Acute beryllium disease has not been seen in the United States since beryllium was banned in the fluorescent and neon lamp industries in the 1960s. Chronic beryllium disease (CBD) is a granulomatous interstitial pneumonitis caused by a cell mediated, delayed hypersensitivity. It develops in only 1 to 3% of those exposed. Patients present with dyspnea on exertion. CBD is indistinguishable from sarcoidosis by older criteria; it is now diagnosed by BeLPT (beryllium lymphocyte proliferation test). [ATSDR Case Studies #19] The BeLPT is also useful in screening beryllium exposed workers. [Harber, p. 494] CBD has been diagnosed in workers exposed below the OSHA permissible exposure limit of 2 ug/m3 and in factories that used only 2% beryllium copper alloy. [
PMID 10224597] In addition to dyspnea, cough, fatigue, anorexia, and weight loss, symptoms of CBD may include fever, arthralgias, and chest pain. The typical chest x-ray findings in CBD are small nodular opacities throughout the lung fields, and mediastinal lymphadenopathy is present in about 1/3 of cases. Conglomerate masses and pleural reactions are seen in advanced cases. In addition to the above, the CT detects septal lines and areas of ground-glass attenuation. Pulmonary function studies show obstruction or mixed obstruction/restriction with restriction predominating in more advanced disease. Over 1/2 of workers who have an abnormal BeLPT develop chronic beryllium disease. [Harber, p. 491-2] Chronic kidney disease in CBD includes granulomas and interstitial fibrosis. [LaDou, p. 422] "Sensitization and CBD were associated with an area in which beryllium air levels exceeded 0.2 ug/m3, and not with areas where this level was rarely exceeded." [
PMID 15712254] Pre-1992 beryllium oxide machinists had cumulative sensitization and CBD rates of 30% and 20%. A marked reduction in sensitization rates was found in workers hired 2000-2004 compared with workers hired 1993-1998. [
PMID 19092488] Beryllium and cobalt are the metals that most frequently cause skin granulomas. Beryllium "is a skin sensitizer as shown by human maximization test, and local lymph node assay." [Kanerva, p. 1540, 523] ". . . occupational history exposure information may be particularly useful in helping determine which persons with sensitization should undergo more extensive diagnostic testing to determine whether thy have CBD or have only sensitization without disease (BeS). . . . Considering the peak exposure level and the frequency of exposure adds considerably to the total number of years of exposure." [
PMID 25099412] "Sensitization was associated with average and highest job exposures, and CBD was associated with cumulative exposure." [
PMID 21877099]