Berylliosis Treatment & Management

  • Author: Raed A Dweik, MD, FACP, FRCP(C), FCCP, FCCM, FAHA; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: May 26, 2011
 

Medical Care

Prevention is a key component in the management of chronic beryllium disease (CBD). The current Occupational Safety and Health Administration (OSHA) standards for workplace air require an 8-hour, time-weighted average maximum permissible level of 2 mcg/m3 along with a peak level of 25 mcg/m3. The beryllium concentration in the air around factories is not to exceed 0.01 mcg/m3. Some studies suggest that the current standard of 2 mcg/m3 is not protective.[9] Although no proof exists that cessation of exposure to beryllium improves the disease course or slows the progression, advising all patients with CBD to avoid any further exposure to beryllium is prudent.

Due to the use of BeLPT testing to screen workers exposed to beryllium, many cases now are diagnosed very early in the course of the disease, before radiographic or physiologic changes are observed and before symptoms or physical signs develop.

The natural history of the disease is not clear in patients who have granulomas on TBBX but who are asymptomatic and have no physiologic or radiographic abnormalities.

The current indications for therapy include the presence of symptoms, abnormal pulmonary function test results, or a decline in pulmonary function over time. In the absence of any of these criteria, no therapy is recommended. Close monitoring of symptoms and follow-up pulmonary function testing is recommended.

No controlled studies for CBD therapy are available. Based on the pathogenesis of the disease (immune-mediated) and due to the similarities with sarcoidosis, CBD is treated with corticosteroids. When corticosteroid therapy fails or in patients who develop significant adverse effects, methotrexate (MTX) may be considered.

Next

Surgical Care

In end-stage cases, lung transplantation may be considered.

Previous
Next

Consultations

A team approach involving industrial hygiene, occupational health, and pulmonary specialists is necessary for prevention, screening, early diagnosis, and appropriate treatment of CBD.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Raed A Dweik, MD, FACP, FRCP(C), FCCP, FCCM, FAHA,  Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine; Director, Pulmonary Vascular Program, Respiratory Institute, Cleveland Clinic

Raed A Dweik, MD, FACP, FRCP(C), FCCP, FCCM, FAHA, is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, American Thoracic Society, Royal College of Physicians and Surgeons of Canada, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Oleh Wasyl Hnatiuk, MD  Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences

Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregg T Anders, DO  Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Gregg T Anders, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

References

  1. Saltini C, Winestock K, Kirby M, Pinkston P, Crystal RG. Maintenance of alveolitis in patients with chronic beryllium disease by beryllium-specific helper T cells. N Engl J Med. Apr 27 1989;320(17):1103-9. [Medline].

  2. Van Dyke MV, Martyny JW, Mroz MM, et al. Risk of Chronic Beryllium Disease by HLA-DPB1 E69 Genotype and Beryllium Exposure in Nuclear Workers. Am J Respir Crit Care Med. Mar 11 2011;[Medline].

  3. Berlin JM, Taylor JS, Sigel JE, Bergfeld WF, Dweik RA. Beryllium dermatitis. J Am Acad Dermatol. Nov 2003;49(5):939-41. [Medline].

  4. Richeldi L, Sorrentino R, Saltini C. HLA-DPB1 glutamate 69: a genetic marker of beryllium disease. Science. Oct 8 1993;262(5131):242-4. [Medline].

  5. Barna BP, Culver DA, Yen-Lieberman B, Dweik RA, Thomassen MJ. Clinical application of beryllium lymphocyte proliferation testing. Clin Diagn Lab Immunol. Nov 2003;10(6):990-4. [Medline].

  6. Newman LS. Significance of the blood beryllium lymphocyte proliferation test. Environ Health Perspect. Oct 1996;104 Suppl 5:953-6. [Medline].

  7. Rossman MD, Kern JA, Elias JA, Cullen MR, Epstein PE, Preuss OP, et al. Proliferative response of bronchoalveolar lymphocytes to beryllium. A test for chronic beryllium disease. Ann Intern Med. May 1988;108(5):687-93. [Medline].

  8. Newman LS, Buschman DL, Newell JD Jr, Lynch DA. Beryllium disease: assessment with CT. Radiology. Mar 1994;190(3):835-40. [Medline].

  9. Kreiss K, Mroz MM, Newman LS, Martyny J, Zhen B. Machining risk of beryllium disease and sensitization with median exposures below 2 micrograms/m3. Am J Ind Med. Jul 1996;30(1):16-25. [Medline].

  10. Amicosante M, Berretta F, Franchi A, Rogliani P, Dotti C, Losi M, et al. HLA-DP-unrestricted TNF-alpha release in beryllium-stimulated peripheral blood mononuclear cells. Eur Respir J. Nov 2002;20(5):1174-8. [Medline].

  11. Culver DA, Dweik RA. Chronic beryllium disease. Clin Pulm Med. 2003;10:72-9.

  12. Kreiss K, Miller F, Newman LS, Ojo-Amaize EA, Rossman MD, Saltini C. Chronic beryllium disease--from the workplace to cellular immunology, molecular immunogenetics, and back. Clin Immunol Immunopathol. May 1994;71(2):123-9. [Medline].

  13. Kreiss K, Mroz MM, Zhen B, Wiedemann H, Barna B. Risks of beryllium disease related to work processes at a metal, alloy, and oxide production plant. Occup Environ Med. Aug 1997;54(8):605-12. [Medline].

  14. Kreiss K, Newman LS, Mroz MM, Campbell PA. Screening blood test identifies subclinical beryllium disease. J Occup Med. Jul 1989;31(7):603-8. [Medline].

  15. Kriebel D, Brain JD, Sprince NL, Kazemi H. The pulmonary toxicity of beryllium. Am Rev Respir Dis. Feb 1988;137(2):464-73. [Medline].

  16. Meyer KC. Beryllium and lung disease. Chest. Sep 1994;106(3):942-6. [Medline].

  17. MOSBY'S GENRx-The Complete Reference For Generic And Brand Drugs. 9th ed. St. Louis, Mo: Mosby-Year Book; 1999.

  18. Müller-Quernheim J, Gaede KI, Fireman E, Zissel G. Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients. Eur Respir J. Jun 2006;27(6):1190-5. [Medline].

  19. Newman LS. Immunology, genetics, and epidemiology of beryllium disease. Chest. Mar 1996;109(3 Suppl):40S-43S. [Medline].

  20. Newman LS, Kreiss K, King TE Jr, Seay S, Campbell PA. Pathologic and immunologic alterations in early stages of beryllium disease. Re-examination of disease definition and natural history. Am Rev Respir Dis. Jun 1989;139(6):1479-86. [Medline].

  21. Newman LS, Lloyd J, Daniloff E. The natural history of beryllium sensitization and chronic beryllium disease. Environ Health Perspect. Oct 1996;104 Suppl 5:937-43. [Medline].

  22. Newman LS, Mroz MM, Balkissoon R, Maier LA. Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care Med. Jan 1 2005;171(1):54-60. [Medline].

  23. Pappas GP, Newman LS. Early pulmonary physiologic abnormalities in beryllium disease. Am Rev Respir Dis. Sep 1993;148(3):661-6. [Medline].

  24. Saber W, Dweik RA. A 65-year-old factory worker with dyspnea on exertion and a normal chest x-ray. Cleve Clin J Med. Nov 2000;67(11):791-2, 794, 797-8, 800. [Medline].

  25. Stokes RF, Rossman MD. Blood cell proliferation response to beryllium: analysis by receiver-operating characteristics. J Occup Med. Jan 1991;33(1):23-8. [Medline].

 
Previous
Next
 
A high-resolution CT scan of the chest showing the typical ground glass appearance in a patient with chronic beryllium disease, or berylliosis.
A histopathology slide (hematosin and eosin stain) showing the typical well-formed granuloma of chronic beryllium disease, or berylliosis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.