Niacin Intoxication from Pumpernickel Bagels -- New York
On April 27, 1983, 14 (20%) of 69 persons attending a brunch
had
acute onset of rash, pruritis, and sensation of warmth. The
illness
was of relatively short duration, with an incubation period of
approximately 30 minutes after consumption of one or more
pumpernickel
bagels served at the brunch. Of 25 persons who ate the bagels, 14
(56%) became ill, whereas none of the 44 persons who did not eat
pumpernickel bagels became ill. The bagels had been produced at a
local bagel factory from a batch of dough originally prepared on
April
23.
A review of reports from the hospital emergency room serving
the
area revealed that an emergency-room visit was made by one person
with
similar symptoms on April 24 and by two other persons on April 27.
All three had eaten pumpernickel bagels made from the same batch of
dough.
Because the pumpernickel bagels were very light in color, the
ingredients were suspected. Investigation revealed that, in an
attempt to enrich the pumpernickel flour, a large quantity of
niacin
had been added, apparently from an improperly labeled container.
Laboratory studies revealed 60 times the normal level of niacin in
the
pumpernickel flour. On the basis of these data, each bagel
contained
approximately 190 mg of niacin; the recommended dietary allowance
for
niacin is 6.6 mg/1000 calories or about 13 mg/day for the average
adult (1). Measures have been taken to assure proper labeling of
all
ingredient containers in the bagel factory.
Reported by J Sevchick, M Guerrette, E George, PhD, New York State
Dept of Agriculture and Markets, J Campana, S Redmond, MD,
JL Nitzkin, MD, Monroe County Health Dept, C Reiffler, MD, Student
Health Svcs, University of Rochester, K Martin, MD, Emergency Dept,
The Genesee Hospital, Rochester, D Eiseman, New York State Dept of
Agriculture and Markets, J Guzewich, R Rothenberg, MD, State
Epidemiologist, New York State Dept of Health; Div of Field Svcs,
Epidemiology Program Office, Epidemiology Branch, Div of Nutrition,
Center for Health Promotion and Education, CDC.
Editorial Note
Editorial Note: Acute ingestion of excessive amounts of niacin
(nicotinic acid, one of the B-complex vitamins), such as in this
instance, can produce an acute syndrome of cutaneous vasodilation
of
the face and trunk, pruritus and sensation of heat (2).
Gastrointestinal distress has also been noted. Although alarming,
these symptoms usually resolve spontaneously over several hours
without sequelae. Outbreaks of this syndrome have previously been
reported in association with inappropriate food additive use (3) or
with mislabeled food ingredient containers (4). An unusual color
of
the implicated food was also noted in the latter outbreak.
Excessive, chronic use of high doses of niacin, which may occur
in
persons taking large amounts of vitamins, has been related to the
occurrence of hepatitis (5).
References
Food and Nutrition Board, National Research Council.
Recommended
dietary allowances. National Academy of Sciences, Washington,
D.C., 1980.
Mosher LR. Nicotinic acid side effects and toxicity: a review.
Amer J Psychiatry 1970;126:1290-6.
Press E, Yeager L. Food "poisoning" due to sodium
nicotinate--report of an outbreak and a review of the
literature.
Am J Public Health 1962;52:1720-8.
CDC. Illness associated with high levels of niacin in
cornmeal--Illinois. MMWR 1981;30:11-2.
Patterson DJ, Dew EW, Gyorkey F, Graham DY. Niacin hepatitis.
South Med J 1983;76:239-42.
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