What is Beryllium Toxicity?
Beryllium is a light, brittle gray metal that ranks fourth on the periodic table. It’s naturally present in things like coal, rocks, dust, and soil, usually combined with other elements. This metal gets released into our environment when dust particles float in the air or when fossil fuels are burned.
Because it is strong, light, and can withstand very high temperatures, beryllium is often used in materials for the aerospace industry, electronics, military technology, X-ray equipment, and in combination with other metals like copper, iron, or nickel to improve their properties.
People can come into contact with beryllium through various sources like water, food, air, and accidental ingestion or contact with soil. But the most common way of getting exposed to beryllium, which can lead to health problems, is through jobs that involve inhaling it, causing lung disease.
Acute beryllium toxicity is a lung condition that can occur after being exposed to high levels of beryllium. It has become less common due to stricter government regulations.
Chronic beryllium disease, also known as berylliosis, is a long-term lung condition caused by exposure to beryllium in people who are sensitive to it. This happens due to a specific type of allergic reaction in the body.
What Causes Beryllium Toxicity?
Beryllium is a natural element commonly found in soil and volcanic dust. It is dispersed into our surroundings via natural events such as decay or volcanic eruptions, and through human activities such as mining and burning. In the 1930s, it was identified as a health risk, especially for people who worked in a factory that produced fluorescent lamps.
Later, exposure to beryllium was also linked to people who work in sectors such as nuclear energy, defense, electronics, medical, and semiconductors. According to studies in the 1970s and 1980s, the number of employees exposed to beryllium in the U.S. went from 21,200 to 800,000. There’s also data suggesting that berylliosis clusters, or groups of cases, may be connected to exposure to concrete dust and regions with beryllium production plants.
Beryllium, in its many forms such as pure metal, beryllium oxide, or as part of other metals, is widely used in industries. Specifically, beryllium oxide is known for its capability to withstand high heat and is primarily used in select electronic devices. Two types of beryllium-based metals are used in industries: high-content beryllium (with up to 30% beryllium), and low-content beryllium (2 to 3% beryllium). These metals are part of manufacturing processes for items such as cars, computers, sports equipment, and dental bridges.
However, intense exposure to beryllium can lead to acute beryllium pneumonitis — a condition resulting from inflammation of the respiratory tract. How serious the inflammation is can depend on how the beryllium compound can dissolve and it isn’t specific to beryllium. However, after implementing workplace safety measures, cases of acute beryllium toxicity have been significantly reduced post-1980s.
For a person to develop chronic beryllium disease, they must become sensitized or allergic to beryllium. This reaction is due to a specific cell defense mechanism. People who have a particular genetic characteristic called HLA-DPB1-Glu polymorphism are more likely to become sensitized to beryllium. This sensitivity stimulates a specific type of immune cell known as CD4+ T cells, to recognize beryllium and initiate a multiplication effect. The various signals from the immune system result in granuloma formation, small areas of inflammation in the body, which are quite similar to another disease condition called sarcoidosis.
Risk Factors and Frequency for Beryllium Toxicity
Being exposed to beryllium and other metals at work can pose health problems to employees worldwide. Although steps have been taken to limit this exposure, such as setting an acceptable limit enforced by organizations like the Occupational Safety and Health Administration (OSHA) in the US, the disease caused by sudden intense exposure to beryllium, known as acute beryllium pneumonitis, has unfortunately become less common. However, even with improved safety measures, the death rate from throat, bronchial, and lung cancer due to exposure to cancer-causing substances at work has increased globally from 1990 to 2019. The International Agency for Research on Cancer has classified beryllium as a substance that can cause cancer in humans.
An instance of one study found that the mortality rate for berylliosis, a disease that affects the lungs due to beryllium exposure, was significantly more in workers who were part of nuclear weapons research. Beryllium sensitivity and chronic beryllium disease only affect individuals who have come into contact with beryllium, so males who are more commonly involved in these types of occupational practices are more likely to develop these conditions. Family members of those working with beryllium and even the workers’ vehicles can also be at risk of beryllium exposure.
While instances of beryllium poisoning are often due to occupational exposure, risks also exist for the general public. Beryllium may be present in small amounts in contaminated soil, air, food, or water. Individuals living near waste disposal sites may be at a higher risk of beryllium exposure through soil. Although beryllium can end up in waterways because of weather conditions, volcanic activity, or human influence, it generally attaches to sediment in these areas and typically doesn’t move around much.
Signs and Symptoms of Beryllium Toxicity
Acute beryllium sensitivity and Berylliosis are conditions that might occur in people exposed to beryllium, especially if they have respiratory symptoms. Acute beryllium toxicity typically occurs when someone has been exposed to certain levels of beryllium. It can cause inflammation of the upper and lower parts of the respiratory system, creating a situation akin to chemical pneumonia.
The symptoms of acute beryllium toxicity could include:
- Coughing
- Shortness of breath
- Fatigue
- Chest pain
- Coughing up blood
- Heart palpitations
- Loss of appetite
- Fever
Some people can develop a sensitivity to beryllium after being exposed to it, and they might not show any symptoms. Skin reactions from beryllium exposure can range from inflammation, beryllium-caused ulcers, and small nodules known as dermal granulomas. These nodules are often seen on the hands, arms, and chest. Non-healing ulcers can result from beryllium getting into a skin wound, and these may require removal through a surgical procedure.
People with chronic beryllium disease typically complain about symptoms like:
- Difficulty breathing after physical activity
- Dry cough
- Unintended weight loss
- Night sweats
- Fatigue
No matter whether the beryllium toxicity is acute or chronic, the first step in treatment is to remove the person from contact with the source of beryllium. A test known as the beryllium lymphocyte proliferation test (BeLPT) can confirm whether a person has become sensitive to beryllium.
Testing for Beryllium Toxicity
Initial signs of beryllium toxicity may not show up on a chest X-ray for up to a week or so after exposure. However, X-rays may later reveal widespread lung changes. If you’ve been exposed and have beryllium sensitivity, your lungs might be functioning normally but show abnormal reactions in a specific test, known as the Beryllium Lymphocyte Proliferation Test (BeLPT). As this condition progresses, it may cause various lung problems, such as breathing difficulties, constricted airways, or issues with gas exchange. In advanced stages, it can even lead to fibrosis, a condition where the lungs become thick and scarred.
Usually, the X-ray patterns of chronic beryllium disease (long-term beryllium toxicity) are unclear and similar to those of another lung condition called sarcoidosis. Early stages may show small, undefined spots or irregular shapes, and abnormal lymph nodes near your windpipe. These may only be visible in the upper part of your lungs. As the disease advances, it can lead to fibrosis, the formation of sacs filled with fluid (blebs), and a condition of damaged and enlarged air sacs, known as emphysema. Even with treatment and removal from exposure, these changes on the X-ray are unlikely to disappear completely.
Chronic beryllium disease can take a long time to develop, and symptoms may not appear until 10 to 20 years after exposure. The disease can still occur even 40 years after initial exposure. This disease can be similar in appearance to pulmonary sarcoidosis, a condition that causes inflammation in various regions of your body. If someone who has been exposed to beryllium in the past presents symptoms like those of sarcoidosis or has poor lung function, this should be taken as a possible case of chronic beryllium disease.
To support a diagnosis, a BeLPT test can be performed to see how your cells respond to beryllium. A biopsy for tissue confirmation should also be performed. Thanks to these testing methods, people who work with beryllium can now be screened for sensitivity and chronic beryllium disease before they even start to show symptoms. This early detection allows for prompt treatment.
Although the lung-related symptoms for sarcoidosis and beryllium disease are nearly identical, they differ when it comes to symptoms outside the lungs. Findings such as bone lesions, eye problems, nerve involvement, heart disease, and gland inflammation are common in sarcoidosis, but not in chronic beryllium disease. Eye exposure to beryllium salts may cause acute conjunctivitis (inflammation of the clear tissue over the white part of the eye), but this does not happen in chronic beryllium disease.
Treatment Options for Beryllium Toxicity
If a person has been exposed to beryllium (a type of metal), the first and most important step is to remove them from the source of exposure and ensure that their vital signs, such as heart rate and blood pressure, are stable. To help with symptoms, doctors may suggest inhaling certain medications that can help relieve the symptoms, such as corticosteroids and short-acting bronchodilators. These medications help to reduce inflammation and open up the airways to make breathing easier.
For people with chronic beryllium disease, which is a long-term condition caused by exposure to beryllium, corticosteroids are the main treatment. These medications can often improve symptoms, and doctors usually monitor patient’s response to treatment every 3 to 6 months, using both physical exams and imaging tests. The amount of medication can be adjusted based on improvements in symptoms and test results.
However, sometimes, even with early detection and treatment, people with chronic beryllium disease may experience worsening of their lung function. This can happen even while they are still taking their prescribed treatments. Over time and as the disease progresses, doctors might need to adjust their medical plan, and the person could require long-term treatment to suppress the immune system.
Long-term use of corticosteroids can have notable side effects. Therefore, if a person is experiencing significant side-effects, doctors may consider alternative treatments. Other medications such as methotrexate, azathioprine or infliximab might be used in place of corticosteroids, as they could cause fewer side effects.
What else can Beryllium Toxicity be?
Beryllium toxicity, which can occur either suddenly (acute) or over time (chronic), can look very similar to various other lung diseases. These may include:
- Fluid in the lungs (pulmonary edema)
- Long-term lung diseases that block airflow (chronic obstructive pulmonary disease)
- Condition that makes airways narrow and swell, often leading to wheezing, shortness of breath, chest tightness, and coughing (asthma)
- A blockage in one of the pulmonary arteries in your lungs (pulmonary embolism)
- A lung infection (pneumonia)
- Inflammation of the lungs due to breathing in foreign substances (chemical pneumonitis)
- An inflammatory disease that affects multiple organs in the body, but mostly the lungs and lymph glands (pulmonary sarcoidosis)
- A type of lung disease that scars your lungs and over time, the tissue becomes thick and stiff (idiopathic pulmonary fibrosis)
- Diseases caused by heavy metal exposure (heavy metal diseases)
What to expect with Beryllium Toxicity
The severity of the health effects from exposure to beryllium can vary significantly. This depends on factors like how long you are exposed for, how high the levels of exposure were, and your individual genetic makeup. There are people who will develop a sensitivity to beryllium, but this doesn’t necessarily mean they will go on to develop chronic beryllium disease, a condition where you have long-term lung damage. These individuals may only need short-term treatment and monitoring.
The progression of this sickness can differ from person to person. Some may only experience a mild sickness which resolves by itself while in others, the sickness could progress rapidly. In about 10% of cases, it can even lead to death. Earlier studies from the 1940s and 1950s suggested the death rate might be as high as 30%. However, the improvements in checking for illness and treatment methods in more recent times makes it uncertain what current death rates are.
Possible Complications When Diagnosed with Beryllium Toxicity
Immediate complications of beryllium sensitivity can involve fluid buildup in the lungs and heart disease related to lung conditions. In the long term, beryllium sensitivity can cause long-lasting liver inflammation (granulomatous hepatitis) and kidney inflammation (chronic interstitial nephritis). This is due to the ongoing inflammation response in the body. Moreover, patients who need long-term steroid treatment can develop complications from their medication. These may include increased blood sugar (hyperglycemia), weakened and brittle bones (osteoporosis), weight gain, and a higher chance of getting infections.
Common Side Effects:
- Fluid buildup in the lungs
- Lung-related heart disease
- Long-lasting liver inflammation
- Kidney inflammation
- Increased blood sugar
- Weakened and brittle bones
- Weight gain
- Increased risk of infection
Preventing Beryllium Toxicity
Beryllium is a type of metal that is found naturally in the earth’s crust and can be released into the air and water. People who work in certain industries, such as nuclear power, defense, electronics, biomedical research, and semiconductors, are more likely to be exposed to beryllium in their work environment. This can sometimes lead to the development of diseases related to beryllium exposure.
Beryllium is harmful because it can cause skin irritation when touched and lung disease when inhaled. It can lead to skin inflammation known as dermatitis, acute lung inflammation called pneumonitis, and chronic lung disease. The early warning signs of serious beryllium exposure might include having trouble breathing, chest pain, or feeling short of breath. Even though there are rules in place to limit people’s exposure to beryllium at work, any exposure to it can potentially cause diseases in both the short and long term.
If a person is suspected of having beryllium poisoning and is experiencing severe symptoms like difficulty breathing or chest pain, they should be immediately taken to the nearest emergency room. The Poison Control Center can also be contacted for additional advice on how to handle the situation.
If there is a concern that harmful amounts of beryllium have been present in a work environment, you can contact the Occupational Safety and Health Administration (OSHA) to help investigate the situation further.
