Pneumologie 2007; 61(2): 109-116
DOI: 10.1055/s-2006-954984
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Chronische Berylliose

Chronic BerylliosisJ.  Müller-Quernheim1 , K.  I.  Gaede2 , A.  Prasse1 , G.  Zissel1
  • 1Abteilung für Pneumologie, Medizinische Klinik, Albert Ludwigs Universität Freiburg
  • 2Medizinische Klinik, Forschungszentrum Borstel, Borstel
Further Information

Publication History

eingereicht 25.9.2006

akzeptiert 1.11.2006

Publication Date:
09 February 2007 (online)

Zusammenfassung

Die chronische Berylliose (CB) ist eine Berufserkrankung, die bei der Differenzialdiagnose granulomatöser Lungenerkrankungen berücksichtigt werden muss. Die Bundesrepublik Deutschland ist einer der größten Beryllium-Importeure mit weiter steigendem Verbrauch und daher muss mit einer zunehmenden Zahl an Erkrankungsfällen gerechnet werden. Da die CB eine perfekte Phänokopie der Sarkoidose ist, kann sie klinisch von ihr nicht differenziert werden. Daher kann davon ausgegangen werden, dass viele CB-Patienten in der Kohorte der Sarkoidosepatienten verborgen sind. Die Epidemiologie, Pathogenese, Diagnostik und Therapie der CB wird dargestellt.

Abstract

Chronic Berylliosis (CB) is an occupational disorder which needs to be considered in the diagnostic work-up of granulomatous pulmonary diseases. Germany imports increasing amounts of beryllium which causes increased occupational exposure and this fact suggests that CB is underdiagnosed. Since CB is a perfect phenocopy of sarcoidosis, it is assumed that many cases are hidden in the cohort of sarcoidosis patients. This review presents the epidemiology, pathogenesis, diagnostics, and therapy of CB.

Literatur

  • 1 Jones Williams W. Beryllium disease. In: James D (ed). Sarcoidosis and other granulomatous disorders. New York: Marcel Dekker 1994: 707-721
  • 2 Meyer K. Beryllium and lung disease disease.  Chest. 1994;  106 942-946
  • 3 Schönherr S, Pevny H. Berylliumallergie.  Arbeitsmed Sozialmed Präventivmed. 1985;  20 281-286
  • 4 Rietschel R, Vowler J J. Fisher's contact dermatitis. 4th ed. Baltimore: Williams & Wilkens 1995
  • 5 MacMahon B. The epidemiological evidence on the carcinogenicity of Beryllium in humans.  J Occup Med. 1994;  36 15-24
  • 6 Steenland K, Ward E. Lung cancer incidence among patients with Beryllium disease: A cohort mortality study.  J Nat Cancer Inst. 1991;  83 1380-1385
  • 7 Askling J, Grunewald J, Eklund A. et al . Increased risk for cancer following sarcoidosis.  Am J Respir Crit Care Med. 1999;  160 1668-1672
  • 8 Sanderson W T, Petersen M R, Ward E M. Estimating historical exposures of workers in a beryllium manufacturing plant.  Am J Ind Med. 2001;  39 145-157
  • 9 Sanderson W T, Ward E M, Steenland K. et al . Lung cancer case-control study of beryllium workers.  Am J Ind Med. 2001;  39 133-144
  • 10 Senatskommisssion zur Prüfung gesundheitsschädlicher Arbeitsstoffe der Deutschen Forschungsgemeinschaft .Beryllium und seine anorganischen Verbindungen. In: Greim H (ed). Gesundheitsschädliche Arbeitsstoffe Toxikologisch-arbeitsmedizinische Begründungen von MAK-Werten (Maximale Arbeitsplatzkonzentrationen). Weinheim: VCH Verlagsgesellschaft 2003: 37. Lieferung
  • 11 Newman L S. Metals that cause sarcoidosis.  Semin Respir Infect. 1998;  13 212-220
  • 12 Newman L S. Beryllium disease and sarcoidosis: Clinical and laboratory links.  Sarcoidosis. 1995;  12 7-19
  • 13 Newman L S, Kreiss K. Nonoccupational beryllium disease masquerading as sarcoidosis: Identification by blood lymphocyte proliferative response to beryllium.  Am Rev Respir Dis. 1992;  145 1212-1214
  • 14 Middleton D C. Chronic beryllium disease: uncommon disease, less common diagnosis.  Environ Health Perspect. 1998;  106 765-767
  • 15 Rossman M D. Chronic beryllium disease: diagnosis and management.  Environ Health Perspect. 1996;  104 Suppl 5 945-947
  • 16 Müller-Quernheim J, Gaede K I, Fireman E. et al . Diagnoses of chronic beryllium disease within cohorts of sarcoidosis patients.  Eur Respir J. 2006;  27 1190-1195
  • 17 Infante P F, Newman L S. Beryllium exposure and chronic beryllium disease.  Lancet. 2004;  363 415-416
  • 18 Henneberger P K, Goe S K, Miller W E. et al . Prevention of beryllium sensitization and chronic beryllium disease.  J Occup Environ Hyg. 2006;  3 D42-43
  • 19 Rossman M D, Kreider M E. Is chronic beryllium disease sarcoidosis of known etiology?.  Sarcoidosis Vasc Diffuse Lung Dis. 2003;  20 104-109
  • 20 Kreiss K, Mroz M M, Newman L S. et al . Machining risk of beryllium disease and sensitization with median exposures below 2 micrograms/m3. .  Am J Ind Med. 1996;  30 16-25
  • 21 Hooper W F. Acute beryllium lung disease.  N C Med J. 1981;  42 551-553
  • 22 Kriebel D, Sprince N L, Eisen E A. et al . Pulmonary function in beryllium workers: assessment of exposure.  Br J Ind Med. 1988;  45 83-92
  • 23 Drexler H, Greim H. The MAK-Collection Part II: BAT Value Documentations, Volume 4. Weinheim: Wiley-VCH 2005
  • 24 Willis H H, Florig H K. Potential exposures and risks from beryllium-containing products.  Risk Anal. 2002;  22 1019-1033
  • 25 Maier L, Martyny J, Mroz M. et al . Genetic and environmental risk factors in beryllium sensitization and chronic beryllium disease.  Chest. 2002;  121 81S
  • 26 Henneberger P K, Cumro D, Deubner D D. et al . Beryllium sensitization and disease among long-term and short-term workers in a beryllium ceramics plant.  Int Arch Occup Environ Health. 2001;  74 167-176
  • 27 Kreiss K, Wassermann S, Mroz M M. et al . Beryllium disease screening in the ceramics industry. Blood lymphocyte test performance and exposure-disease relations.  J Occup Med. 1993;  35 267-274
  • 28 Newman L S, Mroz M M, Balkissoon R. et al . Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk.  Am J Respir Crit Care Med. 2005;  171 54-60
  • 29 Newman L S, Mroz M M, Maier L A. et al . Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant.  J Occup Environ Med. 2001;  43 231-237
  • 30 Entzian P, Pawelek W, Lindner B. et al . Grenzen des Berylliumnachweises mit der Laser-Mikrobereichs-Massenspektrometrie [Limits of beryllium detection with laser microprobe mass spectrometry (LAMMS)].  Pneumologie. 1998;  52 674-679
  • 31 Sumino K, Hayakawa K, Shibata T. et al . Heavy metals in normal Japanese tissues. Amounts of 15 heavy metals in 30 subjects.  Arch Environ Health. 1975;  30 487-494
  • 32 Wegner R, Heinrich-Ramm R, Nowak D. et al . Lung function, biological monitoring, and biological effect monitoring of gemstone cutters exposed to beryls.  Occup Environ Med. 2000;  57 133-139
  • 33 Verma D K, Ritchie A C, Shaw M L. Measurement of beryllium in lung tissue of a chronic beryllium disease case and cases with sarcoidosis.  Occup Med (Lond). 2003;  53 223-227
  • 34 Cullen M R, Kominsky J R, Rossman M D. et al . Chronic beryllium disease in a precious metal refinery. Clinical epidemiologic and immunologic evidence for continuing risk from exposure to low level beryllium fume.  Am Rev Respir Dis. 1987;  135 201-208
  • 35 Bartell S M, Ponce R A, Takaro T K. et al . Risk estimation and value-of-information analysis for three proposed genetic screening programs for chronic beryllium disease prevention.  Risk Anal. 2000;  20 87-99
  • 36 Müller-Quernheim J. Sarcoidosis: immunopathogenetic concepts and their clinical application.  Eur Respir J. 1998;  12 716-738
  • 37 Bost T W, Riches D WH, Schumacher B. et al . Alveolar macrophages from patients with beryllium disease and sarcoidosis express increased levels of mRNA for tumor necrosis factor-α and interleukin-6 but not interleukin-1β.  Am J Respir Cell Mol Biol. 1994;  10 506-513
  • 38 Gaede K I, Mamat U, Schlaak M. et al . Analysis of differentially regulated mRNAs in peripheral blood monocytes of berylliosis patients after in vitro stimulation.  J Mol Med. 2000;  78 293-299
  • 39 Richeldi L, Sorrentino R, Saltini C. HLA-DPB 1 glutamate 69: a genetic marker of beryllium disease.  Science. 1993;  262 242-244
  • 40 Richeldi L, Kreiss K, Mroz M M. et al . Interaction of genetic and exposure factors in the prevalence of berylliosis.  Am J Ind Med. 1997;  32 337-340
  • 41 Wang Z, White P S, Petrovic M. et al . Differential susceptibilities to chronic beryllium disease contributed by different Glu69 HLA-DPB1 and -DPA1 alleles.  J Immunol. 1999;  163 1647-1653
  • 42 Rossman M D, Stubbs J, Lee C W. et al . Human leukocyte antigen Class II amino acid epitopes: susceptibility and progression markers for beryllium hypersensitivity.  Am J Respir Crit Care Med. 2002;  165 788-794
  • 43 Saltini C, Richeldi L, Losi M. et al . Major histocompatibility locus genetic markers of beryllium sensitization and disease.  Eur Respir J. 2001;  18 677-684
  • 44 Maier L A, Sawyer R T, Bauer R A. et al . High beryllium-stimulated TNF-α is associated with the -308 TNF-α promoter polymorphism and with clinical severity in chronic beryllium disease.  Am J Respir Crit Care Med. 2001;  164 1192-1199
  • 45 Gaede K I, Amicosante M, Schurmann M. et al . Function associated transforming growth factor-β gene polymorphism in chronic beryllium disease.  J Mol Med. 2005;  83 397-405
  • 46 Maier L A, Raynolds M V, Young D A. et al . Angiotensin-1 converting enzyme polymorphisms in chronic beryllium disease.  Am J Respir Crit Care Med. 1999;  159 1342-1350
  • 47 Newman L S, Orton R, Kreiss K. Serum angiotensin converting enzyme activity in chronic beryllium disease.  Am Rev Respir Dis. 1992;  146 39-42
  • 48 Weston A, Ensey J, Kreiss K. et al . Racial differences in prevalence of a supratypic HLA-genetic marker immaterial to pre-employment testing for susceptibility to chronic beryllium disease.  Am J Ind Med. 2002;  41 457-465
  • 49 Maier L A. Genetic and exposure risks for chronic beryllium disease.  Clin Chest Med. 2002;  23 827-839
  • 50 Saltini C, Amicosante M, Franchi A. et al . Immunogenetic basis of environmental lung disease: lessons from the berylliosis model.  Eur Respir J. 1998;  12 1463-1475
  • 51 McCunney R J. Genetic testing: ethical implications in the workplace.  Occup Med. 2002;  17 665-672
  • 52 Amicosante M, Sanarico N, Berretta F. et al . Beryllium binding to HLA-DP molecule carrying the marker of susceptibility to berylliosis glutamate beta 69.  Hum Immunol. 2001;  62 686-693
  • 53 Lombardi G, Germain C, Uren J. et al . HLA-DP allele-specific T cell responses to beryllium account for DP- associated susceptibility to chronic beryllium disease.  J Immunol. 2001;  166 3549-3555
  • 54 Fontenot A P, Torres M, Marshall W H. et al . Beryllium presentation to CD4+ T cells underlies disease-susceptibility HLA-DP alleles in chronic beryllium disease.  Proc Natl Acad Sci USA. 2000;  97 12 717-12 722
  • 55 Saltini C, Winestock K, Kirby M. et al . Maintenance of alveolitis in patients with chronic beryllium disease by beryllium-specific helper T cells.  N Engl J Med. 1989;  320 1103-1109
  • 56 Saltini C, Kirby M, Trapnell B C. et al . Biased accumulation of T lymphocytes with “memory”-type CD45 leukocyte common antigen gene expression on the epithelial surface of the human lung.  J Exp Med. 1990;  171 1123-1140
  • 57 Fontenot A P, Canavera S J, Gharavi L. et al . Target organ localization of memory CD4(+) T cells in patients with chronic beryllium disease.  J Clin Invest. 2002;  110 1473-1482
  • 58 Fontenot A P, Falta M T, Freed B M. et al . Identification of pathogenic T cells in patients with beryllium-induced lung disease.  J Immunol. 1999;  163 1019-1026
  • 59 Amicosante M, Berretta F, Franchi A. et al . HLA-DP-unrestricted TNF-α release in beryllium-stimulated peripheral blood mononuclear cells.  Eur Respir J. 2002;  20 1174-1178
  • 60 Tinkle S S, Schwitters P W, Newman L S. Cytokine production by bronchoalveolar lavage cells in chronic beryllium disease.  Environ Health Perspect. 1996;  104 Suppl 5 969-971
  • 61 Ziegenhagen M W, Muller-Quernheim J. The cytokine network in sarcoidosis and its clinical relevance.  J Intern Med. 2003;  253 18-30
  • 62 Middleton D C, Lewin M D, Kowalski P J. et al . The BeLPT: algorithms and implications.  Am J Ind Med. 2006;  49 36-44
  • 63 Stange A W, Furman F J, Hilmas D E. The beryllium lymphocyte proliferation test: Relevant issues in beryllium health surveillance.  Am J Ind Med. 2004;  46 453-462
  • 64 Taylor T P, Ding M, Ehler D S. et al . Beryllium in the environment: a review.  J Environ Sci Health A Tox Hazard Subst Environ Eng. 2003;  38 439-469
  • 65 Vilaplana J, Romaguera C, Grimalt F. Occupational and non-occupational allergic contact dermatitis from beryllium.  Contact Dermatitis. 1992;  26 295-298
  • 66 Bobka C A, Stewart L A, Engelken G J. et al . Comparison of in vivo and in vitro measures of beryllium sensitization.  J Occup Environ Med. 1997;  39 540-547
  • 67 Schreiber J, Zissel G, Greinert U. et al . Diagnostik der chronischen Berylliosis.  Pneumologie. 1999;  53 193-198
  • 68 Curtis G. The diagnosis of Beryllium disease, with special reference to the patch test.  Arch Indust Health. 1959;  19 150-153
  • 69 Newman L S, Kreiss K, King T E. et al . Pathological and immunological alterations in early stages of beryllium disease. Re-examination of disease definition and natural history.  Am Rev Respir Dis. 1989;  139 1479-1486
  • 70 Lundgren R A, Maier L A, Rose C S. et al . Indirect and direct gas exchange at maximum exercise in beryllium sensitization and disease.  Chest. 2001;  120 1702-1708
  • 71 Daniloff E M, Lynch D A, Bartelson B B. et al . Observer variation and relationship of computed tomography to severity of beryllium disease.  Am J Respir Crit Care Med. 1997;  155 2047-2056
  • 72 Newman L S, Buschman D L, Newell Jr J D. et al . Beryllium disease: assessment with CT.  Radiology. 1994;  190 835-840
  • 73 Stange A W, Furman F J, Hilmas D E. Rocky Flats Beryllium Health Surveillance.  Environ Health Perspect. 1996;  104S 981-986
  • 74 Kreiss K, Mroz M M, Zhen B. et al . Risks of beryllium disease related to work processes at a metal, alloy, and oxide production plant.  Occup Environ Med. 1997;  54 605-612
  • 75 Pappas G P, Newman L S. Early pulmonary physiologic abnormalities in Beryllium disease.  Am Rev Respir Dis. 1993;  148 661-666
  • 76 Kreiss K, Mroz M M, Zhen B. et al . Epidemiology of beryllium sensitization and disease in nuclear workers.  Am Rev Respir Dis. 1993;  148 985-991
  • 77 Schepers G. The mineral content of the lung in chronic berylliosis.  J Dis Chest. 1962;  42 600-607
  • 78 Kent D C, Houk V N, Elliott R C. et al . The definitive evaluation of sarcoidosis.  Am Rev Respir Dis. 1970;  101 721-727
  • 79 Grunewald J, Eklund A. [It's difficult to differentiate between sarcoidosis and berylliosis!].  Lakartidningen. 2000;  97 5915-5918
  • 80 Fireman E, Kramer M R, Kaufman N. et al . Beryllium disease: first case reported in Israel.  Isr Med Assoc J. 2001;  3 224-225
  • 81 Bargon J, Rust M, Kronenberger H. et al . Klinik und Diagnostik der chronischen Berylliose - Eine Kasuistik.  Pneumologie. 1990;  44 Suppl 1 320-321
  • 82 Müller-Quernheim J, Zissel G, Schopf R. et al . Differenzialdiagnose Berylliose/Sarkoidose bei einem Zahntechniker.  Dtsch Med Wochenschr. 1996;  121 1462-1466
  • 83 Sprince N L, Kanarek D J, Weber A L. et al . Reversible respiratory disease in beryllium workers.  Am Rev Respir Dis. 1978;  117 1011-1017
  • 84 Müller-Quernheim J. Die Indikation zur Kortikosteroid-Therapie der Sarkoidose und die Bewertung ihrer Resultate.  Pneumologie. 2000;  54 284-286
  • 85 Müller-Quernheim J. Sarcoidosis, part II: Clinical manifestations, staging, and therapy.  Respir Med. 1998;  92 140-139
  • 86 Müller-Quernheim J, Dalhoff K, Schnabel A. Immunsuppressive Therapie bei interstitiellen Lungenerkrankungen und immunologisch vermittelten Pneumonitiden.  Internist (Berl). 1997;  38 553-561
  • 87 Sood A, Beckett W S, Cullen M R. Variable response to long-term corticosteroid therapy in chronic beryllium disease.  Chest. 2004;  126 2000-2007
  • 88 Nagaoka K, Yoshida T, Sakakibara H. et al . Significant improvement from chronic beryllium disease following corticosteroid pulse therapy.  Ind Health. 2006;  44 296-301
  • 89 Müller-Quernheim J, Kienast K, Held M. et al . Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen.  Eur Respir J. 1999;  14 1117-1122
  • 90 Lang L. Beryllium: A Chronic Problem.  Environ Health Perspect. 1994;  102 526-531

Prof. Dr. J. Müller-Quernheim

Abteilung für Pneumologie, Medizinische Klinik, Uniklinikum Freiburg

Killianstraße 5

79106 Freiburg

Email: joachim.mueller-quernheim@uniklinik-freiburg.de

    >