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Beryllium is the lightest metal and has an atomic number of 4. Beryllium, as an element, was first discovered in 1798 by the French chemist Vauquelin and reduced to its metallic form. Subsequently, it was named beryllium in 1828 by the German metallurgist Wohler. Beryllium became a commercial product when it was used as an alloy first with aluminum and later with cooper, nickel, and cobalt after World War I. This commercial product was used in communications (telephones and telecommunication) and medicine (x-ray devices). The industry grew in the 1930s due to the increased use of beryllium–copper products during World War II in defense (military equipment), nuclear energy (nuclear reactors), and household items (fluorescent lamp industries).

With an increased industrial need for beryllium, acute chemical pneumonitis was first described by Weber and Engelhardt1 in Germany in 1933 and in the United States by van Ordstrand et al. in 1943.2 This condition was usually limited to the upper respiratory tract, although it could extend to the bronchi, bronchioli, and alveoli if there was sufficient exposure. The condition peaked in the 1940s. The last reported possible case in the United States occurred in the early 1980s. Acute pneumonitis due to beryllium is now rare and expected to be seen due to large-scale disasters such as beryllium plant explosions or other serious lapses in procedures.3

A second pulmonary complication of beryllium exposure was first described by Hardy and Tabershaw in 1946.4 The disease differed from the acute chemical pneumonitis because of the delayed onset, granulomatous response, and chronic course. Now known as chronic beryllium disease (CBD), the condition is a hypersensitivity reaction, or sensitization to beryllium, and is the major hazard facing beryllium workers today.

In the modern era, acute manifestations of beryllium disease (such as acute pneumonitis) tend to be rare due to stricter governmental regulations that limit exposure in most developed countries. However, beryllium continues to be produced in high quantities in several countries, and exposure occurs in individuals working in select occupations, including primary beryllium factory workers, workers processing beryllium (foundry workers, furnace tenders, machinists, welders), individuals working with beryllium products (dental technicians, golf club manufacturers, bike parts manufacturers), and select industries (e.g., aerospace, automotive, defense, electronics, energy, telecommunications).5,6 It is estimated that as many as 60,000 workers in the United States are still exposed to beryllium.5,6 However, other studies suggest the prevalence of beryllium exposure is as high as 130,000 workers.7

Immunopathogenesis of CBD

There are three important characteristics of CBD.

First, this disease is usually associated with industrial exposure to beryllium. The only cases that have been described in nonindustrial workers have been in individuals who lived near beryllium plants and were exposed to the airborne emissions from the plant or from family members who brought ...

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