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Beryllium Disease



Carrie A. Redlich

, MD, MPH, Yale Occupational and Environmental Medicine Program Yale School of Medicine;

Efia S. James

, MD, MPH, Yale School of Medicine;

Brian Linde

, MD, MPH, Yale Occ and Env Medicine Program

Reviewed/Revised Nov 2023

Chronic beryllium disease is lung inflammation caused by inhaling dust or fumes that contain beryllium, a metal that is used in small amounts in many industries.

  • People with chronic beryllium disease may gradually develop coughing, difficulty breathing, fatigue, and night sweats.

  • Acute beryllium disease is now rare because most industries have reduced exposure levels.

  • Diagnosis of chronic beryllium disease is typically based on the person’s history of exposure, results of chest imaging (x-rays, computed tomography (CT)), tests of the immune system’s reaction to beryllium, and lung biopsy when indicated.

  • Oxygen and corticosteroids may be needed for treatment.

  • People with chronic beryllium disease should be removed from further exposure.

Causes of Beryllium Disease

Beryllium exposure can occur in many industries, including beryllium mining and extraction, alloy production, metal alloy machining, electronics, telecommunications, nuclear weapon and defense industries, aerospace, and metal reclamation and recycling. Small amounts of beryllium may also be added to copper, aluminum, nickel, and other metals to make beryllium alloys.

Relatively low-level exposures can cause chronic beryllium disease. Individuals can develop beryllium sensitization (their T cells in the immune system Overview of the Immune System The immune system is designed to defend the body against foreign or dangerous invaders. Such invaders include Microorganisms (commonly called germs, such as bacteria, viruses, and fungi) Parasites... read more become sensitized to beryllium and then increase rapidly in number on re-exposure). The risk of progression from beryllium exposure to beryllium sensitization has many factors, including the dose of exposures, duration of exposures, and genetic factors. Workers with bystander exposures, such as administrative assistants and security guards, can also develop beryllium sensitization and disease, though at lower rates.

Symptoms of Beryllium Disease

People with chronic beryllium disease have shortness of breath, cough, night sweats, fatigue, and weight loss. Symptoms may develop within months of first exposure or more than 30 years after exposure has ceased.

Diagnosis of Beryllium Disease

  • A history of exposure to beryllium

  • Chest imaging (x-ray or computed tomography)

  • Test for sensitization to beryllium

A chest x-ray may be normal or show abnormalities, often resembling those seen in people with sarcoidosis. High-resolution chest computed tomography Computed Tomography (CT) of the Chest Chest imaging studies include X-rays Computed tomography (CT) CT angiography Magnetic resonance imaging (MRI) read more is more sensitive than x-ray, although people with beryllium disease can have normal imaging test results.

The diagnosis of beryllium disease can be challenging. However, doctors can make a diagnosis of probable beryllium disease based on various combinations of diagnostic criteria, including a history of exposure, chest imaging, abnormal pulmonary function test results, abnormal BeLPT results,, and lung biopsy. Certain findings, such as an abnormal BeLPT, provide greater diagnostic certainty than others, such as nonspecific x-ray changes.

Treatment of Beryllium Disease

  • Discontinuation of exposure

  • Sometimes corticosteroids and immunosuppressants

People with chronic beryllium disease should be removed from further exposure to beryllium.

The natural history of beryllium disease varies, and some people do not require treatment because the disease is stable or progresses relatively slowly. Otherwise, treatment is similar to that of pulmonary sarcoidosis Sarcoidosis Sarcoidosis is a disease in which abnormal collections of inflammatory cells (granulomas) form in many organs of the body. Sarcoidosis usually develops in people aged 20 to 40 years, most often... read more Sarcoidosis .

Corticosteroids, such as oral prednisone, are usually started in people with a combination of pulmonary symptoms and evidence of disease progression. The corticosteroid dose is gradually reduced to the lowest dose that maintains symptomatic and objective improvement. Some people with chronic beryllium disease may be given methotrexate or infliximab.

Prognosis for Beryllium Disease

Chronic beryllium disease has a variable clinical course. Disease can remain stable or progress slowly with loss of respiratory function over time. In a subset of cases, chronic beryllium disease can progress to end-stage lung disease. Disease frequently progresses even after exposure to beryllium is eliminated.

Prevention of Beryllium Disease

Facilities that use beryllium-containing products should implement a control program to minimize exposure to beryllium. The United States Occupational Safety and Health Administration (OSHA) has set the permissible exposure limit of beryllium to 0.2 micrograms per cubic meter of air, averaged over 8 hours (see OSHA Beryllium Standards). This standard is expected to reduce the number of cases but not entirely eliminate chronic beryllium disease, as cases can still develop at exposure levels below the OSHA standard. Efforts should also be made to minimize skin exposure, given the potential for sensitization following skin contact.

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