Health effects from beryllium are caused by the body's immune system response to inhaled dust or fumes containing beryllium metal, alloys, or compounds. This immune system response to beryllium is similar to an allergic reaction and may evolve over many years, even decades. Early evidence of this reaction may be detected by a blood test [i.e., the beryllium lymphocyte proliferation test (Be-LPT)] before there is evidence of damage to the lungs. The Be-LPT is used as a screening test for early evidence that an individual may be at higher risk for beryllium disease based on reaction of the immune system to the metal. Positive test results indicate beryllium sensitization. Sensitization is not a disease. There is no impairment from, or symptoms of, sensitization itself.

The body's reaction may continue to progress and cause damage to the lungs. CBD is said to exist when there is evidence of harmful effects to the lungs, i.e., when healthy lung tissue becomes damaged and changes from functioning lung tissue to fibrotic tissue. Damage to the lungs may be detected early by biopsy before there are symptoms (e.g. shortness of breath). Damage (i.e., fibrosis) may progress to the point that symptoms are severe enough to disable or cause death. In summary, the health effects from beryllium may be clinically silent (i.e., without symptoms) or may progress to substantial impairment or death.

Detection and diagnosis of beryllium health effects are usually a two-step process. First, the Be-LPT is performed to determine whether a worker is sensitized. If the initial test result is confirmed to be positive on a repeat test, the worker is offered further tests, which include bronchoscopy and other medical tests that the examining physician deems necessary to determine whether lung damage or CBD exists.

Not all exposed workers develop sensitization or disease. Research suggests that a small percentage of the population may have a genetic predisposition to CBD. Once a worker becomes sensitized or is diagnosed with CBD, the process is not reversible. There is no cure for CBD. Early diagnosis and treatment of CBD are expected to reduce adverse health effects and improve a person's prognosis.

2.3 Skin and Implantation

Beryllium and its compounds can cause a variety of skin problems depending on the chemical form of beryllium and the type of exposure, as follows:

* Irritant dermatitis--Caused by contact with a soluble compound. Symptoms are inflammation, local edema (i.e., accumulation of excessive amounts of fluids), and transudation of serum (i.e., passage of serum through the skin).

* Allergic contact dermatitis--May occur within 6-15 days of exposure to dust, fumes, or mist. Symptoms include erythema (i.e., inflammatory redness) and varying degrees of edema; lesions may be present.

* Chemical ulcer or ulcerating granuloma--A persistent lesion that results from implantation of a beryllium crystal or metal under the skin. The lesion will not heal until the foreign body (i.e., beryllium) is removed.

A very small number of CBD cases have resulted from skin implantation; the typical effects are those noted above.

2.4 Cancer

The American Conference of Governmental Industrial Hygienists and the International Agency for Research on Cancer classify beryllium and its compounds as confirmed human carcinogens (classifications A1 and Group 1, respectively). These determinations are based on animal studies in which cancers were induced in laboratory animals dosed with beryllium and on human epidemiological studies of workers in beryllium plants that showed a slight increase in lung cancer incidence.

3.0 Controls

All beryllium work shall be controlled to minimize the number of workers and visitors exposed or potentially exposed and the opportunities for exposure. When beryllium needs to be used for an operation, controls shall be implemented in the following order of priority:

* Engineering controls.