Sarcoidosis: An Occupational Disease?

Chest. 2021 Oct;160(4):1360-1367. doi: 10.1016/j.chest.2021.06.003. Epub 2021 Jun 5.

Abstract

Sarcoidosis is an important member of the family of granulomatous lung diseases. Since its recognition in the late 19th century, sarcoidosis has been thought of as a disease of unknown cause. Over the past 20 years, this paradigm has been shifting, more rapidly in the past 10 years. Epidemiologic studies, bolstered by case reports, have provided evidence of causal associations between occupational exposure to specific agents and sarcoidosis. Pathogenesis has been more clearly defined, including the role of gene-exposure interactions. The use of in vitro lymphocyte proliferation testing to detect sensitization to inorganic antigens is being examined in patients with sarcoidosis. These antigens include silica and certain metals. Results of studies to date show differences in immunoreactivity of occupationally exposed sarcoidosis cases compared with control cases, suggesting that lymphocyte proliferation testing may prove useful in diagnosing work-related disease. This review discusses recently published findings regarding associations between occupational exposure to silica and silicates, World Trade Center dust, and metals and risk for sarcoidosis, as well as advances in the development of diagnostic tools. Not all cases of sarcoidosis have an identified cause, but some do. Where the cause is occupational, its recognition is critical to enable effective treatment through removal of the affected worker from exposure and to inform intervention aimed at primary prevention.

Keywords: World Trade Center dust; genetics; lymphocyte proliferation test; sarcoidosis; silica.

Publication types

  • Review

MeSH terms

  • Calcium Carbonate
  • Calcium Sulfate
  • Emergency Responders
  • Humans
  • Immunologic Tests
  • Lymphocyte Activation
  • Metals / adverse effects
  • New York City / epidemiology
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / etiology
  • Occupational Exposure / adverse effects
  • Occupational Exposure / statistics & numerical data*
  • Sarcoidosis / epidemiology
  • Sarcoidosis / etiology
  • Sarcoidosis, Pulmonary / epidemiology*
  • Sarcoidosis, Pulmonary / etiology
  • September 11 Terrorist Attacks
  • Silicates / adverse effects
  • Silicon Dioxide / adverse effects

Substances

  • Metals
  • Silicates
  • Silicon Dioxide
  • Calcium Carbonate
  • Calcium Sulfate