is a form of chronic hives in which even minor scratching, rubbing or friction can trigger itchy, raised welts on the skin.

This has led Rhapsido to become the only prescription treatment in the US with approved uses for both symptomatic dermographism and chronic spontaneous urticaria when antihistamines alone are insufficient.

FDA Approves Remibrutinib For Symptomatic ermographism

The move came after symptomatic dermographism cohort of the Phase III RemIND trial, which included adults who remained symptomatic despite treatment with second-generation H1 antihistamines.

After 12 weeks, 29.3% of patients taking remibrutinib treated hives completely, compared to 14% of those receiving placebo. Novartis said improvements were seen as early as two weeks.

“SD is a chronic, debilitating condition with historically limited treatment options,” said Giselle Mosnaim, MD, MS, lead RemIND trial investigator. “Remibrutinib offers, for the first time, an approach to treatment specifically for SD patients who remain inadequately controlled with H1 antihistamines alone, representing a meaningful step forward for this population.”

Also read: HPV Vaccine May Keep Cervical Cancer Risk Lower In Women With HIV For Years: Lancet

What Is Symptomatic Dermographism?

Dermographism, sometimes called 'skin writing', occurs when the skin develops raised marks or welts after being scratched or pressurised.

In symptomatic dermographism, the reaction is accompanied by significant itching and hives. A person may develop welts after scratching an itch, rubbing against clothing, carrying a bag, drying off with a towel after a shower or any other everyday friction.

The welts can appear within minutes of the physical trigger, making ordinary contact with the skin unexpectedly uncomfortable.

Symptomatic dermographism is classified as a form of chronic inducible urticaria, meaning the hives are triggered by a specific physical stimulus rather than appearing spontaneously.

Also read: New Lymphoma Trial: Experimental Drug Combination Cuts Progression Or Death Risk By 51%

Why Scratching Cause Hives In Symptomatic Dermographism?

The reaction of hives forming after scratching involves mast cells, immune cells found in the skin that can release histamine and other inflammatory substances. When the skin is physically stimulated, these cells activate, triggering the characteristic redness, swelling, and itching.

This is also where remibrutinib works differently from conventional antihistamine. Remibrutinib is an oral, highly selective Bruton’s tyrosine kinase (BTK) inhibitor.

By blocking the BTK process that is involved in immune-cell signalling and histamine release, the drug aims to reduce the chain of events that produce hives and itching.

Living With Symptomatic Dermographism

For most people, the condition is primarily a chronic quality-of-life problem rather than a life-threatening disease. However, persistent itching and unpredictable hives can interfere with sleep, clothing choices, work, and everyday activities.

The FDA approval does not mean remibrutinib is intended for everyone with dermographism. It is approved for adults whose symptomatic dermographism cannot be controlled by existing H1 antihistamines.

The most common adverse events reported with remibrutinib in trials included nasopharyngitis, bleeding, headache, nausea and abdominal pain.

Around 4.9 million people aged 18 years and over (9.8%) smoked cigarettes in the UK in 2025, down from 10.6% in 2024, continuing the long-term decline in smoking, according to the latest report from the UK’s Office for National Statistics (ONS).

But as smoking rates fall, vaping has become increasingly common. In Great Britain, around 5.4 million people aged 16 years and over (9.9%) used an e-cigarette daily or occasionally in 2025, according to the ONS Opinions and Lifestyle Survey.

For the second consecutive year, e-cigarette use was higher than cigarette smoking. In 2025, there were around:

• 5.4 million current e-cigarette users
• 4.8 million current smokers

The proportion of adults using e-cigarettes has also increased over the longer term, rising from 6.4% in 2020 to 9.9% in 2025.

Vaping Highest Among 25-34-Year-Olds

Also read: FDA To Speed Up Approval Process For Vapes & Nicotine Pouches: Does It Mean They Are Safer Than Cigarettes?

E-cigarette use was highest among people aged 25 to 34 years, with 16.4% reporting daily or occasional use.Overall, 6.5% of people aged 16 and over reported vaping daily in 2025, slightly down from 6.7% in 2024. Another 3.4% reported occasional use, up from 3.3%.

The ONS data also show that vaping is not limited to current smokers. In 2025, 7.2% of people reported having previously used an e-cigarette, up from 6.6% in 2024, while the proportion who had never used one fell slightly from 83.4% to 83.0%.

What’s In A Vape?

Vaping is often perceived as a cleaner alternative to smoking because e-cigarettes do not burn tobacco. However, the aerosol produced by these devices can contain substances that may affect the lungs and cardiovascular system.

Unlike harmless water vapour, e-cigarette aerosol may contain:

• Nicotine, which is highly addictive
• Heavy metals, including lead, nickel and tin
• Volatile organic compounds, some of which can be harmful
• Flavoring chemicals, which may have different effects when inhaled
• Ultrafine particles that can penetrate deep into the lungs

“Inhaling these substances directly into the lungs introduces not just nicotine, but also numerous potentially carcinogenic and lung-damaging compounds,” said Dr. Arun Chowdary Kotaru, Head and Senior Consultant of Pulmonology & Sleep Medicine.

“This is not harm reduction—it’s harm diversification.”

Why Are Non-Smokers Turning To Nicotine?

Vaping was initially promoted as a smoking-cessation aid and is generally considered less harmful than smoking combustible cigarettes. However, e-cigarettes are not risk-free.

The concern is particularly relevant for people who have never smoked. For them, taking up vaping can introduce a new source of nicotine exposure and dependence rather than replacing an existing smoking habit.

“Vaping is not harmless,” warns Dr. Arun. “Even if it may contain fewer toxic chemicals than traditional cigarettes, it still delivers a cocktail of harmful substances that are anything but safe.”

Nicotine exposure is also a concern for adolescents because the brain continues developing into the mid-20s.

“The teenage brain is still developing until around the age of 25,” explains Dr. Kotaru. “Nicotine interferes with areas responsible for learning, impulse control, and mood regulation. Early exposure can also set the stage for a lifelong struggle with addiction, increasing vulnerability to other substance abuse later in life.” .