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{{Infobox medical condition (new)
| name            = Berylliosis
| synonyms        = Chronic beryllium disease (CBD)
| image           = Chronic berylliosis (8054314225).jpg
| caption         = Peribronchal non-necrotizing granuloma from berylliosis
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| field           = [[Pulmonology]]
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'''Berylliosis''', or '''chronic beryllium disease''' ('''CBD'''), is a chronic allergic-type lung response and chronic lung [[disease]] caused by exposure to [[beryllium]] and its compounds, a form of [[beryllium poisoning]]. It is distinct from [[acute beryllium poisoning]], which became rare following occupational exposure limits established around 1950.<ref name=OSHAhealtheffects/> Berylliosis is an [[occupational lung disease]].

While there is no cure, symptoms can be treated.<ref>{{cite web |last=Dweik  |first=Raed A |title=Berylliosis: Treatment & Medication |publisher =Medscape |date=2008-11-19 |url=http://emedicine.medscape.com/article/296759-treatment |access-date=2009-08-21}}</ref>

==Signs and symptoms==
With single or prolonged exposure by inhalation the lungs may become sensitized to beryllium. Berylliosis has a slow onset and progression. Some people who are sensitized to beryllium may not have symptoms.<ref name=OSHAhealtheffects>OSHA [https://www.osha.gov/SLTC/beryllium/healtheffects.html Beryllium Health Effects] Page accessed March 29, 2016</ref> Continued exposure causes the development of small inflammatory nodules, called [[granulomas]].<ref>{{Cite journal|pmid=3277503|year=1988|last1=Kriebel|first1=D|last2=Brain|first2=JD|last3=Sprince|first3=NL|last4=Kazemi|first4=H|title=The pulmonary toxicity of beryllium|volume=137|issue=2|pages=464–73|journal=The American Review of Respiratory Disease|doi=10.1164/ajrccm/137.2.464}}</ref> Of note, the authors of a 2006 study suggested that beryllium inhalation was not the only form of exposure and perhaps skin exposure was also a cause, as they found that a reduction in beryllium inhalation did not result in a reduction in chronic beryllium disease or beryllium sensitization.<ref>{{cite journal|last1=Day|first1=GA|last2=Stefaniak|first2=AB|last3=Weston|first3=A|last4=Tinkle|first4=SS|title=Beryllium exposure: dermal and immunological considerations.|journal=International Archives of Occupational and Environmental Health|date=February 2006|volume=79|issue=2|pages=161–4|pmid=16231190|doi=10.1007/s00420-005-0024-0|bibcode=2006IAOEH..79..161D |s2cid=41564437}}</ref>

Granuloma formation is seen in other diseases such as [[tuberculosis]] and [[sarcoidosis]]. Sarcoidosis, like berylliosis, also produces [[Granuloma#Caseating_vs_Non-Caseating|granulomas without a necrotic core]], and so distinction between the two processes can be difficult.

Ultimately, this process leads to [[restrictive lung disease]] (a decrease in [[diffusion capacity]]).

The earliest symptoms are typically [[cough]] and [[shortness of breath]].<ref name="Fishman">{{Cite book | last1=Kreider | first1=ME | last2=Rossman | first2=MD | title=Fishman's Pulmonary Diseases and Disorders | publisher=McGraw-Hill | editor-last1=Grippi | editor-first1=MA | editor-last2=Elias | editor-first2=JA | editor-last3=Fishman | editor-first3=JA | editor-last4=Kotloff | editor-first4=RM | editor-last5=Pack | editor-first5=AI | editor-last6=Senior | editor-first6=RM | year=2015 | chapter=Chapter 87: Chronic beryllium disease and hard-metal lung diseases | edition=5th | isbn=978-0-07-179672-9 }}</ref> Other symptoms include [[chest pain]], [[joint aches]], [[weight loss]], and [[fever]].

Rarely, one can get granulomas in other organs including the [[liver]].

The onset of symptoms can range from weeks up to tens of years from the initial exposure. In some individuals, a single exposure to beryllium can cause berylliosis.

== Pathogenesis ==
In susceptible persons, beryllium exposure can lead to a cell-mediated immune response. The T-cells become sensitized to beryllium. Each subsequent exposure leads to an immune response involving [[T helper cell|CD4+ helper T-lymphocytes]] and [[macrophage]]s accumulating in the lungs. As this response continues macrophages, CD4+ T-lymphocytes and plasma cells aggregate together to form the [[Granuloma|noncaseating granulomas]].<ref>{{Cite journal|last1=Falta|first1=Michael T.|last2=Pinilla|first2=Clemencia|last3=Mack|first3=Douglas G.|last4=Tinega|first4=Alex N.|last5=Crawford|first5=Frances|last6=Giulianotti|first6=Marc|last7=Santos|first7=Radleigh|last8=Clayton|first8=Gina M.|last9=Wang|first9=Yuxiao|date=2013-07-01|title=Identification of beryllium-dependent peptides recognized by CD4+ T cells in chronic beryllium disease|journal=The Journal of Experimental Medicine|language=en|volume=210|issue=7|pages=1403–1418|doi=10.1084/jem.20122426|issn=0022-1007|pmc=3698527|pmid=23797096}}</ref><ref>{{Cite journal|last1=Freiman|first1=D. G.|last2=Hardy|first2=H. L.|date=1970-03-01|title=Beryllium disease. The relation of pulmonary pathology to clinical course and prognosis based on a study of 130 cases from the U.S. beryllium case registry|journal=Human Pathology|volume=1|issue=1|pages=25–44|issn=0046-8177|pmid=5521721|doi=10.1016/S0046-8177(70)80003-X}}</ref> When beryllium is [[Phagocytosis|phagocytized]] by macrophages, the beryllium triggers macrophage apoptosis, thereby reducing beryllium clearance from the lungs and eventually resulting in secondary necrosis and lysis.<ref>{{Cite journal|last1=Sawyer|first1=Richard T.|last2=Maier|first2=Lisa A.|last3=Kittle|first3=Lori A.|last4=Newman|first4=Lee S.|date=February 2002|title=Chronic beryllium disease: a model interaction between innate and acquired immunity|journal=International Immunopharmacology|volume=2|issue=2–3|pages=249–261|issn=1567-5769|doi=10.1016/S1567-5769(01)00177-1|pmid=11811929}}</ref> Eventually, the outcome is [[fibrosis]] of the lung.<ref>{{Cite journal|last1=Saltini|first1=C.|last2=Amicosante|first2=M.|last3=Franchi|first3=A.|last4=Lombardi|first4=G.|last5=Richeldi|first5=L.|date=1998-12-01|title=Immunogenetic basis of environmental lung disease: lessons from the berylliosis model|journal=European Respiratory Journal|language=en|volume=12|issue=6|pages=1463–1475|doi=10.1183/09031936.98.12061463|issn=0903-1936|pmid=9877510|doi-access=free}}</ref><ref name=ATSDRmanagement>Agency for Toxic Substances and Disease Registry via the CDC. [https://www.atsdr.cdc.gov/csem/csem.html Beryllium Toxicity: How Should Patients Exposed to Beryllium Be Treated and Managed?] Page last updated: May 23, 2008</ref>

Several studies have shown that there is a genetic component to beryllium sensitivity. Specifically, those beryllium-exposed workers with a mutation at the [[HLA-DPB1]] Glu<sup>69</sup> position have increased prevalence of beryllium sensitization and chronic beryllium disease.<ref name=GeneRev2011>{{cite journal |vauthors=Rosenman KD, Rossman M, Hertzberg V, Reilly MJ, Rice C, Kanterakis E, Monos D |title=HLA class II DPB1 and DRB1 polymorphisms associated with genetic susceptibility to beryllium toxicity |journal=Occup Environ Med |volume=68 |issue=7 |pages=487–93 |year=2011 |pmid=21186201 |doi=10.1136/oem.2010.055046 |s2cid=27610317 }}</ref>  The HLA-DPB1 gene is important for [[MHC class II]] molecule function on [[Antigen-presenting cell|antigen presenting cells]].<ref name=GeneRev2011/> A study of the immune response to beryllium in individuals who express the [[HLA-DP2]] allele found that CD4 T-cells do not detect the Be+ cation itself, but instead detect surface changes in the HLA-DP2/peptide complex in which Be+ is embedded. Those researchers concluded that chronic beryllium disease is a predisposition that lies between "[[allergy|allergic hypersensitivity]] and [[autoimmunity]]."<ref name=Cell2014>{{cite journal |vauthors=Clayton GM, Wang Y, Crawford F, Novikov A, Wimberly BT, Kieft JS, Falta MT, Bowerman NA, Marrack P, Fontenot AP, Dai S, Kappler JW |title=Structural Basis of Chronic Beryllium Disease: Linking Allergic Hypersensitivity and Autoimmunity  |journal=Cell |volume=158 |issue=1 |pages=132–142 |year=2014 |pmid= 24995984|doi=10.1016/j.cell.2014.04.048 |pmc=4269484 |s2cid= |quote="Individuals carrying the MHCII allele, HLA-DP2, are at risk for chronic beryllium disease (CBD), a debilitating inflammatory lung condition caused by the reaction of CD4 T cells to inhaled beryllium."}}</ref> 

According to the [[International Agency for Research on Cancer]], beryllium and beryllium compounds are [[List of IARC Group 1 carcinogens|Category 1 carcinogens]]; they are carcinogenic to both animals and humans.<ref>{{Cite web|url = http://www.inchem.org/documents/iarc/vol58/mono58-1.html|publisher = International Agency for Research on Cancer|title = IARC Monograph, Volume 58|year = 1993|access-date = 2008-09-18}}</ref>

==Diagnosis==
[[File:Chronic beryllioisis - Case 293 (15528999565).jpg|thumb|X-ray image of a  54-year-old man working in the aerospace manufacturing industry with berylliosis]]
The differential diagnosis for berylliosis includes:<ref>{{cite journal|last1=Newman|first1=LS|title=Beryllium disease and sarcoidosis: clinical and laboratory links.|journal=Sarcoidosis|date=March 1995|volume=12|issue=1|pages=7–19|pmid=7617981}}</ref>
* [[Sarcoidosis]]
* Granulomatous lung diseases
** [[Tuberculosis]]
** Fungal infections (e.g., [[histoplasmosis]])
** [[Granulomatosis with polyangiitis]]
* [[Idiopathic pulmonary fibrosis]]
* [[Hypersensitivity pneumonitis]]
* [[Asthma]]
Diagnosis of berylliosis is based on history of beryllium exposures, documented beryllium sensitivity, and granulomatous inflammation on [[lung biopsy]]. Given the invasive nature of a lung biopsy, diagnosis can also be based on clinical history consistent with berylliosis, abnormal [[Chest radiograph|chest x-ray]] or [[CT scan]] findings, and abnormalities in [[Pulmonary function testing|pulmonary function tests]].<ref name=":02" />

The radiologic and pathologic features of berylliosis are very similar to sarcoidosis.  Due to the strong clinical and histopathological resemblance of sarcoidosis and berylliosis, patients are sometimes misdiagnosed with sarcoidosis until the history of exposure to beryllium is elicited and beryllium hypersensitivity demonstrated with specific testing. Some studies suggest that up to 6% of all cases of sarcoidosis are actually berylliosis.<ref>{{cite journal |last1=Rossman |first1=MD |last2=Kreider |first2=ME |date=June 2003 |title=Is chronic beryllium disease sarcoidosis of known etiology? |journal=Sarcoidosis, Vasculitis and Diffuse Lung Diseases |volume=20 |issue=2 |pages=104–9 |pmid=12870719}}</ref>  <ref>{{Cite journal |last1=Cheva |first1=Angeliki |last2=Kilmpasani |first2=Maria |last3=Stathakis |first3=Eustathios |last4=Dimitriadis |first4=Ioannis |last5=Mpikos |first5=Vasileios |last6=Papaemmanouil |first6=Styliani |date=November 2016 |title=AB042. Sarcoidosis or Berylliosis? Two diseases with similar histologic findings |journal=Annals of Translational Medicine |volume=4 |issue=22 |pages=AB042 |doi=10.21037/atm.2016.AB042 |issn=2305-5839 |pmc=5159372 |doi-access=free }}</ref>

The beryllium lymphocyte proliferation test (BeLPT) is the standard way of determining sensitivity to beryllium.<ref name=":02">{{Cite journal|last1=Balmes|first1=John R.|last2=Abraham|first2=Jerrold L.|last3=Dweik|first3=Raed A.|last4=Fireman|first4=Elizabeth|last5=Fontenot|first5=Andrew P.|last6=Maier|first6=Lisa A.|last7=Muller-Quernheim|first7=Joachim|last8=Ostiguy|first8=Gaston|last9=Pepper|first9=Lewis D.|title=An Official American Thoracic Society Statement: Diagnosis and Management of Beryllium Sensitivity and Chronic Beryllium Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=190|issue=10|pages=e34–e59|doi=10.1164/rccm.201409-1722st|pmid=25398119|year=2014}}</ref> The test is performed by acquiring either peripheral blood or fluid from a bronchial alveolar lavage, and lymphocytes are cultured with beryllium sulfate. Cells are then counted and those with elevated number of cells are considered abnormal.<ref>{{Cite journal|last1=Frome|first1=Edward L|last2=Newman|first2=Lee S|last3=Cragle|first3=Donna L|last4=Colyer|first4=Shirley P|last5=Wambach|first5=Paul F|date=2003-02-01|title=Identification of an abnormal beryllium lymphocyte proliferation test|journal=Toxicology|volume=183|issue=1–3|pages=39–56|doi=10.1016/S0300-483X(02)00439-0|pmid=12504341|bibcode=2003Toxgy.183...39F |url=https://zenodo.org/record/1259989}}</ref> Those exposed persons with two abnormal BeLPT tested with peripheral blood, or one abnormal and one borderline result, are considered beryllium sensitized. Also, those with one abnormal BeLPT tested with fluid from a bronchial alveolar lavage are considered sensitized.<ref name=":02" />

Chest radiography findings of berylliosis are non-specific. Early in the disease radiography findings are usually normal. In later stages interstitial fibrosis,  pleural irregularities, hilar [[lymphadenopathy]] and [[Ground-glass opacity|ground-glass opacities]] have been reported.<ref>{{Cite journal|last1=Aronchick|first1=J. M.|last2=Rossman|first2=M. D.|last3=Miller|first3=W. T.|date=1987-06-01|title=Chronic beryllium disease: diagnosis, radiographic findings, and correlation with pulmonary function tests|journal=Radiology|volume=163|issue=3|pages=677–682|doi=10.1148/radiology.163.3.3575713|issn=0033-8419|pmid=3575713}}</ref><ref name=Sharma>{{Cite journal|last1=Sharma|first1=Nidhi|last2=Patel|first2=Jeet|last3=Mohammed|first3=Tan-Lucien H.|title=Chronic Beryllium Disease|journal=Journal of Computer Assisted Tomography|volume=34|issue=6|pages=945–948|doi=10.1097/rct.0b013e3181ef214e|pmid=21084914|year=2010}}</ref> Findings on CT are also not specific to berylliosis. Findings that are common in CT scans of people with berylliosis include parenchymal nodules in early stages. One study found that ground-glass opacities were more commonly seen on CT scan in berylliosis than in sarcoidosis. In later stages hilar lymphadenopathy, interstitial pulmonary fibrosis and pleural thickening.<ref name=Sharma />

===Classification===
Berylliosis is an [[occupational disease]].<ref name=OSHAhealtheffects/> Relevant occupations are those where beryllium is mined, processed or converted into metal alloys, or where machining of metals containing beryllium and recycling of scrap alloys occurs.<ref>ATSDR. [http://www.atsdr.cdc.gov/toxguides/toxguide-4.pdf ToxGuide for Beryllium] September 2002</ref> It is associated with aerospace manufacturing, microwave semiconductor electronics, beryllium mining or manufacturing of fluorescent light bulbs (which once contained beryllium compounds in their internal phosphor coating).<ref>General Electric ''Fluorescent Lamps TP 111R'', Dec. 1978, says on pg. 23 that ''since 1949 GE lamps used relatively inert phosphates found to be safe in ordinary handling of either the intact or broken lamp.''</ref><ref>{{Cite journal  |title=The uses and adverse effects of beryllium on health  |journal=Indian Journal of Occupational and Environmental Medicine   |first1=Ross G.  |last1=Cooper  |first2=Adrian P.  |last2=Harrison  |date=August 2009   |volume=13  |issue=2  |pages=65–76  |doi=10.4103/0019-5278.55122  |pmc=2847329  |pmid=20386622 |doi-access=free }}</ref><ref>{{Cite journal  |last1=Hardy  |first1=HL  |last2=Tabershaw  |first2=IR  |title=Delayed chemical pneumonitis in workers exposed to beryllium compounds  |journal=Journal of Industrial Hygiene and Toxicology  |year=1946  |volume=28  |pages=197–211  |pmid=21000285}}</ref> [[Beryllia]] was used in lamp manufacture because of ceramic's obvious virtues for insulation and heat resistance, and also because beryllia could be made transparent.<ref>{{Cite book  |title=Lamps and Lighting  |section=7.2.1 Optical ceramics  |editor-last=Cayless  |editor-first=M A  |editor-last2=Marsden  |editor-first2=A M  |edition=3rd  |year=1983  |publisher=Edward Arnold  |isbn=978-0-7131-3487-2  |page=127}}</ref> Certain welding anodes along with other electrical contacts and even non-sparking tools are made of [[beryllium copper]] alloy and the subsequent machining of such materials would cause the disease as well.

==Prevention==
Because it can be difficult to control industrial exposures to beryllium, it is advisable to use any methods possible to reduce airborne and surface contamination by beryllium, to minimize the use of beryllium and beryllium-containing alloys whenever possible, and to educate people about the potential hazards if they are likely to encounter beryllium dust or fumes.<ref name="Lang">{{Cite journal|journal=Environmental Health Perspectives|volume=102|issue=6–7|date=June–July 1994|title=Beryllium: A Chronic Problem|author=Lang, Leslie|pmc=1569745|pmid=9679108|pages=526–31|doi=10.1289/ehp.94102526}}</ref> It is important to damp wipe [[metallographic]] preparation equipment to prevent accumulation of dry particles. Sectioning, grinding, and polishing must be performed under sufficiently vented hoods equipped with special filters.<ref>Batich, Ray and James M. Marder. (1985) Beryllium In (Ed. 9), Metals Handbook: Metallography and Microstructures (pp. 389–391). Metals Park, Ohio: American Society for Metals.</ref>

On 29 January 2009, the Los Alamos National Laboratory announced it was notifying nearly 2,000 current and former employees and visitors that they may have been exposed to beryllium in the lab and may be at risk of disease. Concern over possible exposure to the material was first raised in November 2008, when a box containing beryllium was received at the laboratory's short-term storage facility.<ref>{{Cite news|title = Nearly 2,000 people warned of possible beryllium exposure|url = http://www.cnn.com/2009/HEALTH/01/29/los.alamos.beryllium/index.html?eref=rss_us|publisher=CNN | date=29 January 2009}}</ref>

== Treatment ==
There is no cure for berylliosis; the goals of treatment are to reduce symptoms and slow the progression of disease.<ref name=ATSDRmanagement/><ref name=Sood/>

Although the evidence that stopping exposure to beryllium decreases progression of the disease is limited,<ref name=Seidler/> it is still considered to be an accepted approach to treatment in any stage of disease.<ref name="Rossman 1996 945–947" />

People with early stages of disease, without lung function abnormalities or clinical symptoms, are periodically monitored with physical exams, pulmonary function testing and radiography.<ref name="Sood">{{Cite journal|last=Sood|first=Akshay|title=Current Treatment of Chronic Beryllium Disease|journal=Journal of Occupational and Environmental Hygiene|volume=6|issue=12|pages=762–765|doi=10.1080/15459620903158698|pmc=2774897|pmid=19894178|year=2009}}</ref>

Once clinical symptoms or significant abnormalities in pulmonary function testing appear, treatments include oxygen and oral [[corticosteroid]]s and whatever [[supportive therapy]] is required.<ref name=OSHAhealtheffects/><ref name=":02" /><ref name="Sood"/>

==Outcomes==
Overall mortality rates are 5–38%.<ref>{{Cite journal|pmc=1469683|pmid=8933038|year=1996|last1=Newman|first1=LS|last2=Lloyd|first2=J|last3=Daniloff|first3=E|title=The natural history of beryllium sensitization and chronic beryllium disease|volume=104|pages=937–43|journal=Environmental Health Perspectives|issue=Suppl 5|doi=10.2307/3433014|jstor=3433014}}</ref>

== Epidemiology ==
The number of workers in the United States exposed to beryllium vary but has been estimated to be as high as 800,000 during the 1960s and 1970s.<ref>{{Cite journal|last1=Cullen|first1=Mark|last2=Cherniack|first2=Martin|last3=Kominsky|first3=John|date=1986-01-01|title=Chronic Beryllium Disease in the United States|journal=Seminars in Respiratory and Critical Care Medicine|language=en|volume=7|issue=3|pages=203–209|doi=10.1055/s-2007-1012616|s2cid=72430473 }}</ref> A more recent study from 2004 estimated the number of exposed workers in the United States to be around 134,000.<ref>{{Cite journal|last1=Henneberger|first1=Paul K.|last2=Goe|first2=Sandra K.|last3=Miller|first3=William E.|last4=Doney|first4=Brent|last5=Groce|first5=Dennis W.|date=2004-10-01|title=Industries in the United States with Airborne Beryllium Exposure and Estimates of the Number of Current Workers Potentially Exposed|journal=Journal of Occupational and Environmental Hygiene|volume=1|issue=10|pages=648–659|doi=10.1080/15459620490502233|issn=1545-9624|pmid=15631056|s2cid=19773286|url=https://zenodo.org/record/1234511}}</ref>

The rate of workers becoming sensitized to beryllium varies based on genetics and exposure levels. In one study researchers found the prevalence of beryllium sensitization to range from 9–19% depending on the industry.<ref name=Kreiss>{{Cite journal|last1=Kreiss|first1=K.|last2=Mroz|first2=M. M.|last3=Zhen|first3=B.|last4=Wiedemann|first4=H.|last5=Barna|first5=B.|date=1997-08-01|title=Risks of beryllium disease related to work processes at a metal, alloy, and oxide production plant.|url= |journal=Occupational and Environmental Medicine|language=en|volume=54|issue=8|pages=605–612|doi=10.1136/oem.54.8.605|issn=1470-7926|pmid=9326165|pmc=1128986}}</ref> Many workers who are found to be sensitive to beryllium also meet the diagnostic criteria for chronic beryllium disease.<ref name=Kreiss/> In one study of nuclear workers, among those who were sensitized to beryllium, 66% were found to have chronic beryllium disease as well.<ref name=Kreiss2>{{Cite journal|last1=Kreiss|first1=K.|last2=Mroz|first2=M. M.|last3=Zhen|first3=B.|last4=Martyny|first4=J. W.|last5=Newman|first5=L. S.|date=1993-10-01|title=Epidemiology of beryllium sensitization and disease in nuclear workers|journal=The American Review of Respiratory Disease|volume=148|issue=4 Pt 1|pages=985–991|doi=10.1164/ajrccm/148.4_Pt_1.985|issn=0003-0805|pmid=8214955}}</ref> The rate of progression from beryllium sensitization to chronic beryllium disease has been estimated to be approximately 6–8% per year.<ref name=Seidler>{{Cite journal|last1=Seidler|first1=A.|last2=Euler|first2=U.|last3=Müller-Quernheim|first3=J.|last4=Gaede|first4=K. I.|last5=Latza|first5=U.|last6=Groneberg|first6=D.|last7=Letzel|first7=S.|date=2012-10-01|title=Systematic review: progression of beryllium sensitization to chronic beryllium disease|journal=Occupational Medicine|language=en|volume=62|issue=7|pages=506–513|doi=10.1093/occmed/kqs069|issn=0962-7480|pmid=22705916|doi-access=free}}</ref><ref>{{Cite journal|last1=Newman|first1=Lee S.|last2=Mroz|first2=Margaret M.|last3=Balkissoon|first3=Ronald|last4=Maier|first4=Lisa A.|date=2005-01-01|title=Beryllium Sensitization Progresses to Chronic Beryllium Disease|journal=American Journal of Respiratory and Critical Care Medicine|volume=171|issue=1|pages=54–60|doi=10.1164/rccm.200402-190OC|pmid=15374840|issn=1073-449X}}</ref> Stopping exposure to beryllium in those sensitized has not been definitively shown to stop the progression to chronic beryllium disease.<ref name=Seidler/>

The overall prevalence of chronic beryllium disease among workers exposed to beryllium has ranged from 1–5% depending on industry and time period of study.<ref name=Kreiss/><ref name=Kreiss2 /><ref>{{Cite journal|last1=Henneberger|first1=P. K.|last2=Cumro|first2=D.|last3=Deubner|first3=D. D.|last4=Kent|first4=M. S.|last5=McCawley|first5=M.|last6=Kreiss|first6=K.|date=2001-04-01|title=Beryllium sensitization and disease among long-term and short-term workers in a beryllium ceramics plant|journal=International Archives of Occupational and Environmental Health|volume=74|issue=3|pages=167–176|issn=0340-0131|pmid=11355290|doi=10.1007/s004200100237|bibcode=2001IAOEH..74..167H |s2cid=39949745}}</ref>

The general population is unlikely to develop acute or chronic beryllium disease because ambient air levels of beryllium are normally very low (<0.03&nbsp;ng/m<sup>3</sup>).<ref>{{Cite book|url=http://www.nap.edu/catalog/12007/health-effects-of-beryllium-exposure-a-literature-review|page=11|title=Health effects of beryllium exposure|publisher=National Academies Press|year=2007|isbn=978-0-309-11167-6|author=National Research Council (U.S.). Committee on Beryllium Alloy Exposures, National Research Council (U.S.). Committee on Toxicology}}</ref>  However, a study found 1% of people living within 3/4 of a mile of a beryllium plant in Lorain, Ohio, had berylliosis after exposure to concentrations estimated to be less than 1 milligram per cubic metre of air. In the United States the Beryllium Case Registry contained 900 records, early cases relating to extraction and fluorescent lamp manufacture, later ones coming from the aerospace, ceramics and metallurgical industries.<ref>David Geraint James, Alimuddin Zumla, ''The granulomatous disorders'', Cambridge University Press, 1999, {{ISBN|0-521-59221-6}}, pages 336–337</ref><ref>{{cite web  | author = Brown University Medical School  | title = Berylliosis  | url = http://www.womenandinfants.org/encyclopedia/details.cfm?chunkid=22480&lang=English&db=hlt  | access-date = 2012-08-20  | archive-date = 2017-10-04  | archive-url = https://web.archive.org/web/20171004190330/http://www.womenandinfants.org/encyclopedia/details.cfm?chunkid=22480&lang=English&db=hlt  | url-status = dead  }}</ref>

==History==
Since the 1920s, beryllium has been used in electronics, ceramics, research and development labs, aircraft, and the atomic energy and defense industry.<ref name="Lang"/> Cases of bronchitis and pneumonia-like symptoms were reported in Germany and Russia in the 1930s among workers mining and refining beryllium. By 1946, a cluster of cases associated with fluorescent lamp manufacturers were apparent in the United States, and the lamp industry stopped using beryllium in 1949.<ref name="Rossman 1996 945–947">{{cite journal|last=Rossman|first=M|title=Chronic beryllium disease: diagnosis and management.|journal=Environmental Health Perspectives|year=1996|volume=104|issue=Suppl 5|pages=945–947|doi=10.1289/ehp.96104s5945|pmid=8933039|pmc=1469698}}</ref> At that time, most construction trades and industries were unaware of the potential risks associated with beryllium exposure.<ref>{{cite journal|last=Welch|first=L|title=Beryllium Disease Among Construction Trade Workers at Department of Energy Nuclear Sites|journal=American Journal of Industrial Medicine|year=2013|volume=56|issue=10|pages=1125–1136|doi=10.1002/ajim.22202|pmid=23794247}}</ref>

It occasionally killed early workers in nuclear weapons design, such as [[Herbert L. Anderson]].<ref>{{Cite web|url = http://www.atomicarchive.com/Photos/CP1/image5.shtml|title = Photograph of Chicago Pile One Scientists 1946|date = 19 June 2006|publisher = Office of Public Affairs, Argonne National Laboratory|access-date = 2008-09-18}}</ref>

Beryllium sensitivity testing was first performed as a cutaneous beryllium patch test in the early 1950s, but was discontinued due to the test stimulating sensitization or aggravating existing chronic beryllium disease.<ref>Agency for Toxic Substances and Disease Registry. September 2002 [http://www.atsdr.cdc.gov/toxprofiles/tp4.pdf Toxicological Profile: Beryllium]. See also [http://www.atsdr.cdc.gov/toxprofiles/Beryllium_addendum.pdf 2009 Addendum]</ref>{{rp|115}}

In the 1990s, the [[United States Department of Energy|DOE]] began screening employees using the BeLPT test in facilities where beryllium was used, to take preventive measures against beryllium exposure. Somewhat alarmingly, clerical staff who were never involved in handling the material had developed asymptomatic sensitivities.<ref>{{cite journal|last=Marshall|first=E|title=Science News: Beryllium screening raises ethical issues|journal=Science|year=1999|volume=285|issue=5425|pages=178–179|doi=10.1126/science.285.5425.178b|pmid=10428708|s2cid=11215967}}</ref>

== References ==
{{Reflist|colwidth=35em}}

== External links ==
{{Medical resources
|  DiseasesDB = 
|  ICD10 = {{ICD10|J|63|2|j|60}}
|  ICD9 = {{ICD9|503}}
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* [https://www.atsdr.cdc.gov/csem/csem.html ATSDR Case Studies in Environmental Medicine: Beryllium Toxicity] U.S. [[Department of Health and Human Services]]
* [https://www.cdc.gov/niosh/topics/beryllium/be-sensitization-drds.html CDC – Research on Beryllium Sensitization and Chronic Beryllium Disease – NIOSH Workplace Safety and Health Topic]
* [http://chronicberylliumdisease.com/ Beryllium Network]
* [https://web.archive.org/web/20051112074407/http://respiratory-lung.health-cares.net/berylliosis.php Health-cares.net]
*[http://www.rsc.org/Publishing/Journals/cb/Volume/2008/8/Beryllium_disease.asp Instant insight] from the [[Royal Society of Chemistry]] examining the molecular basis of chronic beryllium disease
*{{cite book |first1=David |last1=Rosner |first2=Gerald E. |last2=Markowitz |title=Dying for work: workers' safety and health in twentieth-century America |chapter-url=https://books.google.com/books?id=I-7VfHOQ-Q0C&pg=PA103 |date=February 1987 |publisher=Indiana University Press |isbn=978-0-253-31825-1 |pages=[https://archive.org/details/dyingforworkwork00rosn/page/103 103–] |chapter=Ch. 7: Salem Sarcoid:The Origins of Beryllium Disease |url-access=registration |url=https://archive.org/details/dyingforworkwork00rosn/page/103 }}

{{Respiratory pathology}}
{{Occupational safety and health}}
{{Elements in biology}}

[[Category:Beryllium]]
[[Category:Biology and pharmacology of chemical elements]]
[[Category:Element toxicology]]
[[Category:Lung diseases due to external agents]]
[[Category:Occupational diseases]]