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New book: "Metal Allergy: From Dermatitis to Implant and Device Failure"

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  • New book: "Metal Allergy: From Dermatitis to Implant and Device Failure"

    P 542

    Hard Metal Lung Disease (HMLD)

    Cobalt is a metal well known due to cobalt-based blue pigments used since ancient times in pottery manufacturing. Nowadays cobalt is mainly employed in the preparation of magnetic, wear-resistant, high-strength alloys. Cobalt sintered together with tungsten carbide is used for the grinding of other metals, including metal tools. Inhaled exposure to cobalt dust may lead to the development of a wide spectrum of lung disease, known as hard metal lung disease (HMLD). The typical clinical manifestation includes giant cell interstitial pneumonitis (GIP), with the most characteristic multinucleated giant cells engulfing other cells (macrophages and neutrophils) present in the air spaces and interstitium. These giant cells may be found in BAL or in histological lung tissue samples and are regarded as pathognomonic for GIP due to hard metal exposure. Other rare lung manifestations of cobalt exposure may present as desquamative interstitial pneumonia or bronchiolitis obliterans organizing pneumonia. Hard metal disease shares some similarities in clinical symptoms and radiology with chronic beryllium disease (CBD). In contrast to CBD, avoiding further exposure at the early stage of the disease may result in significant improvement or total remission; however, substantial fibrosis in advanced disease is not reversible [68].

    Key Points
    • Several metals with increasing industrial
    applications and thus potential occupational
    exposures may induce diseases of the upper
    and lower respiratory tract, with clinical presentations
    of asthma, rhinosinusitis, acute
    bronchitis, acute pneumonitis, carcinoma, and
    interstitial lung disease.
    • Few metals may cause immunological asthma,
    and they all belong to transition metals of the
    fourth (chromium, cobalt, nickel, manganese,
    zinc), fifth (rhodium, palladium), and sixth
    (platinum, iridium) periods of the periodic
    • The pathogenesis of airway allergy to metals
    is relatively poorly understood. The underlying
    immune and nonimmune mechanisms
    involved in asthma caused by metals or metal
    salts are various and have not yet been fully
    • Laboratory tests (skin and serological tests,
    lymphocyte proliferation test) have limited
    value in the diagnosis of metal-induced immunological
    • Specific inhalation challenge tests play a key
    role in the diagnosis of metal-induced asthma.
    • In the case of beryllium, the most common
    manifestations of allergy in the lung include
    beryllium sensitization and chronic granulomatous
    lung disease.
    • Other metals such as indium, zirconium, titanium,
    cobalt, aluminum, and copper sulfate
    may sporadically induce lung pathology.
    • New industrial applications and new formulations
    of metals, including nanoparticles, may
    in the near future result in unpredictable health

  • #2
    Thanks for the heads-up. My employer is a large-scale manufacturer of hard metals in powdered form.
    25 miles north of Buffalo NY, USA


    • #3
      Powdered forms of many things are dangerous, but some metals which at first would seem toxic are not. For instance, some types of cobalt- chrome are used medically, such as replacement knee joints.


      • #4
        I was grinding the mag-chuck and fences of the surface grinder today and thinking that metallic brass dust smells like salad onions!
        Location- Rugby, Warwickshire. UK


        • #5
          I’m having a hard time convincing the doctors I suffered 3 heart attacks due to metal fume, casting steel in particular without breathing the fume is just about impossible, and at the time I worked on the casting floors of blast furnaces, converters and casters, I’ve spent hundreds, no thousands of hours in the fume off ladles, tundishes and mounds. Plus continuous lancing and burning.
          Guys having heart attacks was common, I got 3 hospitalised plus one or two before my first hospitalisation (apparently they can tell), that was before 45 yrs, I’m fairly certain throwing bags of alloy into ladles didn’t help.
          I’ll get that, it might further my case. Thanks


          • #6
            One of my workmates had the first symptoms of cadmium poisoning from fettling plated aircraft parts, so extra precautions were implemented straight away, he is alive and well so far at 72, thankfully.