Pediatric Lead Exposure From Imported Indian Spices and Cultural Powders

From http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1396v1

Cristiane Gurgel Lin, MD, PhDa,b,c, Laurel Anne Schaider, PhDd, Daniel Joseph Brabander, PhDe, Alan David Woolf, MD, MPHb,f

aPediatric Residency Program, Department of Medicine, and
fPediatric Environmental Health Center, Division of General Pediatrics, Children's Hospital Boston, Boston, Massachusetts;
bDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts;
cDepartment of Neonatology, Pediatrix Medical Group, Seton Medical Center, Austin, Texas;
dDepartment of Environmental Health, Harvard School of Public Health, Boston, Massachusetts; and
eDepartment of Geosciences, Wellesley College, Wellesley, Massachusetts

Background Significant lead poisoning has been associated with imported nonpaint products.

Objectives 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).

Patients and 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 µg/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 µg/g lead (for these 22 samples, mean: 2.6 µg/g [95% confidence interval: 1.9–3.3]; maximum: 7.6 µg/g). Forty-six of 71 cultural products contained >1 µg/g lead (for 43 of these samples, mean: 8.0 µg/g [95% confidence interval: 5.2–10.8]; maximum: 41.4 µg/g). Three sindoor products contained >47% lead. With a fixed ingestion of 5 µg/day and 50% bioavailability, predicted geometric mean BLLs for children aged 0 to 4 years increased from 3.2 to 4.1 µg/dL, and predicted prevalence of children with a BLL of >10 µg/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 µg/g lead, and some sindoor contained extremely high bioaccessible lead levels. Clinicians should routinely screen for exposure to these products.



Key Words: pediatric lead poisoning • childhood plumbism • spices • herbal products • cosmetics • religious powders • lead contamination • Indian • sindoor • culture-specific exposure


Abbreviations: CI = confidence interval

Toxics, Partnerships and Stewardship News (Region 5): Wisconsin is first state with lead-based paint renovation, repair and painting program‏

MEDIA CONTACT: Kären Thompson, 312-353-8547, thompson.karen@epa.gov FOR IMMEDIATE RELEASE No. 09-OPA225

Wisconsin is first state with lead-based paint renovation, repair and painting program
(CHICAGO - Nov. 12, 2009) U.S. Environmental Protection Agency Region 5 has announced that two of Wisconsin’s lead-based paint programs have been federally authorized. They are the Lead-based Paint Renovation, Repair and Painting program, and the Pre-Renovation Education program.

Wisconsin is the first state authorized to administer and enforce the Renovation, Repair and Painting rule which mandates training and licensing in lead-safe work practices for construction contractors, property managers and others that work in homes and child-occupied facilities built before 1978. Gov. James E. Doyle has certified that the Wisconsin programs, to be administered by the division of public health, are at least as protective as EPA’s and provide adequate enforcement.

The Lead-based Paint Pre-Renovation Education program requires construction contractors, property managers and others that perform renovations for compensation to distribute the lead pamphlet “Renovate Right; Important Lead Hazard Information for Families, Child Care Providers and Schools” to owners and occupants before starting renovation work. “We commend Wisconsin for taking the initiative to prevent further lead poisoning by ensuring that work that disturbs paint is done in a lead-safe manner,” said Bharat Mathur, acting administrator for EPA Region 5.

“We are very pleased to be implementing these lead-safe renovation programs in Wisconsin,” said Karen Timberlake, Wisconsin Department of Public Health secretary. “Renovators and rental property owners play a big part in protecting children from lead-based paint hazards in their homes. With the training and lead-safe work practices implemented with these programs, they will make even more, older Wisconsin homes safe for children.”

Lead contaminated dust is the most significant source of lead exposure for children. Common renovation activities like sanding, cutting and demolition can create hazardous lead dust and chips by disturbing lead-based paint, which can be harmful to adults and children. Lead-based paint was used in more than 38 million homes until it was banned for residential use in 1978.
Lead exposure can cause reduced IQ, learning disabilities, development delays and behavioral problems in young children.

You can learn more about protecting your family from lead-based paint and EPA’s lead program at http://www.epa.gov/lead or by contacting the National Lead Information Center at 800-424-LEAD (5323).

For more information about Wisconsin’s new program, including information on applying for certification or locating training, contact the Wisconsin Lead Program at 608-261-6876, or visit the state Web site at http://dhs.wisconsin.gov/lead.