Pediatric lead exposure from imported Indian spices and cultural powders.
BACKGROUND
Significant lead poisoning has been associated with imported nonpaint products.


OBJECTIVE
To describe cases of pediatric lead intoxication from imported Indian spices and cultural powders, determine lead concentrations in these products, and predict effects of ingestion on pediatric blood lead levels (BLLs).


METHODS
Cases and case-study information were obtained from patients followed by the Pediatric Environmental Health Center (Children's Hospital Boston). Imported spices (n = 86) and cultural powders (n = 71) were analyzed for lead by using x-ray fluorescence spectroscopy. The simple bioaccessibility extraction test was used to estimate oral bioavailability. The integrated exposure uptake biokinetic model for lead in children was used to predict population-wide geometric mean BLLs and the probability of elevated BLLs (>10 microg/dL).


RESULTS
Four cases of pediatric lead poisoning from Indian spices or cultural powders are described. Twenty-two of 86 spices and foodstuff products contained >1 microg/g lead (for these 22 samples, mean: 2.6 microg/g [95% confidence interval: 1.9-3.3]; maximum: 7.6 microg/g). Forty-six of 71 cultural products contained >1 microg/g lead (for 43 of these samples, mean: 8.0 microg/g [95% confidence interval: 5.2-10.8]; maximum: 41.4 microg/g). Three sindoor products contained >47% lead. With a fixed ingestion of 5 microg/day and 50% bioavailability, predicted geometric mean BLLs for children aged 0 to 4 years increased from 3.2 to 4.1 microg/dL, and predicted prevalence of children with a BLL of >10 microg/dL increased more than threefold (0.8%-2.8%).


CONCLUSIONS
Chronic exposure to spices and cultural powders may cause elevated BLLs. A majority of cultural products contained >1 microg/g lead, and some sindoor contained extremely high bioaccessible lead levels. Clinicians should routinely screen for exposure to these products.
Pediatric Residency Program, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. cristiane.lin@gmail.com
Cristiane Gurgel
CG
Lin
Laurel Anne
LA
Schaider
Daniel Joseph
DJ
Brabander
Alan David
AD
Woolf
D005260:Female; D005502:Food / Q000009:adverse effects; D006801:Humans; D007194:India / Q000208:ethnology; D007223:Infant; D007855:Lead Poisoning / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D008297:Male; D011208:Powders; D012067:Religion; D017365:Spices / Q000009:adverse effects*
D011208:Powders