Exposure Factors Associated With Chronic Beryllium Disease Development in Beryllium BioBank Participants

Chronic Beryllium Disease: Update on a Moving Target

Beryllium exposure remains an ongoing occupational health concern for workers worldwide. Since the initial Occupational Safety and Health Administration (OSHA) ruling on a permissible exposure limit (PEL) for beryllium in 1971, our understanding of the risks of beryllium sensitization and chronic beryllium disease (CBD) has evolved substantially. A new OSHA ruling released in early 2017 and implemented in late 2018 reduced the PEL for beryllium, increased requirements for medical screening and monitoring, and may ultimately enhance worker protection. This review highlights advances in our understanding of the pathway from beryllium exposure to sensitization and progression to CBD that guided the development of this OSHA ruling. Screening workers exposed to beryllium and management of CBD will also be discussed. Finally, we will discuss the role of beryllium as a cause of morbidity and mortality among exposed workers in this potentially preventable occupational lung disease.

Lack of an Exposure Response and Interaction With HLA-DPβ1 and DRβ1 Polymorphisms in the Development of Beryllium Toxicity in a High Beryllium Exposure Cohort

OBJECTIVE

To evaluate interaction of HLA-DPβ1 and DRβ1 polymorphisms with metrics of beryllium exposure, in the development of beryllium sensitization (BeS) and chronic beryllium disease (CBD).

METHODS

A matched case-control study of 61 CBD, 41 BeS, and 259 controls from two beryllium-processing facilities.

RESULTS

BES and CBD were significantly associated with presence of DPβE69. Dose response of exposure was not observed for the development of BES and CBD with/without adjustment for DPβE69 (P > 0.05). The DRβE71 polymorphism was more common in BeS than CBD after adjusting for exposure and maybe a protective factor (aOR 0.4, 95% CI 0.2 to 0.9) against the progression of BeS to CBD.

CONCLUSION

No exposure-response association was found, which may reflect that the workers in this high exposure cohort were above a threshold level where an exposure-response could be observed.

Beryllium BioBank: 2. Lymphocyte proliferation testing

OBJECTIVE

To incrementally improve the use of beryllium lymphocyte proliferation test (LPT) results.

METHODS

Beryllium BioBank data were analyzed for 532 subjects in three groups: beryllium-exposed, sensitized, or chronic beryllium disease. Predictor variables were LPT stimulation index (SI) at the date of the earliest available data and at the study entry date.

RESULTS

Cross-sectionally, LPT SI magnitude does not distinguish among the three groups. The likelihood of progression from sensitization to disease is associated with the absolute value of SI, but LPT SI interpreted by traditional cut point criteria was not predictive.

CONCLUSIONS

Updating the criteria for interpreting beryllium LPT data should be considered. Prediction of progression to chronic beryllium disease may be improved by changing the cut point for interpretation or by using the SI as a continuous variable.