Sensitization, beryllium

Madl, A. K., Unice, K. M., Brown, J. L., Kolanz, M. E., and Kent, M. S. (2007). Exposure-response analysis for beryllium sensitization and chronic beryllium disease among worka-s in a beryllium metal machining plant. J Occup Environ Hyg 4(6), 448-466. 

Department of Energy has adopted 0.2 pg m as an action level (US Department of Energy 1999). Whether this new lower standard will eliminate this disease is not yet known. Unfortunately, because of the long latency from initial exposure until the development of clinical disease (i.e., more than 10 years), it will take at least 10 years and the evaluation of only newly hired workers to determine whether or not this new standard will eliminate the disease. Because the beryllium LPT can be used to detect beryllium sensitization before the onset of clinical symptoms, it... 

Although skin exposure to beryllium has been associated with disease in the past (Epstein 1991), it is uncertain whether skin exposure today is a cause of beryllium sensitization (Henneberger etal. 2001). Nevertheless, prudence would dictate precautions to eliminate the potential for skin exposures in workers. 

Henneberger PK, Cumro D, Deubner DD, Kent MS, McCawley M and Keeiss K (2001) Beryllium sensitization and disease among long-term and short- term workers in a beryllium ceramics plant. Int Arch Occup Environ Health 74 167-176. 

Immunologic Sensitivity to beryllium was investigated among 362 workers at an aluminium smelter in Norway [40 ]. One had abnormal results in two separate blood samples and was sensitized to beryllium. Three others had one abnormal test that was not confirmed by a second test. One of a control group of 31 people had one abnormal and one normal test result. This frequency of beryllium sensitivity is much lower than is found in the beryllium handling industry, which the authors attributed to lower atmospheric concentrations, beryllium speciation effects, or the use of respiratory protective equipment. 

Beryllium exposure has been studied in 3185 workers from nine aluminium smelters owned by four different aluminium-producing companies, of whom 1932 workers participated in medical surveillance programs that included the serum beryllium lymphocyte proliferation test, confirmation of sensitization by at least two abnormal test results, and further evaluation for chronic beryllium disease in workers with beryllium sensitivity [41 ]. Nine workers had beryllium sensitivity (prevalence rate = 0.47%, 95% CI = 0.21, 0.88). The authors attributed the low rate of sensitization in aluminium smelters to the more soluble form of beryllium found in the aluminium smelting work environment and the consistent use of respiratory protection. 

Taiwo OA, Slade MD, Cantley LF, Kirsche SR, Wesdock JC, Cullen MR. Prevalence of beryllium sensitization among aluminium smelter workers. Occup Med (Lond) 2010 60(7) 569-71. 

Beryllium-related pulmonary manifestations exist on a continuum from acute inhalational injury to acute pneumonitis, beryllium sensitization, and the chronic form, that has been called berylliosis, chronic berylliosis, and which is now known as chronic beryllium disease (CBD). 

The use of the blood BeLPT has defined a subset of exposed workers who develop an adaptive immune response to beryllium, but in whom there are no pathologic or clinical features of CBD. These individuals are asymptomatic and have normal pulmonary function, exercise tolerance, chest radiographs, and lung biopsies. Although their blood BeLPT is abnormal, they have not yet developed a clinically detectable inflammatory process in the lung. The rate of beryllium sensitization without disease in a few published smdies has ranged from 1% to... 

As for any occupational illness or injury, it is incumbent upon the diagnosing clinician to make patients aware that they have been diagnosed with a work-related illness and that this may qualify them for workers compensation benefits. These benefits vary state to state and country to country. In the United States, patients with beryllium sensitization, CBD or lung cancer who have worked around beryllium at a U.S. Department of Energy site may qualify for a special compensation program under the Energy Employees Occupational Illness Compensation Act (EEOICPA) and should be encouraged to contact the U.S. Department of Labor. 

Stange AW, Hilmas DE, Furman FJ, et al. Beryllium sensitization and chronic beryllium disease at a former nuclear weapons facility. Appl Occup Environ Hyg 2001 16(3) 405-417. 

Stefaniak AB, Day GA, Hoover MD, et al. Differences in dissolution behavior in a phagolysosomal simulant fluid for single-constituent and multi-constituent materials associated with beryllium sensitization and chronic beryllium disease. Toxicol In Vitro 2006 20(1) 82-95. 

Newman LS, Lloyd J, Daniloff E. The natural history of beryllium sensitization and chronic beryllium disease. Environ Health Perspect 1996 104(suppl 5) 937-943. 

Newman LS, Mroz MM, Balkissoon R, et al. Beryllium sensitization progresses to chronic beryUium disease a longitudinal study of disease risk. Am J Respir Crit Care Med 2005 171(l) 54-60. 

Maier LA, McGrath DS, Sato H, et al. Influence of MHC class II in susceptibility to beryllium sensitization and chronic beryllium disease. J Immunol 2003 171(12) 6910-6918. 

Weston A, Snyder J, McCanlies EC, et al. Immunogenetic factors in beryllium sensitization and chronic beryllium disease. Mutat Res 2005 592(l-2) 68-78. 

McCanlies EC, Ensey JS, Schuler CR, et al. The association between HLA-DPBlGlu69 and chronic beryllium disease and beryllium sensitization. Am J Ind Med 2004 46(2) 95-103. 

Sato H, Silveira L, FingerUn T, et al. TNF polymorphism and bronchoalveolar lavage cell TNF-alpha levels in chronic beryllium disease and beryllium sensitization. J Allergy Clin Immunol 2007 119(3) 687-696. 

Stoeckle JD, Hardy HL, Weber AL. Chronic beryUium disease long-term followup of sixty cases and selective review of the literature. Am J Med 1969 46 545-561. Lundgren RA, Maier LA, Rose CS, et al. Indirect and direct gas exchange at maximum exercise in beryllium sensitization and disease. Chest 2001 120(5) 1702-1708. 

Farris GM, Newman LS, Frome EL, et al. Detection of beryllium sensitivity using a flow cytometric lymphocyte proliferation test the Immuno-Be-LPT. Toxicology 2000 143(2) 125-140. 

Milovanova TN, Pompa SH, Cherian S, et al. Flow cytometric test for beryllium sensitivity. Cytometry B Clin Cytom 2004 60(l) 23-30. 

In the U.S., laboratories performing the test formed a working group, the Committee to Accredit Beryllium Sensitivity Testing, to address technical issues (Barna et al. 2003). 

Beryllium exposure occurs in a wide variety of occupations. It may cause acute berylliosis (currently very rare), beryllium sensitization, chronic beryllium disease, or lung cancer. Imaging manifestations of chronic beryllium disease are generally similar to those of sarcoidosis, with nodules, ground glass abnormality, septal thickening, conglomerate masses, and mediastinal or hilar lymphadenopathy. 

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