{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T20:36:40Z","timestamp":1793824600297,"version":"4.6.1"},"reference-count":86,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>The aetiology and pathophysiology of sarcoidosis is ill defined\u2014current hypotheses centre on complex genetic\u2013immune\u2013environmental interactions in an individual, triggering a granulomatous process. The aim of this systematic review is to define and describe which airborne occupational exposures (aOE) are associated with and precede a diagnosis of pulmonary sarcoidosis. The methodology adopted for the purpose was systematic review and meta-analyses of ORs for specified aOE associated with pulmonary sarcoidosis (DerSimonian Laird random effects model (pooled log estimate of OR)). Standard search terms and dual review at each stage occurred. A compendium of aOE associated with pulmonary sarcoidosis was assembled, including mineralogical studies of sarcoidosis granulomas. N=81\u2009aOE were associated with pulmonary sarcoidosis across all study designs. Occupational silica, pesticide and mould or mildew exposures were associated with increased odds of pulmonary sarcoidosis. Occupational nickel and aluminium exposure were associated with a non-statistically significant increase in the odds of pulmonary sarcoidosis. Silica exposure associated with pulmonary sarcoidosis was reported most frequently in the compendium (n=33 studies) and was the most common mineral identified in granulomas. It was concluded that aOE to silica, pesticides and mould or mildew are associated with increased odds of pulmonary sarcoidosis. Equipoise remains concerning the association and relationship of metal dusts with pulmonary sarcoidosis.<\/jats:p>","DOI":"10.1136\/oemed-2022-108632","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T17:20:19Z","timestamp":1693243219000},"page":"580-589","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-3492","authenticated-orcid":false,"given":"Christopher C","family":"Huntley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketan","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishah Z","family":"Mughal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley","family":"Coelho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P Sherwood","family":"Burge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice M","family":"Turner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth I","family":"Walters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"2023100507551389000_80.10.580.1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.2.ats4-99"},{"key":"2023100507551389000_80.10.580.2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202002-0251ST"},{"issue":"Supplement_6","key":"2023100507551389000_80.10.580.3","doi-asserted-by":"crossref","first-page":"S429","DOI":"10.1513\/AnnalsATS.201707-565OT","article-title":"Genetic immunologic, and environmental basis of Sarcoidosis","volume":"14","author":"Moller","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"2023100507551389000_80.10.580.4","unstructured":"European Committee for Standardization (CEN) . Workplace atmospheres-size fraction definitions for measurement of airborne particles (Report no.BS EN 481: 1993). London, England: CEN, British Standards Institute, 1993."},{"key":"2023100507551389000_80.10.580.5","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20050648"},{"key":"2023100507551389000_80.10.580.6","first-page":"125","article-title":"HLA and environmental interactions in Sarcoidosis","volume":"25","author":"Rossman","year":"2008","journal-title":"J Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"2023100507551389000_80.10.580.7","doi-asserted-by":"crossref","unstructured":"Rossides M , Grunewald J , Eklund A , et al . Familial aggregation and Heritability of Sarcoidosis: a Swedish nested Case\u2212Control study. Eur Respir J 2018;52:1800385. doi:10.1183\/13993003.00385-2018","DOI":"10.1183\/13993003.00385-2018"},{"key":"2023100507551389000_80.10.580.8","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.094060"},{"key":"2023100507551389000_80.10.580.9","doi-asserted-by":"crossref","unstructured":"Hena KM . Sarcoidosis epidemiology: race matters. Front Immunol 2020;11:537382. doi:10.3389\/fimmu.2020.537382","DOI":"10.3389\/fimmu.2020.537382"},{"key":"2023100507551389000_80.10.580.10","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000715"},{"key":"2023100507551389000_80.10.580.11","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/2040622318790197","article-title":"Epidemiology of Sarcoidosis: Current findings and future directions","volume":"9","author":"Arkema","year":"2018","journal-title":"Ther Adv Chronic Dis"},{"key":"2023100507551389000_80.10.580.12","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00477-2016"},{"key":"2023100507551389000_80.10.580.13","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00197808"},{"key":"2023100507551389000_80.10.580.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2006.00773.x"},{"key":"2023100507551389000_80.10.580.15","doi-asserted-by":"publisher","DOI":"10.1378\/chest.116.5.1183"},{"key":"2023100507551389000_80.10.580.16","doi-asserted-by":"publisher","DOI":"10.1136\/thx.43.4.342"},{"key":"2023100507551389000_80.10.580.17","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.5.1431"},{"key":"2023100507551389000_80.10.580.18","doi-asserted-by":"publisher","DOI":"10.1136\/oem.55.10.657"},{"key":"2023100507551389000_80.10.580.19","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1093\/occmed\/kqz118","article-title":"Silica dust and Sarcoidosis in Swedish construction workers","volume":"69","author":"Jonsson","year":"2019","journal-title":"Occup Med"},{"key":"2023100507551389000_80.10.580.20","doi-asserted-by":"crossref","unstructured":"Ronsmans S , De Ridder J , Vandebroek E , et al . Associations between occupational and environmental exposures and organ involvement in Sarcoidosis: a retrospective case-case analysis. Respir Res 2021;22:224. doi:10.1186\/s12931-021-01818-5","DOI":"10.1186\/s12931-021-01818-5"},{"key":"2023100507551389000_80.10.580.21","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200402-249OC"},{"key":"2023100507551389000_80.10.580.22","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201904-0717ST"},{"key":"2023100507551389000_80.10.580.23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"2023100507551389000_80.10.580.24","doi-asserted-by":"crossref","unstructured":"Page MJ , McKenzie JE , Bossuyt PM , et al . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi:10.1136\/bmj.n71","DOI":"10.1136\/bmj.n71"},{"key":"2023100507551389000_80.10.580.25","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/139.6.1479"},{"key":"2023100507551389000_80.10.580.26","doi-asserted-by":"publisher","DOI":"10.1097\/01.jom.0000155711.88781.91"},{"key":"2023100507551389000_80.10.580.27","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.5.1527"},{"key":"2023100507551389000_80.10.580.28","first-page":"49","article-title":"Photocopier exposure and risk of Sarcoidosis in African-American Sibs","volume":"21","author":"Rybicki","year":"2004","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"2023100507551389000_80.10.580.29","first-page":"182","article-title":"Sarcoidose Cutanee Secondaire a L\u2019Inhalation de Particules de Flocage D\u2019Isolation","volume":"125","author":"Bodokh","year":"1998","journal-title":"Ann Dermatol Venereol"},{"key":"2023100507551389000_80.10.580.30","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1097\/00029330-200709010-00018","article-title":"Pulmonary Sarcoid-like granulomatosis induced by aluminium dust: report of a case and literature review","volume":"120","author":"Cai","year":"2007","journal-title":"Chin Med J (Engl)"},{"key":"2023100507551389000_80.10.580.31","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/1752-1947-4-259","article-title":"Sarcoidosis in a dental surgeon: a case report","volume":"4","author":"Checchi","year":"2010","journal-title":"J Med Case Reports"},{"key":"2023100507551389000_80.10.580.32","doi-asserted-by":"publisher","DOI":"10.1136\/thx.33.2.219"},{"key":"2023100507551389000_80.10.580.33","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1002\/ajim.23030","article-title":"Granulomatous lung disease in two workers making light bulbs","volume":"62","author":"Ronsmans","year":"2019","journal-title":"Am J Ind Med"},{"key":"2023100507551389000_80.10.580.34","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-019-0096-x","article-title":"Sarcoidosis","volume":"5","author":"Grunewald","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2023100507551389000_80.10.580.35","doi-asserted-by":"crossref","unstructured":"Vihlborg P , Bryngelsson I-L , Andersson L , et al . Risk of Sarcoidosis and Seropositive rheumatoid arthritis from occupational silica exposure in Swedish iron foundries: a retrospective cohort study. BMJ Open 2017;7:e016839. doi:10.1136\/bmjopen-2017-016839","DOI":"10.1136\/bmjopen-2017-016839"},{"key":"2023100507551389000_80.10.580.36","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1002\/ajim.23333","article-title":"Sarcoidosis in northern Ontario hard-rock miners: A case series","volume":"65","author":"Oliver","year":"2022","journal-title":"Am J Ind Med"},{"key":"2023100507551389000_80.10.580.37","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1002\/ajim.21030","article-title":"Tunnel Excation triggering pulmonary Sarcoidosis","volume":"55","author":"Kawano-Dourado","year":"2012","journal-title":"Am J Ind Med"},{"key":"#cr-split#-2023100507551389000_80.10.580.38.1","doi-asserted-by":"crossref","unstructured":"Patel DC , Jaber J , Krefft SD , et al . Sarcoidosis in military deployers to iraq, afghanistan and southwest asia. American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX","DOI":"10.1164\/ajrccm-conference.2019.199.1_MeetingAbstracts.A1869"},{"key":"#cr-split#-2023100507551389000_80.10.580.38.2","doi-asserted-by":"crossref","unstructured":"May 2019:A1869 doi:10.1164\/ajrccm-conference.2019.199.1_MeetingAbstracts.A1869","DOI":"10.1164\/ajrccm-conference.2019.199.1_MeetingAbstracts.A1869"},{"key":"2023100507551389000_80.10.580.39","unstructured":"Silhan LL , Hines SE , Shah NG . Another war syndrome? A case of Neuro- and pulmonary Sarcoidosis in a Solider returning from Iraq. Am J Respir Crit Care Med 2013;187:A6143."},{"key":"2023100507551389000_80.10.580.40","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/JOM.0000000000002281","article-title":"Silica dust exposure increases risk for rheumatoid arthritis. A Swedish National Registry case-control study","volume":"63","author":"Wrangel","year":"2021","journal-title":"J Occup Environ Med"},{"key":"2023100507551389000_80.10.580.41","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.114694"},{"key":"2023100507551389000_80.10.580.42","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2016.00097"},{"key":"2023100507551389000_80.10.580.43","doi-asserted-by":"crossref","first-page":"2805","DOI":"10.1111\/all.14202","article-title":"Silica-related diseases in the modern world","volume":"75","author":"Hoy","year":"2020","journal-title":"Allergy"},{"key":"2023100507551389000_80.10.580.44","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1023\/A:1015967017103","article-title":"Effect of inhaled crystalline silica in a rat model: time course of pulmonary reactions","volume":"234\u2013235","author":"Castranova","year":"2002","journal-title":"Mol Cell Biochem"},{"key":"2023100507551389000_80.10.580.45","doi-asserted-by":"publisher","DOI":"10.1097\/01.mcp.0000152998.11335.24"},{"key":"2023100507551389000_80.10.580.46","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.chest.2017.11.030","article-title":"The pathogenesis of pulmonary Sarcoidosis and implications for treatment","volume":"153","author":"Patterson","year":"2018","journal-title":"Chest"},{"key":"2023100507551389000_80.10.580.47","doi-asserted-by":"publisher","DOI":"10.1136\/oem.55.10.668"},{"key":"2023100507551389000_80.10.580.48","doi-asserted-by":"publisher","DOI":"10.1186\/1476-069X-10-8"},{"key":"2023100507551389000_80.10.580.49","doi-asserted-by":"crossref","unstructured":"Greaves SA , Ravindran A , Santos RG , et al . Cd4+ T cells in the lungs of acute Sarcoidosis patients recognize an Aspergillus Nidulans EPITOPE. J Exp Med 2021;218:e20210785. doi:10.1084\/jem.20210785","DOI":"10.1084\/jem.20210785"},{"key":"2023100507551389000_80.10.580.50","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s12890-016-0332-z","article-title":"Is there any association between Sarcoidosis and infectious agents?: a systematic review and meta-analysis","volume":"16","author":"Esteves","year":"2016","journal-title":"BMC Pulm Med"},{"key":"2023100507551389000_80.10.580.51","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-9-36"},{"key":"2023100507551389000_80.10.580.52","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.1992.tb05093.x"},{"key":"2023100507551389000_80.10.580.53","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/ina.12278","article-title":"Bacteria in a water-damaged building: associations of Actinomycetes and non-tuberculous mycobacteria with respiratory health in occupants","volume":"27","author":"Park","year":"2017","journal-title":"Indoor Air"},{"key":"2023100507551389000_80.10.580.54","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.00006014"},{"key":"2023100507551389000_80.10.580.55","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-216523"},{"key":"2023100507551389000_80.10.580.56","doi-asserted-by":"publisher","DOI":"10.1007\/s00204-002-0326-x"},{"issue":"Suppl 5","key":"2023100507551389000_80.10.580.57","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1289\/ehp.98106s51151","article-title":"Reactive oxygen species: their relation to Pneumoconiosis and carcinogenesis","volume":"106 Suppl 5","author":"Vallyathan","year":"1998","journal-title":"Environ Health Perspect"},{"key":"2023100507551389000_80.10.580.58","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2011-100244"},{"key":"2023100507551389000_80.10.580.59","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.00006114"},{"key":"2023100507551389000_80.10.580.60","doi-asserted-by":"crossref","unstructured":"Lakey PSJ , Berkemeier T , Tong H , et al . Chemical exposure-response relationship between air Pollutants and reactive oxygen species in the human respiratory tract. Sci Rep 2016;6:32916. doi:10.1038\/srep32916","DOI":"10.1038\/srep32916"},{"key":"2023100507551389000_80.10.580.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.04.014"},{"key":"2023100507551389000_80.10.580.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2008.10.007"},{"key":"2023100507551389000_80.10.580.63","doi-asserted-by":"crossref","unstructured":"Fois SS , Canu S , Fois AG . The role of oxidative stress in Sarcoidosis. Int J Mol Sci 2021;22:11712. doi:10.3390\/ijms222111712","DOI":"10.3390\/ijms222111712"},{"key":"2023100507551389000_80.10.580.64","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/S0140-6736(05)65119-7","article-title":"Granulomatous Pneumonitis and Mediastinal Lymphadenopathy due to Photocopier toner dust","volume":"348","author":"Armbruster","year":"1996","journal-title":"The Lancet"},{"key":"2023100507551389000_80.10.580.65","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0272-5231(21)01167-9","article-title":"Occupational asthma: diagnosis, management and prevention","volume":"16","author":"Newman","year":"1995","journal-title":"Clin Chest Med"},{"key":"2023100507551389000_80.10.580.66","first-page":"212","article-title":"Metals that cause Sarcoidosis","volume":"13","author":"Newman","year":"1998","journal-title":"Seminars in Resp Infections"},{"key":"2023100507551389000_80.10.580.67","doi-asserted-by":"publisher","DOI":"10.2174\/0929867053764635"},{"key":"2023100507551389000_80.10.580.68","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.93.03020202"},{"key":"2023100507551389000_80.10.580.69","first-page":"152","article-title":"Induced Sputum as an additional tool in the identification of metal-induced Sarcoid-like reaction","volume":"21","author":"Fireman","year":"2004","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"2023100507551389000_80.10.580.70","first-page":"652","article-title":"Granulomatous disease associated with pulmonary deposition of titanium","volume":"43","author":"Redline","year":"1986","journal-title":"Br J Ind Med"},{"key":"2023100507551389000_80.10.580.71","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.02110703"},{"key":"2023100507551389000_80.10.580.72","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0b013e31822a3596"},{"key":"2023100507551389000_80.10.580.73","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.20924"},{"key":"2023100507551389000_80.10.580.74","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2114"},{"key":"2023100507551389000_80.10.580.75","doi-asserted-by":"crossref","unstructured":"Cleven KL , Ye K , Zeig-Owens R , et al . Genetic variants associated with FDNY WTC-related Sarcoidosis. Int J Environ Res Public Health 2019;16:1830. doi:10.3390\/ijerph16101830","DOI":"10.3390\/ijerph16101830"},{"key":"2023100507551389000_80.10.580.76","doi-asserted-by":"publisher","DOI":"10.1378\/chest.116.5.1183"},{"key":"2023100507551389000_80.10.580.77","doi-asserted-by":"crossref","unstructured":"Beijer E , Meek B , Bossuyt X , et al . Immunoreactivity to metal and silica Associates with Sarcoidosis in Dutch patients. Respir Res 2020;21:141. doi:10.1186\/s12931-020-01409-w","DOI":"10.1186\/s12931-020-01409-w"},{"key":"2023100507551389000_80.10.580.78","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.chest.2016.01.020","article-title":"Association between occupational exposures and Sarcoidosis: an analysis from death certificates in the United States, 1988-1999","volume":"150","author":"Liu","year":"2016","journal-title":"Chest"},{"key":"2023100507551389000_80.10.580.79","first-page":"104","article-title":"Is chronic beryllium disease Sarcoidosis of known etiology? Sarcoidosis","volume":"20","author":"Rossman","year":"2003","journal-title":"Vasc Diffuse Lung Dis Off J WASOG"},{"key":"2023100507551389000_80.10.580.80","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2114"},{"key":"2023100507551389000_80.10.580.81","first-page":"1011","article-title":"Reversible respiratory disease in beryllium workers","volume":"117","author":"Sprince","year":"1978","journal-title":"Am Rev Respir Dis"},{"key":"2023100507551389000_80.10.580.82","first-page":"327","article-title":"Sarcoidosis, inorganic dust exposure and content of Bronchoalveolar Lavage fluid: the MINASARC pilot study","volume":"35","author":"Catinon","year":"2018","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis"},{"key":"2023100507551389000_80.10.580.83","doi-asserted-by":"crossref","unstructured":"Graff P , Larsson J , Bryngelsson I-L , et al . Sarcoidosis and silica dust exposure among men in Sweden: a case-control study. BMJ Open 2020;10:e038926. doi:10.1136\/bmjopen-2020-038926","DOI":"10.1136\/bmjopen-2020-038926"},{"key":"2023100507551389000_80.10.580.84","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(00)00179-4"},{"key":"2023100507551389000_80.10.580.85","unstructured":"Levin AM , Chen Y , She R , et al . Identification of environmental exposures associated with risk of Sarcoidosis in African Americans. Am J Respir Crit Care Med 2018;197:A5367."}],"container-title":["Occupational and Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/oemed-2022-108632","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T14:57:06Z","timestamp":1696517826000},"score":1,"resource":{"primary":{"URL":"https:\/\/oem.bmj.com\/lookup\/doi\/10.1136\/oemed-2022-108632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,28]]},"references-count":86,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,5]]},"published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1136\/oemed-2022-108632"],"URL":"https:\/\/doi.org\/10.1136\/oemed-2022-108632","relation":{},"ISSN":["1351-0711","1470-7926"],"issn-type":[{"value":"1351-0711","type":"print"},{"value":"1470-7926","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,28]]}}}