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Beryllium: a paradigm for occupational lung disease and its prevention
  1. Kathleen Kreiss
  1. Correspondence to Dr Kathleen Kreiss, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control, 1095 Willowdale Road, H-2800, Morgantown, West Virginia, WV 26505, USA; kxk2{at}cdc.gov

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In this issue of the journal, Van Dyke and colleagues have shown that the supra-typic genetic marker, HLA-DPB1(E69), has an additive and independent contribution with beryllium exposure to cell-mediated beryllium sensitisation and chronic beryllium disease in a cohort at a US nuclear weapons plant.1 This finding of statistical independence between required beryllium exposure and genetic characteristics is quantitatively consistent with an earlier finding in a small beryllia ceramics operation,2 and is extended by a concurrent publication in a second, larger nuclear weapons plant population.3 In the latter case–control study, Van Dyke et al showed that the subset of rare HLA-DPB1(E69) alleles (non-*02), most with greater electronegativity in the antigen-binding groove,4 conferred much higher risk of sensitisation and disease than the more common *02 HLA-DPB1(E69) genotypes: Both sensitisation and chronic beryllium disease risks were equally associated with genotype, but these two health outcomes differed with respect to exposure risk. Cumulative and average lifetime beryllium exposures were associated with chronic beryllium disease but not with beryllium sensitisation. Other recent studies of newly exposed beryllium workers demonstrate that sensitisation often occurs within months of employment, presumably before a beryllium lung burden sufficient for chronic beryllium disease is attained.5–7 Although the Van Dyke paper in this issue did not have sufficient numbers to analyse beryllium sensitisation and beryllium disease cases separately, it showed compatible results, with the beryllium-sensitised cases having much lower indices of beryllium exposure compared with the chronic beryllium disease …

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