While it’s not clear whether children exposed to recalled applesauce packets have suffered acute lead poisoning, pediatricians should take recent warnings seriously, experts told MedPage Today.
Morri Markowitz, MD, director of the Lead Poisoning Prevention and Treatment Program at the Children’s Hospital at Montefiore in the Bronx, New York, told MedPage Today that blood lead levels of 20 micrograms per deciliter (mcg/dL) or higher in young kids can bring on clinical disease in some children.
These levels are typically associated with a “higher frequency of intestinal complaints,” he said.
Children are usually hospitalized at 45 mcg/dL, and are at risk of severe consequences, including death, at 100 mcg/dL, Markowitz said.
So far, there have been 22 cases of high blood lead levels tied to cinnamon-containing applesauce packets in more than a dozen U.S. states, in kids ages 1 to 3 — and blood lead levels have ranged from 4 to 29 mcg/dL, according to the CDC. Kids’ lead levels are considered elevated at just 3.5 mcg/dL.
“It is of concern to me,” Markowitz told MedPage Today, though he cautioned that the “amount of lead in the blood is not necessarily a good predictor of how much lead is in the brain, or how much lead has accumulated in the bone.”
Nonetheless, there are “potentially lasting consequences from early lead absorption,” he said. Much of the concern is focused on the potential for decline in cognitive function and changes in the brain.
Cases were initially flagged to the FDA by officials in North Carolina. Though the North Carolina Department of Health and Human Services could not provide information on specific cases due to patient privacy, a spokesperson said in an emailed statement that the agency works with local health departments and providers to identify children with elevated levels of lead and help assess for exposures in the home.
In North Carolina, all blood lead test results for kids under age 6 are reportable to the department under state law, the spokesperson said. A child under 6 who has two consecutive blood lead test results of at least 5 mcg/dL is “considered to have an elevated lead level and is eligible for a home investigation by environmental health staff to identify the source of the lead hazard.”
The agency uses a spice and food data collection form designed to “enhance surveillance efforts and collect the information the FDA needs (e.g., food consumption history, lot numbers and purchase locations) in order to issue a public health advisory,” the spokesperson said. “This is how information is provided quickly to the FDA.”
While the most well known health hazards are lead-based paint or lead in water, “non-paint hazards have been found to contain lead and include spices, ceremonial powders, and alternative medicines,” the spokesperson said, pointing to a 2018 Morbidity and Mortality Weekly Report authored by Kim Angelon-Gaetz, PhD, of the department, and colleagues.
“This is also a good reminder for parents and caregivers to have children tested for lead during their well-child visit at age 1 and again at age 2, when hand-to-mouth behavior is highest,” the spokesperson said. “Especially since initial symptoms of lead poisoning may not be present or can be hard to identify.”
As for the recent cases, there may be more questions than answers at this stage, including about the ultimate source of lead in the recalled food items.
“If it’s the cinnamon,” Markowitz said, “what else is the cinnamon in?”