This information was reviewed and approved by Lisa A. Maier, MD, MSPH, FCCP (6/30/2021).
The beryllium lymphocyte proliferation test (BeLPT) is a blood test that measures beryllium sensitization, which is an "allergic" reaction to beryllium. The test is very specific, meaning that if your blood reacts to beryllium, nothing other than beryllium could have caused this reaction. An abnormal test means that your immune system thinks beryllium is a "foreign substance," and sends immune cells in the bloodstream that react to the beryllium.
What is a beryllium lymphocyte proliferation test (BeLTP)?
How is a BeLPT done?
Who should have a BeLPT?
Will the BeLPT tell me whether or not I have CBD?
What do the values on the test result mean?
I have a 2.5 SI on my National Jewish Health test result. Is this considered almost abnormal?
Does a very high SI value on my test result mean I have CBD?
Do I need to fast (not eat) prior to my blood test?
Will taking prednisone affect my test result?
Is there a program that will pay for my test?
Will my insurance company and/or employer have access to my test results?
Can I have a normal test and still have beryllium sensitization or CBD?
What is the false positive rate for the blood BeLPT?
What is the false negative rate for the blood BeLPT?
Can you test urine or hair for beryllium sensitization?
The beryllium lymphocyte proliferation test (BeLPT) is a test that helps determine if your immune system recognizes beryllium as a foreign substance and responds by generating a population of immune cells in the bloodstream that react to beryllium. The test is very specific, meaning that if your blood reacts to beryllium, nothing besides beryllium could have caused the reaction. In individuals who do not have beryllium sensitization or CBD, the immune system does not respond to beryllium.
To perform the test, blood is drawn from a vein in your arm. In the laboratory, the white blood cells are separated from the rest of the blood cells and then mixed with a beryllium solution. If your immune system is sensitized to beryllium, these cells will multiply, producing an abnormal BeLPT result. If your immune system is not sensitized to beryllium, the cells will not multiply, producing a normal BeLPT result. In normal (non-sensitized) individuals, cells do not multiply.
National Jewish Health® recommends that individuals who are or have been exposed to any form of beryllium dust or fumes (including pure beryllium metal, copper-, aluminum-, nickel-, and magnesium-beryllium alloys; ceramics and composite materials) have a BeLPT. This includes:
Individuals who currently work directly or have in the past worked with beryllium or in buildings where beryllium dust or fumes were created by others
Individuals who have disturbed beryllium dust in some manner (such as through janitorial work, building maintenance or construction)
Short-term employees, including summer students, since beryllium sensitization and CBD can develop with just a few months of exposure
Any person diagnosed with lung disease (especially scarring lung diseases) who has current or past exposure to beryllium. CBD can be mistaken for asthma, sarcoidosis, pulmonary fibrosis, chronic bronchitis, COPD or other lung ailments. The blood BeLPT helps correct mistakes in diagnosis.
The blood BeLPT only determines beryllium sensitivity; it does not differentiate between beryllium sensitivity and CBD. An abnormal blood response to beryllium does mean that you are beryllium sensitized, and the majority of people with beryllium sensitization will eventually develop CBD. Individuals with two or more abnormal BeLPT results are considered to have “confirmed beryllium sensitization” and are encouraged to undergo further evaluation to determine if they have chronic beryllium disease (CBD).
Individuals with other combinations of non-normal test results, such as an abnormal and a borderline BeLPT or three borderlines, should also be referred for further evaluation. This medical evaluation typically includes an appointment with a physician familiar with the health effects of beryllium, exercise tolerance testing, pulmonary function testing, a chest X-ray or CT scan, blood work and diagnostic bronchoscopy with biopsy and lavage (lung washing). The types of testing your physician performs may differ based on your overall health. Depending on the results of the tests, your physician will be able to determine if you have CBD.
The BeLPT is performed in two parts, which are done at the same time with a single blood sample: one part ensures your blood cells are alive and normal when they arrive at the laboratory, and the other part tests the blood cells for their reaction to beryllium.
Part 1: To ensure that your white blood cells are acting normally, we test them for their ability to react to two different substances known to make nearly everyone’s cells multiply, these are called positive controls. One is an antigen and the other is a mitogen. If your cells react normally to these positive controls, the cells are then tested to see if they will react to a beryllium solution.
Part 2: In the test for the reaction to beryllium, we use three different concentrations of beryllium salt solutions and check the cells at two different points in time. This results in six differeny beryllium conditions. If your cells multiply in two or more of these six beryllium conditions, the test is interpreted as abnormal.
Results: Your cells’ reactions to controls (the mitogen and antigen) to make sure the test works, and beryllium are reported in the results. Each laboratory that performs the BeLPT sets its own values to determine whether cell responses to beryllium are normal or abnormal. Results are reported as a “stimulation index” (SI), which is a ratio of your cells grown with beryllium compared to your cells grown without beryllium.
In the National Jewish laboratory, tests with all values 2.5 and less are considered normal. In our laboratory, two of the six measurements must be greater than 2.5 for the test to be abnormal.
National Jewish Health has not found that high abnormal values are linked to disease. A person with a stimulation index of 12.8 is no more likely to have CBD than a person with a 5.8. Further testing is needed to determine whether or not an individual has CBD.
No, your test results are not affected by food or drink.
We are able to perform the test in people who are taking prednisone. National Jewish Health sees many patients who are on immunosuppressive drugs, such as corticosteroids like prednisone, who have abnormal BeLPTs. Although definitive research has not been done, it is preferable that you discontinue medicines that suppress the immune system 3 months prior to a BeLPT if possible. This should be done only if your doctor considers it safe to reduce or stop your medicines. If you were on an immunosuppressive drug when your BeLPT was done, and you have doubts about the validity of your test results, we suggest you meet with your personal physician to determine if you should discontinue your medication and have a repeat test.
If you are a current or former Department of Energy employee or subcontractor, you may qualify for free testing. Many private insurance companies will cover the cost of the test, as will Medicare. Because plans vary in coverage, you should contact your insurance company for benefit information. For information on Department of Energy programs, please see www.dol.gov.
If your employer or insurance company pays for your BeLPT, most likely you will have to sign a waiver allowing an authorized representative to see the results of your test. If you file a workers’ compensation or Department of Labor claim for beryllium sensitization or CBD, you will need to release your test results to the claims examiner before your claim can be processed. Under federal law (HIPAA), no one may access your test results unless you give them permission by signing a release of medical information.
National Jewish Health physicians have diagnosed CBD in individuals who have granulomas in their lungs but normal blood BeLPT results. In such instances, the lung cells usually react to beryllium when the lavage BeLPT is performed using cells washed from the lungs.
If a person has an abnormal (“positive”) blood BeLPT, there is a greater likelihood that it will again be abnormal when it is repeated. Of people who have two abnormal blood BeLPT results, the chances of the test becoming consistently normal again in the future is low. These rates vary some among the laboratories that perform the BeLPT.
A “false negative” test means that the test was read as being normal (“negative”) when a person has beryllium sensitization or chronic beryllium disease. This occurs rarely. Although a normal blood BeLPT is reassuring, it is not a 100 percent guarantee that you do not have beryllium sensitization or CBD. The test should be repeated if there is a strong suspicion that you have beryllium sensitization or CBD.
In some instances, it may be necessary to do other tests to determine if you have beryllium sensitization or CBD, in which case your physician should contact our medical staff to discuss options. Additionally, exposed individuals may have multiple normal BeLPTs and then have an abnormal result. This means the individual developed sensitization in the time period between the last normal test and the current abnormal test.
While it is possible to test for beryllium in urine and hair, it is not helpful in determining if you have beryllium sensitization or CBD. A urine test and tests on hair can determine if someone is or has been recently exposed to beryllium, but it does not detect beryllium sensitization or CBD.
For more information on beryllium, please contact National Jewish Health® at 1.800.222.5864, extension 1722.
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