Recent Advances in the Clinical Management of Lead Poisoning.
AbstractLead poisoning is a historic universal disease. Acute or chronic lead exposure may cause reversible or even permanent damages in human beings. Environmental lead exposure is a global health concern in children. Occupational lead poisoning is still a health issue, particularly in developing countries. During the last decades, new methods and medications have been advocated for the prevention and treatment of lead poisoning. This review deals mainly with recent developments in the management of lead poisoning. Sources of lead exposure are introduced, and methods for the primary prevention of lead poisoning are discussed. Details for the screening of adults and children are also explained to serve as a practical guideline for the secondary prevention. Standard chelation therapy in different groups and up-to-date less toxic new medications for the treatment of lead poisoning are finally discussed. Our published clinical research on the therapeutic effects of garlic tablets in mild to moderate occupational lead poisoning will also be discussed.
Needleman H. Lead poisoning. Annu Rev Med. 2004;55:209-22.
Warniment C, Tsang K, Galazka SS. Lead poisoning in children. Am Fam Physician 2010;81(6):751-7.
Kianoush S, Balali-Mood M, Mousavi SR, et al. Clinical, toxicological, biochemical, and hematologic parameters in lead exposed workers of a car battery industry. Iran J Med Sci 2013;38(1):30-7.
Farhat A; Mohammadzadeh A, Balali-Mood M, et al. Correlation of Blood Lead Level in Mothers and Exclusively Breastfed Infants: A Study on Infants Aged Less Than Six Months. Asia Pac J Med Toxicol 2013;2(4):150 - 2.
Farhat AS, Parizadeh SM, Balali M, et al. Comparison of blood lead levels in 1-7 year old children with and without seizure. Neurosciences (Riyadh, Saudi Arabia) 2005;10(3):210-2.
Tong S, von Schirnding YE, Prapamontol T. Environmental lead exposure: a public health problem of global dimensions. Bull World Health Organ. 2000;78(9):1068-77.
Centers for Disease Control and Prevention (CDC). Blood lead levels--United States, 1999-2002. MMWR Morb Mortal Wkly Rep 2005;54(20):513-6.
Landrigan PJ, Schechter CB, Lipton JM, et al. Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environ Health Perspect 2002;110(7):721-8.
From the Centers for Disease Control and Prevention. Update: blood lead levels--United States, 1991-1994. JAMA 1997;277(13):1031-2.
Lead. Centers for Disease Control and Prevention; 2012. (Accessed in March 2015, 5, at http://www.cdc.gov/nceh/lead).
Ji A, Wang F, Luo W, et al. Lead poisoning in China: a nightmare from industrialisation. Lancet 2011;377(9776).
Finkelman J. Phasing out leaded gasoline will not end lead poisoning in developing countries. Environ HealthPerspect 1996;104(1):10-1.
Levin R, Brown MJ, Kashtock ME, et al. Lead exposures in U.S. Children, 2008: implications for prevention. Environ Health Perspect 2008;116(10):1285-93.
Woolf AD, Goldman R, Bellinger DC. Update on the clinical management of childhood lead poisoning. Pediatr Clin North Am 2007;54(2):271-94.
Azizi M, Azizi F. Lead Poisoning in the World and Iran. Int J Occup Environ Med 2010;1(2):81 - 7.
Pourmand A, Khedir Al-Tiae T, Mazer-Amirshahi M. Perspective on lead toxicity, a comparison between the United States and Iran. Daru 2012;20(1):70.
Jalili M, Azizkhani R. Lead Toxicity Resulting from Chronic Ingestion of Opium. West J Emerg Med 2009;10(4):244 - 6.
Cikrt M, Bencko V. Hygienic-toxicological aspects of exposure to lead. A critical review. J Hyg Epidemiol Microbiol Immunol 1982;26(4):343-57.
Chandran L, Cataldo R. Lead poisoning: basics and new developments. Pediatr Rev 2010;31(10):399-405.
Bravo AH, Sanchez AP, Sosa ER, et al. The potential impact of gasoline additives on air quality in developing countries. Clean Technol Environ Policy 2006;8(3):174-81.
Balali-Mood M, Shademanfar S, Rastegar Moghadam J, et al. Occupational Lead Poisoning in Workers of Traditional Tile Factories in Mashhad, Northeast of Iran. Int J Occup Environ Med 2010;1(1):29-38.
Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics 2005;116(4):1036-46.
Gorospe EC, Gerstenberger SL. Atypical sources of childhood lead poisoning in the United States: a systematic review from 1966-2006. Clin Toxicol (Phila). 2008 Sep;46(8):728-37.
Graeme KA, Pollack CV, Jr. Heavy metal toxicity, part II: lead and metal fume fever. J Emerg Med 1998;16(2):171-7.
Staudinger KC, Roth VS. Occupational lead poisoning. Am Fam Physician 1998;57(4):719-26, 31-2.
Hettmansberger TL, Mycyk MB. Lead poisoning presents a difficult diagnosis. Am Fam Physician 2002;66(10):1839-40.
Lormphongs S, Morioka I, Miyai N, et al. Occupational health education and collaboration for reducing the risk of lead poisoning of workers in a battery manufacturing plant in Thailand. Ind Health 2004;42(4):440-5.
Chey H, Buchanan S. Toxins in everyday life. Prim Care. 2008 Dec;35(4):707-27.
D'Souza H S, Dsouza SA, Menezes G, et al. Diagnosis, evaluation, and treatment of lead poisoning in general population. Indian J Clin Biochem 2011;26(2):197-201.
Benevich T. New sources add to lead poisoning concerns. JAMA 1990 ;263(6):790-1.
Kosnett MJ. Unanswered questions in metal chelation. J Toxicol Clin Toxicol 1992;30(4):529-47.
Meyer PA, McGeehin MA, Falk H. A global approach to childhood lead poisoning prevention. Int J Hyg Environ Health 2003;206(4-5):363-9..
Meyer PA, Pivetz T, Dignam TA, et al. Surveillance for elevated blood lead levels among children--United States, 1997-2001. MMWR Surveill Summ 2003;52(10):1-21.
Mousavi SR, Balali-Mood M, Riahi-Zanjani B, et al. Concentrations of mercury, lead, chromium, cadmium, arsenic and aluminum in irrigation water wells and wastewaters used for agriculture in Mashhad, northeastern Iran. Int J Occup Environ Med 2013;4(2):80-6.
Vahdati N, Balali-Mood M, Timcheh Hariri A, et al. Determination of lead in Mashhad city tap water by graphite furnace atomic absorption spectrometry. Pharmacologyonline 2011;3:1419-26.
Binns HJ, Campbell C, Brown MJ. Interpreting and managing blood lead levels of less than 10 microg/dL in children and reducing childhood exposure to lead: recommendations of the Centers for Disease Control and Prevention Advisory Committee on Childhood Lead Poisoning Prevention. Pediatrics 2007;120(5):e1285-98.
Schneider JS, Lee MH, Anderson DW, et al. Enriched environment during development is protective against leadinduced neurotoxicity. Brain Res 2001;896(1-2):48-55.
Guilarte TR, Toscano CD, McGlothan JL, et al. Environmental enrichment reverses cognitive and molecular deficits induced by developmental lead exposure. Ann Neurol 2003;53(1):50-6.
CDC. managing elevated blood lead levels among young children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. (Accessed in March 2015, 10, http://www.cdc.gov/nceh/lead/casemanagement/managing EBLLs.pdf).
Keramati MR, Manavifar L, Badiee Z, et al. Correlation between blood lead concentration and iron deficiency in Iranian children. Niger Med J 2013 Sep;54(5):325-8.
Keramati MR, Sadeghian MH, Mood M. Correlation Between Iron Deficiency and Lead Intoxication in the Workers of a Car Battery Plant. Int J Hematol Oncol 2010;20(3):169-74.
Henretig F. Lead poisoning prevention, not chelation (commentary). J Toxicol Clin Toxicol 2001;39(7):659-60.
Shannon MW, Townsend MK. Adverse effects of reduceddose d-penicillamine in children with mild-to-moderate lead poisoning. Ann Pharmacother 2000;34(1):15-8.
Bradberry S, Vale A. Dimercaptosuccinic acid (succimer; DMSA) in inorganic lead poisoning. Clin Toxicol (Phila) 2009;47(7):617-31.
Vilensky JA, Redman K. British anti-Lewisite (dimercaprol): an amazing history. Ann Emerg Med2003;41(3):378-83.
Goldman M, Dacre JC. Lewisite: its chemistry, toxicology, and biological effects. Rev Environ Contam Toxicol 1989;110:75-115.
Bradberry S, Vale A. A comparison of sodium calcium edetate (edetate calcium disodium) and succimer (DMSA) in the treatment of inorganic lead poisoning. Clin Toxicol (Phila) 2009;47(9):841-58.
Treatment guidelines for lead exposure in children. American Academy of Pediatrics Committee on Drugs. Pediatrics 1995;96(1 Pt 1):155-60.
Chisolm JJ, Jr. The use of chelating agents in the treatment of acute and chronic lead intoxication in childhood. JPediatr 1968;73(1):1-38.
Delangle P, Mintz E. Chelation therapy in Wilson's disease: from D-penicillamine to the design of selectivebioinspired intracellular Cu(I) chelators. Dalton Trans 2012;41(21):6359-70.
Kim JS, Hamilton DL, Blakley BR, et al. The effects of thiamin on lead metabolism: organ distribution of lead 203. Can J Vet Res 1992;56(3):256-9.
Najarnezhad V, Aslani MR, Balali-Mood M. The therapeutic potential of thiamine for treatment of experimentally induced sub-acute lead poisoning in sheep.Comp Clin Patol. 2010;19(1):69:73.
Wang C, Liang J, Zhang C, et al. Effect of ascorbic Acid and thiamine supplementation at different concentrations on lead toxicity in liver. Ann Occup Hyg 2007;51(6):563-9.
Sajitha GR, Jose R, Andrews A, et al. Garlic Oil and Vitamin E Prevent the Adverse Effects of Lead Acetate and Ethanol Separately as well as in Combination in the Drinking Water of Rats. Indian J Clin Biochem 2010;25(3):280-8.
Chen W, Ercal N, Huynh T, et al. Characterizing Nacetylcysteine (NAC) and N-acetylcysteine amide (NACA) binding for lead poisoning treatment. J Colloid Interface Sci 2012;371(1):144-9.
Aykin-Burns N, Franklin EA, Ercal N. Effects of Nacetylcysteine on lead-exposed PC-12 cells. Arch Environ Contam Toxicol. 2005 Jul;49(1):119-23.
Caylak E, Aytekin M, Halifeoglu I. Antioxidant effects of methionine, alpha-lipoic acid, N-acetylcysteine and homocysteine on lead-induced oxidative stress to erythrocytes in rats. Exp Toxicol Pathol 2008;60(4-5):289-94.
Flora SJ, Pande M, Bhadauria S, et al. Combined administration of taurine and meso 2,3-dimercaptosuccinic acid in the treatment of chronic lead intoxication in rats. Hum Exp Toxicol 2004;23(4):157-66.
Kilikdar D, Mukherjee D, Mitra E, et al. Protective effect of aqueous garlic extract against lead-induced hepatic injury in rats. Indian J Exp Biol 2011;49(7):498-510.
Najar-Nezhad V, Aslani MR, Balali-Mood M. Evaluation of allicin for the treatment of experimentally induced subacute lead poisoning in sheep. Biol Trace Elem Res 2008;126(1-3):141-7.
Kianoush S, Balali-Mood M, Mousavi SR, et al. Comparison of therapeutic effects of garlic and d- Penicillamine in patients with chronic occupational lead poisoning. Basic Clin Pharmacol Toxicol 2012;110(5):476-81.
Deldar K, Nazemi E, Balali Mood M, et al. Effect of Coriandrum sativum L. extract on lead excretion in 3-7 year old children. J Birjand Univ Med Sci 2008;15(3):9 -11.