Health Effects

Exposure to beryllium via inhalation of airborne beryllium or skin contact with beryllium-containing dust, fume, mist or solutions can cause health effects. Employers must reduce exposures to airborne beryllium to or below the beryllium PELs through engineering controls to the extent feasible, supplemented by respirators where all feasible controls are not sufficient to reduce exposures to or below the PELs. Under OSHA's Hazard Communication standard, employers must provide employees "effective information about hazardous chemicals in their work area," such as beryllium, including "chemical-specific information ... through labels and safety data sheets." 29 CFR 1910.1200(h)(1). OSHA also recommends employers provide workers with additional detailed training on the health effects of beryllium.

The following information describes the primary health effects associated with exposure to beryllium, medical testing and surveillance, and treatment.

Primary Health Effects Associated with Exposure to Beryllium

The most common adverse health effects associated with overexposure to beryllium in the workplace include: beryllium sensitization, chronic beryllium disease (CBD), and lung cancer. Acute Beryllium Disease (ABD) is extremely rare in the workplace today due to more stringent exposure controls implemented following occupational and environmental standards set in the 1970s.

Beryllium Sensitization - Beryllium sensitization is the activation of the immune system to react to beryllium exposure such that subsequent exposure to beryllium can progress to serious lung disease. Beryllium sensitization can result from inhalation or skin exposure to beryllium and is an essential step for development of CBD.

Chronic Beryllium Disease - CBD is a chronic granulomatous lung disease caused by inhaling airborne beryllium after becoming sensitized to beryllium. The common symptoms of CBD are shortness of breath, unexplained coughing, fatigue, weight loss, fever, and night sweats. CBD can result from inhalation exposure to beryllium at levels below the current OSHA PEL (2 μg/m³). Progression of CBD can vary among individuals. For instance, some workers after initial exposure to beryllium may quickly develop signs and severe symptoms. Others may not experience signs and symptoms until months or years after initial exposure. It is also important to note that the symptoms can sometimes worsen even after the worker has been removed from exposure. CBD can progress to a chronic obstructive lung disorder, resulting in loss of quality of life and the potential for decreased life expectancy.

CBD shares many signs and symptoms with pulmonary sarcoidosis, a granulomatous lung disease of unknown cause or origin. Without appropriate diagnosis, CBD may be difficult to distinguish from sarcoidosis. It is estimated that up to 6 percent of all patients diagnosed with sarcoidosis may actually have CBD (Fireman et al., 2003; Rossman and Kreiber, 2003).

Lung cancer - Occupational exposure to beryllium is known to cause lung cancer in humans. Based on numerous studies in occupational settings, the International Agency for Research on Cancer (IARC) classifies beryllium in Group 1 (carcinogenic to humans), and the National Toxicology Program (NTP) lists beryllium as a known human carcinogen.

Acute Beryllium Disease (ABD) - Acute beryllium disease (ABD) is a rapid onset form of chemical pneumonia that results from breathing high airborne concentrations of beryllium. ABD is generally associated with exposure to beryllium levels at or above 100 μg/m³ and may be fatal in 10 percent of cases. ABD is extremely rare in the workplace today due to more stringent exposure controls implemented following occupational and environmental standards set in the 1970s.

Medical Screening and Surveillance

Medical screening and medical surveillance are two fundamental strategies for optimizing employee health. Although the terms are often used interchangeably, they are quite distinct concepts. Medical screening is, in essence, only one component of a comprehensive medical surveillance program. The fundamental purpose of screening is early diagnosis and treatment of the individual and thus has a clinical focus. The fundamental purpose of surveillance is to detect and eliminate the underlying causes such as hazards or exposures of any discovered trends and thus has a prevention focus. Both can contribute significantly to the success of worksite health and safety programs. However OSHA "medical surveillance" requirements are generally clinically focused (e.g., medical and work histories, physical assessment, biological testing) with information obtained from the clinical processes used in the monitoring and analysis elements of medical surveillance.

Medical Screening - Beryllium sensitization may be detected with the beryllium lymphocyte proliferation test (BeLPT), a blood test for measuring the immune response to beryllium. The observation of beryllium-specific lymphocyte proliferation in an individual peripheral blood sample indicates an abnormal response and beryllium sensitization. Workers found to be sensitized to beryllium are at risk for developing CBD and in need of continuing medical follow-up.

There is some concern about the accuracy of the BeLPT. A single BeLPT has been reported to have a false-positive rate of about 1% (Middleton et al., 2008). Many programs therefore rely on a second test to confirm a positive result (NAS, 2008), which has been reported to reduce the false-positive rate to about 0.02% (Middleton et al., 2008). CBD is generally confirmed when it can be shown there is a history of beryllium exposure; positive histopathology findings in the lung (e.g. fiber-optic bronchoscopy, X-ray, CT scan, lung biopsy); and beryllium sensitization.

Medical Surveillance - If sensitization and/or CBD are identified, the employer should evaluate workplace controls to reduce or eliminate the exposure. OSHA recommends employers develop surveillance programs for workers with potential beryllium exposure. For more information see OSHA's Safety and Health Topics page on medical screening and surveillance.

Treatment

There is no cure for CBD. Treatment for CBD can vary for each patient, depending on the severity of the disease.   Treatment may include corticosteroids, oxygen, and other means to ease symptoms or slow the disease progression.

For more information, see the National Institute for Occupational Safety and Health Workplace Safety and Topics – Beryllium webpage; National Jewish Medical and Research Center Chronic Beryllium Disease Treatment webpage; the Agency for Toxic Substance and Disease Registry ToxFAQs for Beryllium webpage; and the Department of Energy Chronic Beryllium Disease Prevention Program webpage.

The following webpages provide additional information on the health effects of beryllium.

• Health Effects of Exposure to Beryllium*. OSHA Fact Sheet (Publication 3822), (2015).
• Beryllium. National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic. Provides links to sources of information on a variety of topics relating to beryllium.
• Report on Carcinogens (ROC). U.S. Department of Health and Human Services (DHHS), National Toxicology Program (NTP). Identifies and discusses agents, substances, mixtures, or exposure circumstances that may pose a health hazard due to their carcinogenicity.
  • Beryllium and Beryllium Compounds*. NTP classification: Known to be human carcinogens
• International Agency for Research on Cancer (IARC) Monographs on the Evaluation of Carcinogenic Risks for Humans. World Health Organization, International Agency for Research on Cancer. IARC Classification: Carcinogenic to humans (Group 1).
• Toxicological Profile for Beryllium. Agency for Toxic Substances and Disease Registry (ATSDR), (September 2002). Provides exposure risks, exposure limits, and health effects for beryllium.
• ToxFAQs - Beryllium. Agency for Toxic Substances and Disease Registry (ATSDR), (September 2002). Answers the most frequently asked health questions about beryllium.
• Chronic Beryllium Disease Prevention Program. U.S. Department of Energy (DOE), (December 8, 1999). Provides links to DOE policies, guidance, and training regarding beryllium.
• Chronic Beryllium Disease: Overview. National Jewish Medical and Research Center, (2010). Describes the health effects of beryllium.
• Health Effects of Beryllium. National Academy of Sciences, (2007). Summarizes the health effects literature on beryllium.
• Managing Health Effects of Beryllium Exposure. National Academy of Sciences, (2008). Provides information on clinical studies of beryllium sensitization and CBD. Includes information on designing a beryllium exposure and disease management program for Air Force workers.

Journal Articles

A list of journal articles related to beryllium:

• Balkissoon, R.C. and Newman, L.S. (1999). Beryllium Copper Alloy (2%) Causes Chronic Beryllium Disease. J. Occup. Environ. Med. 41(4): 304-8.
• Balmes JR, Abraham JL, Dweik RA, Fireman E, Fontenot AP, Maier LA, Muller-Quernheim J, Ostiguy G, Pepper LD, Saltini C, Schuler CR, Takaro TK, Wambach PF; ATS Ad Hoc Committee on Beryllium Sensitivity and Chronic Beryllium Disease. An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease.  Am J Respir Crit Care Med. 2014 Nov 15;190(10):e34-59.
• Berlin J.M. et al. (2003). Beryllium Dermatitis. J. Am. Acad. Dermatol. 49(5): 939-41.
• Cummings, K.J. et al. (2009). A Reconsideration of Acute Beryllium Disease. Environmental Health Perspectives. 117(8): 1250-6.
• Dai S, Falta MT, Bowerman NA, McKee AS, Fontenot AP. T cell recognition of beryllium. Curr Opin Immunol. 2013 Dec;25(6):775-80.
• Hines SE, Pacheco K, Maier LA. The role of lymphocyte proliferation tests in assessing occupational sensitization and disease. Curr Opin Allergy Clin Immunol. 2012 Apr;12(2):102-10.
• Kirshen C, Pratt M. Dental allergic contact dermatitis: an interesting case series and review of the literature. Dermatitis. 2012 Sep-Oct;23(5):222-6.
• Kreis, K, et al. (1993). Epidemiology of Beryllium Sensitization and Disease in Nuclear Workers. Am. Rev. Respir. Dis. 148(4 Pt 1): 985-91.
• Lang, L.  (1994). Beryllium: A Chronic Problem . Environmental Health Perspectives 102(6-7): 526-531.
• Maier, L. A. et al. (2008). Recent Chronic Beryllium Disease in Residents Surrounding a Beryllium Facility. Am. J. Respir. Crit. Care Med. 177(9): 1012-7.
• Mayer AS, Hamzeh N, Maier LA. Sarcoidosis and chronic beryllium disease: similarities and differences. Semin Respir Crit Care Med. 2014 Jun;35(3):316-29.
• Martin SC, Larivière C. Community health risk assessment of primary aluminum smelter emissions. J Occup Environ Med. 2014 May;56(5 Suppl):S33-9.
• Middleton D, Kowalski P. Advances in identifying beryllium sensitization and disease. Int J Environ Res Public Health. 2010 Jan;7(1):115-24
• Middleton, D.C. (1998).  Chronic Beryllium Disease: Uncommon Disease, Less Common Diagnosis. Environmental Health Perspectives 106 (12):765-767.
• Newman, L.S., et al. (1996). The Natural History of Beryllium Sensitization and Chronic Beryllium Disease. Environmental Health Perspectives 104(Supplement 5): 937-943.
• Schubauer-Berigan MK, Deddens JA, Couch JR, Petersen MR. Risk of lung cancer associated with quantitative beryllium exposure metrics within an occupational cohort. Occup Environ Med. 2011 May;68(5):354-60.
• Seidler A, Euler U, Müller-Quernheim J, Gaede KI, Latza U, Groneberg D, Letzel S. Systematic review: Progression of beryllium sensitization to chronic beryllium disease. Occup Med (Lond). 2012 Oct;62(7):506-13.
• Skaugset, N.P. et al. (2012). Occupational Exposure to Beryllium in Primary Aluminum Production. J. Environ. Monit. 14(2): 353-9.
• Stanton, M. L. et al. (2006). Sensitization and Chronic Beryllium Disease Among Workers in Copper-Beryllium Distribution Centers. J. Occup. Environ. Med. 48(2): 204-11.
• Thomas, C. A.et al. (2013). Long-Term Efficacy of a Program to Prevent Beryllium Disease. Am. J. Ind. Med. 56(7): 733-41.

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