Who Should Not Get EBO2 (EBOO)? Contraindications Compared Across Sources

No regulator publishes a list of who should not have EBO2 (also called EBOO). Ozone therapy is not FDA-approved for any condition, and federal regulation calls ozone “a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy” [17], so there is no approved labeling with contraindications. The lists that exist come from four kinds of source: an ozone physiologist’s book chapter, an Italian national consensus on one kind of spinal injection, the exclusion rules of a randomized trial, and clinics’ own pages. This guide compares them condition by condition, gives each source’s reasoning, and shows what clinics say about screening.

They agree on a short core: bleeding or clotting problems, pregnancy, G6PD deficiency, an unstable heart, and uncontrolled hyperthyroidism. Beyond that they diverge, and none of them rests on a study of who has been harmed by EBO2. Whether an item matters for a particular person is a question for that person’s own doctor; our doctor questions tool turns these items into questions to take along. The clinic directory shows what each clinic publishes.

How the lists compare

The three non-clinic sources each cover a different procedure. Bocci’s chapter addresses ozone therapy in general and especially autohemotherapy [1]. The 2008 consensus from Italy’s national health institute covers intramuscular injections beside the spine for disc herniation [2]. The 2022 trial excluded certain patients from autohemotherapy [3]. The eleven clinic pages are ones we chose because each gives an itemized list for its EBO2 or EBOO service; other clinic pages mention contraindications more briefly, so the counts describe this set, not all clinics. They are cited by number in the table [4][5][6][7][8][9][10][11][12][13][14].

The clinics also rank items differently. in2GREAT calls only favism and G6PD deficiency absolute and weighs everything else case by case [4], while Charleston calls active hyperthyroidism, severe G6PD deficiency, pregnancy, an active bleeding disorder, and a recent stroke absolute [5]. A list on one clinic’s page tells a reader what that clinic says it screens for, not what another clinic does.

Contraindications most sources share

G6PD deficiency

Glucose-6-phosphate dehydrogenase helps red blood cells handle oxidation, and ozone is an oxidant. The warning has two roots. A 1977 paper, available to us only as a one-sentence abstract, modeled ozone exposure at levels reached in some cities and predicted that people with the deficiency may experience acute hemolysis, the breakdown of red blood cells [15]. It describes breathing polluted air, not any ozone therapy. Bocci lists a significant G6PD deficit among the situations that preclude or limit ozone therapy and says patients should be checked for it [1], and a 2026 scoping review of autohemotherapy safety lists G6PD screening as mandatory among its key safety measures [16]. We found no published case of hemolysis after EBO2 in a person with the deficiency. See G6PD deficiency and hemolysis.

Pregnancy

Bocci lists pregnancy, particularly its early phase, to exclude any mutagenic risk, which he calls unlikely [1]. The Italian consensus excludes pregnancy from paravertebral injection [2], and the 2022 trial excluded pregnant and breastfeeding women [3]. Ten of the eleven clinic pages list pregnancy; two limit it to the first trimester, and one of those cites medical and legal reasons [8]. We found no study of EBO2 in pregnancy.

Uncontrolled hyperthyroidism

Bocci groups hyperthyroidism with low platelets and serious cardiovascular instability as abnormal situations that preclude or limit ozone therapy [1], and the consensus excludes clinically evident hyperthyroidism [2]. Neither source explains the reasoning further. Five clinic pages list it, as active, uncontrolled, or Graves disease [4][5][7][8][13].

Active bleeding or severe thrombocytopenia

Every clinic page in the comparison lists bleeding or clotting problems in some form, from a history of severe clotting failure to an active bleeding disorder [4][5][6][7][8][9][10][11][12][13][14], and the 2022 trial excluded people with coagulation dysfunction [3]. EBO2 adds two needle sites and an anticoagulated circuit. The FDA-approved label of a heparin product, the anticoagulant the EBOO papers describe, lists low platelet counts and hemophilia among conditions with a higher risk of bleeding, and an uncontrollable active bleeding state as a reason not to use heparin [24]. Our blood thinners and medicines guide covers the circuit’s anticoagulant in detail.

Recent heart attack or stroke

Bocci lists serious cardiovascular instability [1], the consensus lists cardiovascular decompensation [2], and the trial excluded heart failure [3]. Clinic pages word it as a recent heart attack, an unstable cardiovascular status, or severe cardiovascular instability; one Indiana clinic adds that such patients “cannot handle systemic fluid shifts” [6]. Three list stroke, recent or hemorrhagic [4][5][8].

Ozone allergy

Bocci notes that an allergy to ozone has been claimed and asks what it would be, suggesting that asthma patients’ reactions to polluted air have caused confusion and that plastic bags can release allergenic material [1]. One clinic lists a known sensitivity to ozone [10]. A past reaction to any ozone treatment is worth describing to both the clinic and one’s own doctor.

Relative precautions

These items appear on fewer lists, or as conditions clinics weigh rather than rule out.

• Anemia. Four clinic pages list severe or uncontrolled anemia [6][9][10][12]. A 2025 case report describes two series of three EBOO treatments in an 88-year-old woman with chronic anemia whose hemoglobin was 7.4 g/dL at baseline, 6.8 after the first series, and 7.5 after the second; after the second series she reported feeling worse, more tired than after the first. The paper has no adverse-events section and attributes neither change to EBOO [20].
• Veins. EBO2 needs a working line in each arm for the whole session. One clinic lists two compliant veins, one in each arm, as a prerequisite [8], and another says it places its own sterile lines and does not use existing PICC lines or ports [23]. The authors of an ozone dialysis paper chose smaller catheters because of concern that larger ones would damage patients’ veins over repeated treatments [22].
• Blood pressure. One clinic lists severe hypotension [9] and another uncontrolled high blood pressure [7]; the heparin label lists severe hypertension among conditions with higher bleeding risk [24].
• Kidney disease. The trial excluded renal injury [3]. A 2017 case report describes sinus arrest from high potassium in a woman with chronic kidney disease after nine days of autohemotherapy, which its authors hypothesize was linked to the therapy [21].
• Infection. One clinic excludes active, severe blood-borne infections [6].
• Blood sugar. One clinic tells patients to eat a proper meal before treatment because, it says, ozone and ultraviolet blood treatment affect blood sugar; it cites no source [4].
• Cancer. One clinic excludes people in active cancer treatment [6], another lists cancer without qualification [14], and three list leukemia [4][7][8]. Our cancer claims guide covers what clinics say EBO2 does for cancer.

Medication interactions clinics ask about

Only one medicine class appears in a non-clinic source: Bocci reports sudden, marked drops in blood pressure when ozonated blood was reinfused quickly into patients taking ACE inhibitors, from an unpublished observation and two of his own patients, and lists ACE inhibitor treatment among situations that preclude or limit ozone therapy [1]. Clinic pages add others without giving reasons: anticoagulants [9][13], heparin allergy [4][7][8], iron infusions [4], sulfa drugs [8], high-dose vitamin K [14], and chemotherapy agents, which one clinic says need additional assessment alongside certain anticoagulants [25]. Heparin’s label lists a known hypersensitivity to heparin or pork products as a reason not to use it, and notes that the drug is derived from pig intestinal mucosa [24]. The blood thinners and medicines guide covers what the label says about other drugs. A complete list of medicines and supplements is what lets a clinician check any of this.

What clinics say about intake screening

As of October 4, 2026, 132 of the 174 clinics whose EBO2 page we could read describe what happens before a first session, in the intake statement we recorded for each. Of those 132 statements, 33 mention lab tests, bloodwork, or biomarkers, 11 name a G6PD test, and 9 mention medications; two of the G6PD statements, from two locations of one business, call the test helpful rather than required. The intake statement is one quoted sentence or two per clinic, so a clinic may screen more than its statement shows. The block under “From our data” at the end of this page shows the full transparency figures.

The specific requirements vary. A Kansas clinic reviews a metabolic panel, a complete blood count, a G6PD test, fasting insulin, C-reactive protein, and D-dimer before the first treatment [4]. A South Carolina clinic requires a blood count, a metabolic panel, and a G6PD test, and calls the G6PD screen and a consultation non-negotiable [5]. A Seattle practice requires one well-tolerated session of intravenous ultraviolet blood irradiation, two compliant veins, and lab values in the normal range [8]. A New Mexico clinic requires a high-dose intravenous ozone treatment first, to check that a patient tolerates high-dose ozone [26].

Two practitioner bodies have called for common standards. The Madrid Declaration on Ozone Therapy has sections on contraindications, interactions, and graded adverse effects in its table of contents [18], and a 2025 paper from the Italian society SIOOT argues that standardized protocols are needed for safety [19].

Questions to expect at intake

Bocci writes that before ozone therapy the physician must know the patient’s full medical history and current drugs [1]. Questions a careful intake would cover, drawn from the lists above:

• Any bleeding or clotting problem, low platelets, or past reaction to heparin.
• Pregnancy or breastfeeding.
• A known G6PD deficiency or favism, or whether a G6PD test has been done.
• Thyroid disease, heart disease, a recent heart attack or stroke, and blood pressure.
• Kidney or liver disease, anemia, an active infection, or cancer treatment.
• Every medicine and supplement, including blood thinners, ACE inhibitors, and iron.
• Past reactions to any ozone treatment, and how good the veins in both arms are.

Every source above assumes that these questions are asked before a first session. It is reasonable to ask a clinic what it screens for, which labs it requires, what it does when a result raises one of these concerns, and whether it will talk with the patient’s own doctor.

What we could not verify

• Evidence behind any list. No source we found tested who is harmed by EBO2; the lists are precautions, practice rules, or trial design choices.
• A documented G6PD case. We found no published report of hemolysis after EBO2 in a person with G6PD deficiency, and the 1977 model behind the warning is available to us only as a one-sentence abstract [15].
• The Madrid Declaration’s contraindications. Its text is sold by its publisher; we read only the table of contents [18].
• Reasons for many clinic items, including sulfa drugs, photosensitivity, porphyria, alcohol, iron, and vitamin K, which the pages list without explanation.
• What clinics actually screen. Our figures count what intake statements say, not what happens in the room.
• The reasoning for hyperthyroidism and heart conditions, which the book and the consensus list without further explanation.

How this guide was made

We compared 26 sources: a book chapter, an Italian national consensus, a randomized trial, five other papers read through NCBI, an FDA-approved heparin label, a federal regulation, two practitioner documents, and fourteen clinic pages saved on September 28, 2026, labeled clinic-stated. The intake figures come from our clinic dataset as of October 4, 2026, and the transparency block below is computed from it when the site is built. Drafting used AI tools. A human editor has not yet checked this guide claim by claim against its sources, and no clinical reviewer has signed off yet.