Metal Allergy pp 337-347 | Cite as

Metal Allergy: Beryllium

  • James S. Taylor
  • Raed A. Dweik
  • Jane M. Taylor


Beryllium is one of the lightest metals, with unique mechanical, physical, and nuclear properties that allow major applications in the aircraft and aerospace industries as well as for nuclear reactors and defense. An estimated 300,000 workers are exposed to beryllium during ore extraction, processing, and manufacturing. Potential toxicities include acute and chronic beryllium disease (CBD) and lung cancer. Skin manifestations include irritant and allergic contact dermatitis, chemical ulcers, and ulcerating and dermal granulomas. Diagnosis of CBD includes (1) a history of beryllium exposure, (2) a positive lymphocyte proliferation test (BeLPT) either from blood or bronchoalveolar lavage, and (3) compatible pathology on lung biopsy. Beryllium sensitization (BeS) occurs with (1) and (2) in the absence of lung pathology. The BeLPT has been the cornerstone of both medical surveillance and the diagnosis of BeS and CBD and, in the occupational and pulmonary settings, has mostly replaced the beryllium patch test because of multiple reports of patch test sensitization. Contact stomatitis to dental alloys has been reported in the more recent dermatology literature, with beryllium patch testing recommended primarily on an aimed rather than a screening basis. Determinants of progression from BeS to CBD are uncertain, but higher beryllium exposures and the presence of a genetic variant in the HLA-DP β-chain appear to increase the risk. The US Occupational Health and Safety Administration has just issued a new permissible exposure limit (PEL) standard dramatically reducing the allowed workroom air concentration of beryllium. In addition, standard industrial hygiene controls including personal protective clothing and equipment are required since the PEL for beryllium does not always protect workers from dermal exposure and skin sensitization.


  1. 1.
    Stonehouse AJ, Zenczak S. Properties, production processes and applications. In: Rossman MD, Preuss OP, Powers MB, editors. Beryllium biomedical and environmental aspects. Baltimore: Williams and Wilkins. p. 27–58. 319pp.Google Scholar
  2. 2.
    Strupp C. Beryllium metal I. Experiment results on acute oral toxicity, local skin and eye effects and genotoxicity. Ann Occup Hyg. 2011;55:30–42.PubMedGoogle Scholar
  3. 3.
    Balmes JR, Abraham JL, Dweik RA, et al. An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease. Am J Respir Crit Care Med. 2014;190:e34–59.CrossRefGoogle Scholar
  4. 4.
    Powers MB. History of beryllium, Chapter 2 in 58. In: Rossman MD, Preuss OP, Powers MB, editors. Beryllium biomedical and environmental aspects. Baltimore: Williams and Wilkins. 319pp.Google Scholar
  5. 5.
    Van Ordstrand HS, Hughes R, Carmody MG. Chemical pneumonia in workers extracting beryllium oxide. Cleve Clin Q. 1943;10:10.CrossRefGoogle Scholar
  6. 6.
    Curtis GH. Cutaneous hypersensitivity due to beryllium, a study of thirteen cases. Arch Dermatol Syph. 1951;54:470–82.Google Scholar
  7. 7.
    Denardi JM, Van Ordstrand HS, Curtis GH, Sielinski J. Berylliosis; summary and survey of all clinical types observed in a twelve-year period. AMA Arch Ind Hyg Occup Med. 1953;8:1–24.PubMedGoogle Scholar
  8. 8.
    Van Ordstrand HS, Netherton EW, De Nardi JM, Carmody MG. Beryllium and skin granulomas from a broken fluorescent light tube. Cleve Clin Q. 1950;17:34–7.CrossRefGoogle Scholar
  9. 9.
    Epstein WL. Commentary and update: beryllium granulomas of the skin: a small window to understanding. Cleve Clin Q. 1983;50:73–5.CrossRefGoogle Scholar
  10. 10.
    Hardy HL, Tabershaw IR. Delayed chemical pneumonitis occurring in workers exposed to beryllium compounds. J Ind Hyg Toxicol. 1946;28:197–211.PubMedGoogle Scholar
  11. 11.
    Hardy HL, Rabe EW, Lorch S. United States beryllium case registry (1952-1966); review of its methods and utility. J Occup Med. 1967;9:271–6.PubMedGoogle Scholar
  12. 12.
    Jones-Williams W. Pathology and histopathology of chronic beryllium disease. Chapter 13 pp151–160. In: Rossman MD, Preuss OP, Powers MB, editors. Beryllium biomedical and environmental aspects. Baltimore: Williams and Wilkins. 319pp.Google Scholar
  13. 13.
    Epstein WL. Cutaneous effects of beryllium. Chapter 9 pp 113–117. In: Rossman MD, Preuss OP, Powers MB, editors. Beryllium biomedical and environmental aspects. Baltimore: Williams and Wilkins. 319pp.Google Scholar
  14. 14.
    Rossman MD. Chronic beryllium disease, a hypersensitivity disorder. Appl Occup Environ Hyg. 2001;16:615–8.CrossRefGoogle Scholar
  15. 15.
    Cummings KJ, Stefaniak AB, Virji MA, et al. A reconsideration of acute beryllium disease. Environ Health Perspect. 2009;11:1250–6.CrossRefGoogle Scholar
  16. 16.
    Maier LA, Martyny JW, Liang J, et al. Recent chronic beryllium disease in residents surrounding a beryllium facility. Am J Respir Crit Care Med. 2008;177:1012–7.CrossRefGoogle Scholar
  17. 17.
    Vilaplana J, Romaguera C, Grimalt F. Occupational and non-occupational allergic contact dermatitis from beryllium. Contact Dermatitis. 1992;26:295–8.CrossRefGoogle Scholar
  18. 18.
    Haberman AL, Pratt M, Storrs FJ. Contact dermatitis from beryllium in dental alloys. Contact Dermatitis. 1993;28:17–162.CrossRefGoogle Scholar
  19. 19.
    Toledo F, Silvestre JF, Cuesta L, Latorre N, Monteagudo A. Contact allergy to beryllium chloride: report of 12 cases. Contact Dermatitis. 2011;64:104–9.CrossRefGoogle Scholar
  20. 20.
    Sneddon IB. Beryllium disease. Postgrad Med J. 1968;34:262–7.CrossRefGoogle Scholar
  21. 21.
    Berlin JM, Taylor JS, Sigel JE, et al. Beryllium dermatitis. J Am Acad Dermatol. 2003;49:939–41.CrossRefGoogle Scholar
  22. 22.
    Kirshen C, Pratt M. Dental allergic contact dermatitis: an interesting case series and review of the literature. Dermatitis. 2012;23:222–6.CrossRefGoogle Scholar
  23. 23.
    Newman LS, Maier LA. Chronic beryllium disease (berylliosis). UpToDate 2016. Accessed 7 June 2016.Google Scholar
  24. 24.
    Curtis GH. The diagnosis of beryllium disease, with special reference to the patch test. AMA Arch Ind Health. 1959;19:150–3.PubMedGoogle Scholar
  25. 25.
    Waksman BH. The diagnosis of beryllium disease with special reference to the patch test; discussion of paper by Dr Curtis. AMA Arch Ind Health. 1959;19:154–6.PubMedGoogle Scholar
  26. 26.
    Sneddon IB. Berylliosis, a case report. Br Med J. 1955;1(4928):1448–50.CrossRefGoogle Scholar
  27. 27.
    Sneddon IB. Berylliosis. Proc R Soc Med. 1955;48:175–7.PubMedGoogle Scholar
  28. 28.
    Henderson WR, Fukuyama K, Epstein WL, et al. In vitro demonstration of delayed hypersensitivity in patients with berylliosis. J Invest Dermatol. 1972;58:5–7.CrossRefGoogle Scholar
  29. 29.
    Bobka CA, Stewart LA, Engelken GA, et al. Comparison of in vivo and in vitro measures of beryllium sensitization. J Occup Environ Med. 1997;39:540–7.CrossRefGoogle Scholar
  30. 30.
    Costa AL, Salvador JFS, Perez-Crespo M, et al. Late reactions to beryllium: report of two cases. Contact Dermatitis. 2008;59:190–1.CrossRefGoogle Scholar
  31. 31.
    Bircher AJ. Patch tests with beryllium salts. Contact Dermatitis. 2011;64:363–4.CrossRefGoogle Scholar
  32. 32.
    Harber P, Su J, Alongi G. Beryllium biobank: 2. Lymphocyte proliferation testing. J Occup Environ Med. 2014;56:857–60.CrossRefGoogle Scholar
  33. 33.
    Harber P, Su J. Beryllium biobank: 3. Considerations for improving chronic beryllium disease screening. J Occup Environ Med. 2014;56:861–6.CrossRefGoogle Scholar
  34. 34.
    Tinkle SS, Antonini JM, Rich BA, et al. Skin as a route of exposure and sensitization in chronic beryllium disease. Environ Health Perspect. 2003;111:1202–8.CrossRefGoogle Scholar
  35. 35.
    Occupational Safety and Health Administration (OSHA) US Department of Labor. Occupational exposure to beryllium. Final rule. Fed Regist. 2017;82(5):2470–24757.Google Scholar
  36. 36.
    Walberg JE, Bowman A. Guinea pig maximization test. In: Anderson KE, Maibach HI, editors. Contact allergy. Predictive tests in guinea pigs. Current problems in dermatology, vol. 14. Basel: Karger; 1985. p. 59–106.Google Scholar
  37. 37.
    Kligman AM. The identification of contact allergens by human assay. III. The maximization test: A procedure for screening and rating contact sensitizers. J Invest Dermatol. 1966;47:393–409.CrossRefGoogle Scholar
  38. 38.
    Epstein WL, Byers VS. Transfer of contact sensitivity to beryllium using dialyzable leukocyte extracts (transfer factor). J Allerg Clin Immunol. 1979;63:111–5.CrossRefGoogle Scholar
  39. 39.
    Borak J. Chronic beryllium disease. The search for a dose-response. J Occup Environ Med. 2016;58:e355–61.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • James S. Taylor
    • 1
  • Raed A. Dweik
    • 2
  • Jane M. Taylor
    • 1
    • 3
  1. 1.Department of DermatologyDermatology-Plastic Surgery Institute, Cleveland Clinic Lerner College of MedicineClevelandUSA
  2. 2.Pulmonary Vascular Program, Respiratory InstituteCleveland Clinic Lerner College of MedicineClevelandUSA
  3. 3.New Albany Plain Local SchoolsNew AlbanyUSA

Personalised recommendations