January 5, 2024
Update on High Blood Lead Levels in Children Consuming Recalled Cinnamon Applesauce Pouches and Potential Chromium Exposure
The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), as well as state and local officials are investigating a link between blood lead levels (BLLs) ≥3.5 µg/dL and children consuming certain apple purée and applesauce products containing cinnamon. WanaBana, Schnucks, and Weis brands have voluntarily recalled certain lots of the following products that were tested and found to contain high levels of lead:
CDC’s National Center for Environmental Health (NCEH) and FDA’s Coordinated Outbreak Response & Evaluation (CORE) Network continue investigations to identify individuals across the United States who may have consumed these products with high levels of lead. Updates about the investigation can be found on the FDA’s website, Investigation of Elevated Lead Levels: Cinnamon Applesauce Pouches (November 2023) | FDA. More details about case identification are available on CDC’s website, Lead Poisoning Outbreak Linked to Cinnamon Applesauce Pouches. Additional information for clinicians can be found in the CDC Health Advisory published November 13, 2023, Health Alert Network (HAN) - 00500 | High Blood Lead Levels in Children Consuming Recalled Cinnamon Applesauce Pouches.
FDA product testing has also identified high levels of chromium in cinnamon samples and recalled apple cinnamon puree pouches. Chromium is a naturally occurring element with trace levels normally found in the diet. The most common forms of chromium found in chromium compounds are trivalent chromium (chromium(III)) and hexavalent chromium (chromium(VI)). Chromium(III) is considered an essential nutrient and can be found in dietary supplements. Chromium(VI), however, is a known carcinogen. Chronic, prolonged inhalational and skin exposure to chromium(VI) has been associated with chronic lung disease and ulceration of skin and mucous membranes. Lead chromate, which contains chromium(VI), has been used to adulterate turmeric and other spices. While harm resulting from ingesting lead-contaminated food is relatively well researched, the effects of eating food contaminated with chromium(VI), as a constituent of lead chromate, are not well understood. Chromium(VI) compounds may be converted to chromium(III) in acidic environments. Currently, FDA testing cannot identify whether the chromium in the cinnamon and recalled apple cinnamon puree pouches is chromium(III) or chromium(VI).
Recommendations for Clinicians:
For Possible Lead Exposure
For Possible Chromium Exposure
For more Information
America’s Poison Centers
Pediatric Environmental Health Specialty Unit
American College of Medical Toxicology
Association of Occupational and Environmental Clinics
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