Systematic review: progression of beryllium sensitization to chronic beryllium disease

Background The relevance of beryllium sensitization testing for occupational health practice and prevention is unclear. Aims To analyse the natural course of beryllium sensitization and clarify the prognosis following cessation of exposure among sensitized workers. Methods An electronic literature search was conducted in PubMed, Embase,Toxline and Cochrane databases supplemented by a manual search. Data abstraction and study quality assessment with adapted guideline checklists were performed independently by three reviewers. Seven studies met the eligibility criteria and were included in the systematic review; however, six of the seven studies were of low methodological quality. Results A substantial (although not specifically quantifiable) proportion of beryllium-sensitized employees will develop chronic beryllium disease (CBD). To date, it is unknown if cessation of exposure in sensitized workers reduces the progression rate to CBD. Conclusions To determine the utility of regular assessments for beryllium sensitization among exposed workers, there is a need for prospective studies. This should include detailed and continuous exposure monitoring, regular tests for beryllium sensitization and a thorough diagnostic evaluation of sensitized workers to confirm or exclude CBD.