Lead (Pb) continues to be a contaminant of public health concern throughout the world. This narrative review identified electronic papers on the risk assessment of Pb to assess the impact of the lack of a reference dose (RfD) for Pb on the methods and approaches of its risk assessment. Although the World Health Organization (WHO) withdrew the provisional tolerable weekly intake (PTWI) and the United States Environmental Protection Agency (USEPA) desisted from issuing an RfD for Pb, the use of these parameters has continued to be prevalent in the literature. This is worrisome and concerning as these parameters are not sufficiently protective, have no scientific basis, and may lead to misleading conclusions and recommendations. On the other hand, using a predetermined risk level, benchmark dose (BMD), and probabilistic approaches offer viable alternatives to the risk assessment of Pb. Remarkably, the use of a probabilistic RfD and the use of a deterministic RfD along with probabilistic exposure data can be observed in the literature, with the latter failing to address the risk assessment challenges that arise from lead's lack of no-observed-adverse-effect level (NOAEL). Biokinetic models are also often used to convert environmental Pb to blood lead, with appropriate actions taken to reduce exposure at the WHO-recommended blood Pb concentration of ≥5 ug/dl (observed or predicted).
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