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Review
. 2012 Apr;12(2):145-50.
doi: 10.1097/ACI.0b013e3283515173.

Occupational causes of sarcoidosis

Kira L Newman  1 , Lee S Newman
Affiliations
Review

Occupational causes of sarcoidosis

Kira L Newman et al. Curr Opin Allergy Clin Immunol. 2012 Apr.

Abstract

Purpose of review: Sarcoidosis, the multiorgan granulomatous disease of unknown cause, remains mysterious. Several important investigations in the past 2 years add to the accumulating evidence for both occupational and environmental causes of granulomatous inflammation.

Recent findings: This review considers the most recent studies that contribute to the hypothesis that sarcoidosis occurs when individuals are exposed to foreign antigens and to inorganic particulates that promote inflammation. Major recent findings, such as those emerging from the study of World Trade Center responders, the study of nanoparticles, and cases of work-associated sarcoidosis, support the probability that occupational, as well as environmental, exposures to inflammatory stimuli trigger sarcoidosis-like illness. Major recent studies of microbially rich indoor environments, including moldy indoor workplaces and mycobacterially contaminated settings, contribute to the evidence that a variety of microbial antigens serve as targets for the hypersensitivity immune response in an inflammatory milieu.

Summary: There is increasing evidence that sarcoidosis can occur in workplace settings in which there is exposure to both foreign antigens and inorganic triggers of inflammation that promote an exuberant granulomatous immune response. It is likely that sarcoidosis has more than one cause.

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Conflict of interest statement

Conflict of Interest:

No declared conflict of interest for either author.

Figures

Figure 1
Figure 1
METALWORKING FLUID EXPOSURES CAN CAUSE SARCOIDOSIS-LIKE ILLNESS IN METAL MACHINING INDUSTRIES. Metal parts are commonly flooded with synthetic and semi-synthetic oils that serve as coolants during machining. Such fluids are commonly recycled and can become contaminated with mycobacteria, endotoxin, and microbial antigens. Workers often develop hypersensitivity pneumonitis that is initially mistaken for sarcoidosis.
See this image and copyright information in PMC

References

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    1. Laney AS, Cragin LA, Blevins LZ, et al. Sarcoidosis, asthma, and asthma-like symptoms among occupants of a historically water-damaged office building. Indoor Air. 2009;19:83–90.. This study is an interesting investigation of the contribution of mold contamination to the development of not only sarcoidosis, but other immune-mediated respiratory disorders. Like other studies of its kind, there is emerging evidence that office building-related sarcoidosis occurs.

    1. Iossifova YY, Cox-Ganser JM, Park J-H, et al. Lack of respiratory improvement following remediation of a water-damaged office building. Am. J. Ind. Med. 2011;54(4):269–277.. In this follow-up study of workers exposed to mold in a water-damaged building, researchers reexamined individuals after the building was cleaned. Unfortunately, there continued to be a high incidence of respiratory illness after remediation.

    1. Terčelj M, Salobir B, Harlander M, et al. Fungal exposure in homes of patients with sarcoidosis - an environmental exposure study. Environ Health. 2011;10(1):8. - PMC - PubMed

    1. Terčelj M, Stopinšek S, Ihan A, et al. In vitro and in vivo reactivity to fungal cell wall agents in sarcoidosis. Clin. Exp. Immunol. 2011;166(1):87–93.. This intriguing study showed that patients with sarcoidosis mount increased blood mononuclear cell cytokine responses to fungal cell wall antigens as compared to controls. Researchers also conducted sampling in patients’ homes and found a positive correlation between high household fungal antigen levels and increased IL-6, IL-10, and IL-12 secretion.

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