July 2022 additions to NERDB

July 2022 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database is on the NERDB page

On the website, we will publish regular updates on new disease-exposure combinations we added to the database. Currently, we have 346 entries. Ordered by year in which the abstract is published

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New entries:

Dental Technician
Afbeelding van Ri Butov via Pixabay

Tiraboschi MM, Sala E, Ferroni M, Tironi A, Borghesi A, Gilberti ME, Ceruti P, Sansone E, De Palma G. Early signs of pneumoconiosis in a dental technician in Italy: a case report. BMC Pulm Med. 2021 Nov 7;21(1):352. doi: 10.1186/s12890-021-01721-1. PMID: 34743717; PMCID: PMC8572569.


Dental technicians are at high risk of pneumoconiosis, usually driven by inhalation of mixed dusts, including metals. An etiological diagnosis is not easy to be performed, particularly in advanced stages.

Case presentation

We describe the case of early pneumoconiosis occurring in a 47-year-old dental technician who developed respiratory symptoms shortly after beginning work. She described the work environment as dusty and lacking relevant primary prevention tools. A chest CT showed multiple peripheral pseudonodular lesions in both lower lobes; bronchoalveolar lavage and bronchial aspirate evidenced numerous macrophages with reflective metal bodies included into the cytoplasm, that at scanning electron microscopy coupled to Energy Dispersive X-Ray Analysis resulted Zirconium and Aluminum, whereas Tungsten (W) was localized outside cells. End-of-shift urinary concentrations of W were substantially raised as compared to pre-shift (1.1 vs. 0.2 µg/L).


We concluded for diagnosis of early work-related pneumoconiosis due to abnormal occupational exposure to metals. The case demonstrates the need also for dental professionals to comply with industrial hygiene standards and to be monitored by occupational health physicians.

Tustin AW, Kundu-Orwa S, Lodwick J, Cannon DL, McCarthy RB. An outbreak of work-related asthma and silicosis at a US countertop manufacturing and fabrication facility. Am J Ind Med. 2022 Jan;65(1):12-19. doi: 10.1002/ajim.23304. Epub 2021 Oct 20. PMID: 34671999..

Background: Outbreaks of severe silicosis have affected workers who fabricate artificial stone countertops. Work-related asthma (WRA) has not been a prominent feature of those prior outbreaks.

Methods: This report describes an outbreak of WRA and silicosis at a facility that manufactures and fabricates chemical-resistant countertops comprised of sand, epoxy resin, and phthalic anhydride (PA), a known respiratory sensitizer. The multidisciplinary investigation included clinical examinations of workers, an industrial hygiene survey with qualitative and quantitative exposure assessments, and a cross-sectional questionnaire.

Results: Engineering controls and personal protective equipment were inadequate. Some workers were exposed to PA or silica above permissible exposure limits established by the Occupational Safety and Health Administration (OSHA). Clinical and epidemiologic investigations identified 16 workers with confirmed or suspected WRA. Two years later, after OSHA began to enforce its new silica standards, 12 workers received medical surveillance for silicosis. Of these 12 workers, four (33.3%) were diagnosed with silicosis based on abnormal chest computed tomography examinations.

Conclusions: Artificial stone countertop workers can develop asthma or silicosis. The risk of asthma may be highest in workers exposed to asthmagens such as PA and epoxy resins while manufacturing the artificial stone material.

Hosseininejad, M., Mirzamohammadi, E., Mohsenizadeh, S. A., & Mohammadi, S. (2021). The relationship between occupational exposure to organic solvents and metabolic syndrome in petroleum refinery workers in Tehran, IranDiabetes & Metabolic Syndrome: Clinical Research & Reviews15(5), 102223. 

Aims: The rising prevalence of metabolic syndrome has made it a major health concern. Chronic occupational exposure to organic solvents affects different systems of the body. This study aimed to investigate the association between exposure to organic solvents and the prevalence of metabolic syndrome in petroleum refinery workers.

Method: This study was conducted in 2019–2020 on workers employed in an Iranian petroleum refinery. The demographic and occupational information on the participants was obtained using the interview method. Their height, weight, and blood pressure were measured by the occupational health team, and fasting blood samples were taken from them to measure the para-clinical parameters.

Results: In this study, 1009 petroleum refinery workers were analyzed. The prevalence of metabolic syndrome in workers was 20.1%, and it was about two times higher in exposed workers (CI 95%: 1.61–3.35) compared to non-exposed ones. Factors associated with the prevalence of metabolic syndrome include age, higher BMI, exercise, and longer exposure to organic solvents.

Conclusion: The findings of this study suggested that exposure to organic solvents is associated with an increased prevalence of metabolic syndrome (the highest association was observed with elevated serum triglycerides). Besides, longer exposure to organic solvents increased the risk of developing metabolic syndrome.

Janssen, L.M.F., Ghosh, M., Lemaire, F. et al. Exposure to silicates and systemic autoimmune-related outcomes in rodents: a systematic reviewPart Fibre Toxicol 19, 4 (2022). https://doi.org/10.1186/s12989-021-00439-6.

Background: Autoimmunity can result from the interplay between genetic background and effects of environmental and/or occupational exposure to hazardous materials. Several compounds, including silica dust, have been linked with systemic autoimmunity and systemic autoimmune diseases, based on epidemiological evidence. For asbestos, a strong link with systemic autoimmune diseases does not yet exist, however, several studies have documented features of autoimmunity following asbestos exposure. Even so, human studies are limited in their ability to identify and examine isolated exposures, making it difficult to demonstrate causation or assess pathogenic mechanisms. Therefore, this systematic review examines the existing animal evidence regarding autoimmunity and exposure to silicates (silica and asbestos).

Methods: PubMed and EMBASE were systematically searched for peer-reviewed studies examining systemic autoimmune disease-related outcomes after silicate exposure in rodents. Literature databases were searched up to September 2021 for studies written in English and where the full text was available. Search strings were established based on a PECO (Population, Exposure, Comparator, Outcome) format. After title, abstract, and full-text screening, thirty-four studies were identified for further analysis. Quality assessment through ToxR tool and qualitative analysis of the results was performed.

Results: Although there was significant heterogeneity in the included studies in terms of exposure protocol and genetic background of the rodent models used, it was noted that both genetic background and exposure to silicates [(crystalline) silica and asbestos] are highly relevant to the development of (sub-) clinical systemic autoimmune disease.

Conclusion: Parallels were observed between the findings from the animal (this review) and human (epidemiological) studies, arguing that experimental animal models are valuable tools for examining exacerbation or development of autoimmune disease after silicate exposure. However, genetic background and synergism between exposures should be considered in future studies.



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