Ozone therapy is a treatment method published for the first time by H.H.Wolf in 1974 (Die Behandlung peripherer Durchblutungsstörungen mit Ozon) and recently taken to the headlines for the anti-inflammatory therapeutic results that can be achieved in various diseases.

However, according to the latest scientific studies, exposure of the respiratory tract to ozone must be authorized by a pulmonary specialist because, as we will see, there are pros and cons, but above all beware of "do it yourself".

PRO

The first and fundamental global consensus document concerning ozone therapy was the "Madrid Declaration on Ozone Therapy" of 2010 in which the therapy guidelines were indicated, followed by the second edition of 2015 (1).

Over time, two methods of treatment using ozone have developed:

external, to treat skin or rheumatic diseases (acne vulgaris, systemic sclerosis, fistulas, ophthalmic, vaginal,  vesicourethral, otic, tonsils and others). Vaporizers are used to spray a mixture including ozone, or water and ozone baths (2).

internal, through

• intramuscular and intra-articular infiltration
• paravertebral infiltration
• disc herniation
• intradiscal infiltration
• Infiltration sacral hiatus flow / epidural transluminal
• Infiltration intraforaminal

Ozone therapy is a mixture of O3/O2 gases, produced by medical grade oxygen with an ozone generator and which must be performed in situ due to the short half-life (at 20 °C the O3 concentration is halved within 40 minutes, at 30 °C within 25 minutes) (3).

Ozone is used extensively in various applications in skin diseases against bacteria, viruses and gram-negative and gram-positive fungi.

Ozone therapy studies

CONS

Several scientific studies agree on the danger of ozone exposure, not so much for its negative consequences on the cardiovascular system, on which there is no unanimous consensus in the scientific literature, but for the negative impact on pulmonary function.

In fact, ozone exposure must be strictly regulated and authorized by medical authorities for specific purposes and at prescribed doses.

Ozone production has recently increased due to COVID-19 with the commercial proliferation of ozonizers for the home and other indoor environments (stores, businesses, gyms, etc.). However, many of these devices produce higher amounts of ozone than are generally considered safe for humans.(4)

This recent study has shown that "In this multicenter clinical study of older healthy subjects, ozone exposure caused concentration-related reductions in lung function and presented evidence for airway inflammation and injury." (5)

The only currently effective solution for filtering and improving indoor air quality are HVAC filters and EPA, HEPA, HULPA filters applied in handling, filtering, and air conditioning systems. Essential condition for their effectiveness: a correct and frequent cleaning of the filter. (6)

ASHRAE, the international association that studies and proposes regulations in the air conditioning, refrigeration, ventilation and heating sectors, has recently expressed, through some of its members, a definitely negative opinion on the use of ozone in the sectors it deals with.".. we might expect they ( EPA and AHAM two bodies developing regulations on household appliances) will begin the even more arduous effort to achieve international agreement on a test method and rating system for labels on consumer products. This would be an important tool to protect the public from ozone and from potentially unwanted by-products of emerging gas cleaning technologies. Devices that claim to remove gaseous contaminants through electrochemical or photochemical means are not yet tested nor rated by any independent organization. The EPA guidance clearly states that ozone is a pollutant to be avoided, and that without independent testing and certification neither the safety nor the effectiveness of technologies that rely on ozone, plasma, ionization and photocatalysis (as implemented in air cleaners in the consumer space) can be easily assessed at present." (7)

Nevertheless, we are seeing more and more advertisements claiming ozonizers as the ideal solution for odor removal, sanitization and mold elimination. As the NOAI CERTIFIED organization points out "This is stupidity exceeds honestly" (8) because ozonizers must not exceed 0.005 ppm in residential environments with people present and with such a small amount of ozone emissions neither sanitize an environment nor remove mold. An industrial ozonizer producing 6 ppm can achieve this, but the output is such that no human can remain in the environment treated with these emissions.

Considering therefore that a non-industrial ozonizer can sanitize at the most a drawer or a cabinet, we must verify that the emissions are below those allowed, 0.005 ppm and, above all, that this result has been certified by a valid institution. In addition, "Under certain use conditions ion generators and other ozone generating air cleaners can produce levels of this lung irritant significantly above levels thought harmful to human health."(9) 

The topic is too important to equate with buying a blender.

Is the purchase worth the risk?

References_____________________________________________

(1) https://isco3.org

(2) Positive effect of ozonotherapy on serum concentration of soluble interleukin-2 receptor and neopterin in patients with systemic sclerosis. Nowicka D.  Postepy Dermatol Alergol. 2019 Apr;36(2):158-163. doi: 10.5114/ada.2019.83651. 

(3) OZONE A new medical drug. Bocci, Velio  ISBN 978-90-481-9234-2

(4) What are ionizers and other ozone generating air cleaners? | Indoor Air Quality (IAQ) | US EPA 

(5) Frampton MW, Balmes JR, Bromberg PA, Stark P, Arjomandi M, Hazucha MJ, Rich DQ, Hollenbeck-Pringle D, Dagincourt N, Alexis N, Ganz P, Zareba W, Costantini MG. Multicenter Ozone Study in oldEr Subjects (MOSES): Part 1. Effects of Exposure to Low Concentrations of Ozone on Respiratory and Cardiovascular Outcomes. Res Rep Health Eff Inst. 2017 Jun;(192, Pt 1):1-107. PMID: 31898880.

(6) Air Cleaners and Air Filters in the Home | Indoor Air Quality (IAQ) | US EPA 

(7) New Guidance for Residential Air Cheaners ASHRAE Journal Sep 2019 (epa.gov) 

(8) Understanding PPM for Ozone Generators | NOAI CERTIFIED 

(9) What are ionizers and other ozone generating air cleaners? | Indoor Air Quality (IAQ) | US EPA