Folk prescription for treating rhinitis as a rare cause of childhood lead poisoning: a case series

Background

Folk prescriptions continue to be important sources of childhood lead poisoning. Nasal spray folk prescriptions for treating rhinitis has only been reported once previously as a cause of lead poisoning.

Case presentation

We identified three pediatric cases of severe lead poisoning caused by nasal spray folk medicines prescribed for treating rhinitis. The three patients had similar clinical manifestations including: severe abdominal pain, headache, pale appearance and fatigue. Liver function tests were abnormal. Blood lead levels (BLLs) of the three patients were 91 μg/dL, 91 μg/dL, and 105 μg/dL, respectively. After chelation BLLs decreased. The lead content of the three folk remedies as measured by inductively coupled plasma mass spectrometry (ICP-MS) were 14.8, 22.3, and 33.4%. All the symptoms resolved during a course of chelation therapy. There were no severe side effects of treatment.

Conclusions

Nasal spray folk prescriptions for treating rhinitis may contain extremely high bio-accessible lead content and are potential sources of lead poisoning. Clinicians should be alert to this possibility especially in those children presenting with multisystem symptoms.

Sources, symptoms and characteristics of childhood lead poisoning: experience from a lead specialty clinic in China

OBJECTIVES

This study explored the sources of lead exposure, identified patients' geographic distribution and evaluated the symptoms of children with elevated blood lead levels (BLLs) referred to a pediatric lead specialty clinic in China.

MATERIAL AND METHODS

Data were collected from 515 consecutive outpatients attending the Pediatric Lead Poisoning Clinic in Xinhua Hospital, Shanghai, China, between 2011 and 2016, referred for BLLs ≥5 μg/dL. Atomic absorption spectrometry was used to measure venous BLLs.

RESULTS

The mean ± standard deviation age of the patients was 4.1 ± 3.2 years. Their BLLs ranged from 5 to 126 μg/dL. The geometric mean and median BLLs were 24 and 26 μg/dL, respectively. Two hundred and twenty-two children (43.1%) were exposed to industrial lead pollution-mainly from Zhejiang, Jiangsu, Hunan, Henan and Anhui provinces; whereas, 41.4% (213 cases) were induced by folk medicines used widely throughout China. Other nonindustrial sources of lead exposure included lead-containing tinfoil and tin pots. Household lead paint was a rare source. Most patients exhibited nonspecific symptoms, such as hyperactivity, attention difficulty, aggressiveness, constipation and anorexia.

CONCLUSIONS

Industrial pollution and folk medicines are important sources of lead exposure in China. Childhood lead poisoning may be difficult to diagnose clinically as symptoms are nonspecific. Thus, blood lead screening may be necessary to identify children at high risk of exposure. Education to raise the awareness of potential sources of exposure resulting in their elimination would be expected to decrease the incidence of children with elevated BLLs.

Sex differences in the effects of prenatal lead exposure on birth outcomes

Studies on the associations between prenatal lead exposure and birth outcomes have been inconsistent, and few data are available on the sex differences in these associations. We measured the cord blood lead levels of newborns in Shanghai and determined their associations with birth outcomes, which included birth weight, birth length, head circumference, and the ponderal index, in the total sample and within sex subgroups. A total of 1009 mother-infant pairs were enrolled from 10 hospitals in Shanghai between September 2008 and October 2009. The geometric mean of the cord blood lead concentrations was 4.07 μg/dl (95% CI: 3.98-4.17 μg/dl). A significant inverse association was found between cord blood lead levels and head circumference only in the male subgroup, and increasing cord blood lead levels were related to significant decreases in the ponderal index only in females. The birth weights of the male infants were positively associated with cord blood lead levels; after adjusting for the maternal intake frequency of preserved eggs, the estimated mean differences in birth weights decreased by 11.7% for each 1-unit increase in the log10-transformed cord blood lead concentration. Our findings suggest that prenatal lead exposure may have sex-specific effects on birth outcomes and that maternal dietary intake may be a potential confounder in these relationships. Further studies on this topic are highly warranted.

Effect of suppression of TGF-beta1 expression on cell-cycle and gene expression of beta-1,4-galactosyltransferase 1 in human hepatocarcinoma cells

beta-1,4-galactosyltransferase 1 (beta1,4-GT 1) is localized both in the Golgi complex where it catalyzes the transfer of galactose from UDP-galactose to terminal N-acetylglucosamine forming Galbeta1 --> 4GlcNAc structure, and on the cell surface where it serves as an adhesion molecule. It has previously been reported that the expression of beta1,4-GT 1 was cell-cycle-specific, regulated by cell growth. Transforming growth factor-beta1 (TGF-beta1) could regulate cell G1/S phase transition and modulate cell growth in many types of cells. In this study, we introduced the antisense-TGF-beta1 into SMMC-7721 cell, a human hepatocarcinoma cell line, for blocking its intrinsic TGF-beta1 expression, and changing its cell-cycle, and then analyzed the gene expression of beta1,4-GT 1 together with the beta1,4-GT activity. The result showed that the antisense-TGF-beta1 transfected SMMC-7721 cells (AST/7721) were growth enhanced, with more cells in S phase and less cells in G2/M phase compared with the mock transfected cells (pcDNA3/7721). At the same time, it was found that the gene expression of beta1,4-GT 1 in AST/7721 was decreased to one fifth that of pcDNA3/7721, and the cell surface beta1,4-GT activity was reduced to one fifth of the control, while the total activity of beta1,4-GT was decreased to one half that of the control. The results indicate that suppression of TGF-beta1 expression resulted in change of cell-cycle together with the decreased gene expression of beta1,4-GT 1 and beta1,4-GT activity in human hepatocarcinoma cells.