New aspects of chronic beryllium disease

Chronic beryllium disease (CBD) is a granulomatous lung disorder resulting from a cell-mediated immune response to beryllium exposure. Despite exposure regulations, new cases continue to emerge across both traditional and nontraditional occupational settings. In this review, we underscore ongoing diagnostic and preventive challenges, and strategies for screening and treatment of beryllium exposed patients.

Recent updates to exposure standards and medical surveillance have broadened recognition of at-risk populations, including military personnel and construction workers. Advances in understanding the immunopathogenesis of CBD - particularly the central role of beryllium-specific CD4 + T cells and the strong genetic association with HLA-DPB1 alleles containing glutamic acid at position 69 (Glu69) - have provided critical insight into disease susceptibility and progression. However, gaps persist in access to testing, biomarker development, and understanding the natural history of sensitization and disease progression. Treatment remains centered on corticosteroids, with emerging but limited evidence for immunomodulatory and biologic therapies.

Future directions include development of improved diagnostic biomarkers, refinement of screening protocols, and multicenter trials assessing steroid-sparing regimens. Coordinated translational and occupational research is essential to address persistent diagnostic uncertainty, reduce morbidity, and guide evidence-based management for affected individuals.