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Swallowing a tablespoon of the dry spice on a dare could lead to serious health problems, according to the latest report on the practice.

The so-called cinnamon challenge went viral in 2012 as over 50,000 video clips of people attempting to swallow a tablespoon of cinnamon in under 60 seconds popped up on YouTube — along with the inevitable gagging, coughing and misery of the unsuccessful dares. Excessive amounts of cinnamon, as the teens in the videos now know, can cause burning and inflammation of sensitive tissues in the mouth, nose and throat, and led to a spike in calls to poison-control centers. The American Association of Poison Control Centers (AAPCC) reported that in the first three months of 2012, these centers received 139 calls for cinnamon abuse, 122 of which were related to the cinnamon challenge. Thirty of those people required immediate medical attention.

(MORE: Cinnamon Challenge, Popular With Teens, Proves Risky)

Now a new study published in the journal Pediatrics details more health harms related to the dare. The latest data, the authors of the study say, showed that 222 calls came in to poison centers in 2012 related to the stunt, compared with 51 calls in 2011. Some teens were treated for collapsed lungs and required ventilators after attempting the challenge.

When swallowed by the tablespoon, powdered cinnamon coats and dries out the mouth, making swallowing difficult. Cinnamon also contains a substance called cellulose that can stick in the lungs and compromise their ability to exchange oxygen and carbon dioxide. The study authors acknowledge that while these effects are usually temporary, people who have asthma or more delicate lungs could be at greater risk of more serious breathing problems if they try the stunt. “The cellulose doesn’t break down,” Dr. Steven Lipshultz, one of the authors of the study from the University of Miami Miller School of Medicine said to the New York Times. “So when it gets into the lungs it sits there long term, and if it’s coated with this caustic cinnamon oil, that leads to chronic inflammation and eventually scarring of the lungs, something we call pulmonary fibrosis. Getting scarring in the lungs is equivalent to getting emphysema.”

(MORE: The Choking Game: 1 in 7 College Students Has Tried It, Texas Study Finds)

In TIME’s coverage of the spike in poison-center calls related to the cinnamon challenge, officials of the AAPCC warned of the some of the more serious hazards of the stunt:

‘Teens who engage in this activity often choke and vomit, injuring their mouths, throats and lungs,’ said Dr. Alvin Bronstein, managing and medical director for the Rocky Mountain Poison and Drug Center, in the AAPCC statement. ‘Teens who unintentionally breathe the cinnamon into their lungs also risk getting pneumonia as a result.’

The report should raise the alarm for pediatricians who need to be aware of the potential dangers of the dare, Dr. Stephen Pont, a spokesman for the American Academy of Pediatrics told ABC News. He said the study is “a call to arms to parents and doctors to be aware of things like the cinnamon challenge” and urged parents and doctors to talk to their kids about the risks.