About Beryllium Sensitization and Chronic Beryllium Disease

What is beryllium sensitization?
What are the symptoms of beryllium sensitization?
What is chronic beryllium disease?
What are the symptoms of chronic beryllium disease (CBD)?
How do you get beryllium sensitization or CBD?
How do I know if I have beryllium sensitization or CBD?
What is medical surveillance?
What can I do to prevent beryllium sensitization and CBD?
References

What is beryllium sensitization?

Beryllium sensitization is an “allergic” condition to beryllium that can develop after a person breathes beryllium dust or fumes. Some researchers think it might also occur if beryllium penetrates the skin through an open cut or from a beryllium splinter.

In individuals with beryllium sensitization, the immune system sees beryllium as a “foreign invader,” and builds an “army” of cells in the bloodstream that are prepared to react to beryllium wherever they see it in the body. These cells can be found in the blood using a blood test called the beryllium lymphocyte proliferation test (BeLPT).

What are the symptoms of beryllium sensitization?

Beryllium sensitization does not have any symptoms.

What is chronic beryllium disease?

Chronic beryllium disease (CBD) is a lung condition that can develop after a person breathes beryllium dust or fumes. The immune system sees beryllium as a “foreign invader,” and builds an “army” of cells in the bloodstream that are prepared to react to beryllium wherever they see it in the body. When an individual is diagnosed with CBD, it generally means the battle between the immune system and the beryllium particles has resulted in scarring (called granulomas) in the lungs.

What are the symptoms of chronic beryllium disease (CBD)?

Individuals with CBD may not have any symptoms at first, especially if the disease is diagnosed at an early stage. Patients may notice shortness of breath with walking, climbing stairs, or another activity, as well as a dry cough that will not go away. Some people may also experience fatigue, night sweats, chest and joint pain, and loss of appetite as the disease progresses.

How do you get beryllium sensitization or CBD?

It is important to know that no one develops beryllium sensitization or chronic beryllium disease unless they are exposed to beryllium. Beryllium sensitization and CBD may develop after an individual breathes beryllium dust or fume. Not every individual who is exposed to beryllium will experience health effects. Studies have shown that on average, 2-6% of exposed workers develop sensitivity, although the rates can be as high as 20% among workers with the highest exposures, such as beryllium machinists ^1,2-5. It is estimated that CBD occurs in 2 to 5% of all beryllium-exposed workers, although the rates have been shown to be as high as 16% among individuals performing certain processes, such as machinists ^1,4-6. Factors such as particle size, type of beryllium used, amount and duration of exposure to beryllium, occupation, industry, and genetics may all play a role in determining why some people get sick and others do not. Once you are exposed to beryllium, you carry a lifelong risk of developing beryllium sensitization or CBD, even if the exposure amount was small or you are no longer exposed.

How do I know if I have beryllium sensitization or CBD?

Diagnosis of beryllium sensitization and CBD begins with a beryllium lymphocyte proliferation test (BeLPT). The BeLPT is a blood test that helps determine if your immune system recognizes beryllium as a foreign invader and responds by building an “army” of cells in the bloodstream that are prepared to react to beryllium. In individuals who do not have beryllium sensitization or CBD, the immune system does not respond to beryllium in any manner. The BeLPT is an important first step in diagnosing disease, but it cannot determine if you have CBD (scarring in the lungs or simply beryllium sensitization (“allergy” to beryllium). Additional testing is needed to determine whether or not you have disease.

Individuals with two or more abnormal BeLPT results are encouraged to undergo further evaluation to determine if they have CBD. This evaluation typically includes an appointment with a physician familiar with the health effects of beryllium, exercise tolerance testing , pulmonary function testing , a chest x-ray and B read, blood work, and bronchoscopy with biopsy and lavage. Based on the outcomes of these tests, your physician will likely be able to determine if you have CBD.

What is medical surveillance?

Medical surveillance programs for beryllium are designed to identify individuals with beryllium sensitization or CBD, as well as work practices that may cause beryllium sensitization and CBD. Surveillance programs typically have several components, including medical screening tests, exposure assessment, and work task analysis. Data collected during surveillance can help identify rates of sensitization and disease among individuals who perform similar types of work, leading to better exposure controls for all workers.

What can I do to prevent beryllium sensitization and CBD?

The Occupational Safety and Health Administration (OSHA) has set the permissible exposure limit (PEL) for beryllium at 2 micrograms per cubic meter in an 8-hour period. This is roughly equivalent to an amount of beryllium dust the size of a pencil tip spread across an area the length of a football field, 8 feet high. This standard has been shown to be inadequate to prevent beryllium sensitization and CBD ^5,7,8, and many in the beryllium community and at OSHA are currently working to establish a lower limit in the workplace. Because we do not know of a definite “safe” level of exposure below which sensitization and disease do not occur, it is important to limit beryllium exposure to the lowest level possible. In the workplace, you should substitute another product for beryllium if at all possible, avoid dry sweeping of work areas, use proper exhaust ventilation and equipment, minimize the number of individuals who have access to areas where beryllium is used, ensure respirators fit properly and are used appropriately, change clothes before leaving the beryllium area and work facility, and ensure employees receive regular training on the proper handling of beryllium, as well as the hazards of beryllium exposure. For more information on safe work practices, or for an industrial hygiene consultation at your facility, please contact us at 1-800-423-8891, x1722, or via e-mail at beryllium@njc.org.

References:

1. Kreiss K, Mroz MM, Zhen B, Martyny JW, Newman LS. Epidemiology of beryllium sensitization and disease in nuclear workers. Am Rev Respir Dis 1993; 148:985-991.
2. Kriebel D, et al. The pulmonary toxicity of beryllium. Am Rev Respir Dis 1988; 137: 464-473.
3. Kreiss K, Newman LS, Mroz M, Campbell PA. Screening blood test identifies subclinical beryllium disease. J Occ Med 1989; 31:603-608.
4. Kreiss K, Wasserman S, Mroz MM, Newman LS. Beryllium disease screening in the ceramics industry: Blood test performance and exposure-disease relations. J Occup Med 1993; 35:267-274.
5. Kreiss K, Mroz MM, Newman LS, Martyny J, Zhen B. Machining risk of beryllium disease and sensitization with median exposures below 2 mg/m³. Am J Indust Med 1996; 30:16-25.
6. Kreiss K, et al. Risks of beryllium disease related to work processes at a metal, alloy and oxide production plant. Occup Environ Med 1997; 54:605-612.
7. Yoshida T, Shima S, Nagaoka K et al. A study on the Beryllium Lymphocyte Transformation Test and the beryllium levels in working environment. Ind Health 1997; 35:374-379.
8. Cullen M, et al. Chronic beryllium disease in a precious metal refinery: clinical, epidemiologic, and immunologic evidence for continuing risk from exposure to low-level beryllium fume. Am Rev Respir Dis 1987; 135:201-208.