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Beryllium Sensitization Progresses to Chronic Beryllium Disease

A Longitudinal Study of Disease Risk

Division of Environmental and Occupational Health Sciences and Division of Pulmonary Medicine, Department of Medicine, National Jewish Medical and Research Center; and Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine and Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado

Correspondence and requests for reprints should be addressed to Lee S. Newman, M.D., M.A., National Jewish Medical and Research Center, 1400 Jackson Street, Room G-010, Denver, CO 80206. E-mail: newmanl{at}njc.org

The blood beryllium lymphocyte proliferation test is used in medical surveillance to identify both beryllium sensitization and chronic beryllium disease. Approximately 50% of individuals with beryllium sensitization have chronic beryllium disease at the time of their initial clinical evaluation; however, the rate of progression from beryllium sensitization to chronic beryllium disease is unknown. We monitored a cohort of beryllium-sensitized patients at 2-year intervals, using bronchoalveolar lavage and repeated transbronchial lung biopsies to determine progression to chronic beryllium disease as evidenced by granulomatous inflammation in lung tissue. Fifty-five individuals with beryllium sensitization were monitored with a range of 2 to 5 clinical evaluations. Disease developed in 17 sensitized individuals (31%) within an average follow-up period of 3.8 years (range, 1.0–9.5 years). Thirty-eight of the 55 (69%) remained beryllium sensitized without disease after an average follow-up time of 4.8 years (range, 1.7–11.6 years). Progressors were more likely to have worked as machinists. We found no difference in average age, sex, race or ethnicity, smoking status, or beryllium exposure time between those who progressed to chronic beryllium disease and those who remained sensitized without disease. We conclude that beryllium sensitization is an adverse health effect in beryllium-exposed workers and merits medical follow-up.

Key Words: berylliosis • beryllium • lymphocyte proliferation test • medical surveillance • transbronchial biopsy

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