The median time from starting work with tobacco leaves to symptom onset is about 10 hours, but this varies widely. The almost universal symptoms of weakness, nausea, vomiting, diarrhea and dizziness may be confused with pesticide poisoning or heat stress illness. Since its recognition in the 1970s, no fatalities have been ascribed to green tobacco sickness, but it may play a role in cardiovascular disease and death. Certainly, poisoning with concentrated forms of nicotine has led to vascular collapse, arrthythmias and death. 3 Green tobacco sickness is self-limited, usually lasting 1 to 2 days.
Ipecac is contraindicated because it lowers the threshold for seizures.
The risk of green tobacco sickness is increased by handling tobacco that is wet from rain or dew. The condition is preventable by use of protective clothing and by avoiding skin contact with wet tobacco. However, water-resistant clothing and rubber gloves, which provide an impermeable barrier to nicotine, increase the risk of heat stress, so ordinary shirts, trousers and cotton gloves are recommended. When clothing becomes wet from environmental dampness or sweating, it should be changed to maintain an effective barrier. From early July through October tobacco leaves are harvested as they mature, from bottom to top of the plants, but most harvesting is now mechanized, so contact with leaves occurs during boxing or racking of leaves.