Occupational exposure to toxic particles and risk of pulmonary sarcoidosis: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Workers with occupational exposure to toxic particles |
| I — Intervention | Exposure to various occupational toxic particles (chemicals, inorganic dusts, metals, mixed dusts and fumes, organic dusts) |
| C — Comparator | Workers without occupational exposure or general population controls |
| O — Outcomes | Risk of developing pulmonary sarcoidosis |
Bottom Line
This systematic review and meta-analysis of 13 studies identifies occupational exposure to silica, pesticides, mould/mildew, and World Trade Center dust as risk factors for pulmonary sarcoidosis development. The evidence is strongest for WTC dust and mould exposures, with sensitivity analyses confirming robustness of these associations. Interestingly, gold exposure appeared protective. However, the silica association was attenuated in higher-quality studies, suggesting potential bias in lower-quality research. The findings support enhanced occupational health surveillance in high-risk industries and implementation of exposure control measures. Clinicians should maintain heightened awareness of sarcoidosis risk in workers with relevant occupational exposures, particularly in construction, agriculture, and post-disaster cleanup scenarios. The authors appropriately call for future research examining gene-environment interactions to better understand individual susceptibility and refine preventive strategies.
Key Findings
P Value: Not reported in abstract
Effect Size: Not specified in abstract
Primary Outcome: Increased odds of pulmonary sarcoidosis development
Nnt Or Sensitivity: Sensitivity analyses confirmed robustness for WTC dust and mould exposures; silica association attenuated in high-quality studies
Confidence Interval: Not provided in abstract
Clinical Application
Findings support enhanced occupational health surveillance and exposure control measures in high-risk industries Highly relevant to Australian occupational health practice; aligns with Safe Work Australia guidelines for hazardous substance exposure monitoring and RACGP occupational health screening recommendations Workers in industries with exposure to silica, pesticides, moulds, and mixed dusts; particularly relevant for construction, agriculture, and manufacturing sectors
Abstract
INTRODUCTION: The onset of sarcoidosis is likely the result of a complex genetic-environment-immunological interaction. This systematic review and meta-analysis aimed to identify occupational toxic particles associated with an increased risk of developing pulmonary sarcoidosis. METHODS: Publications in English, published from January 2000 to January 2025, were searched in PubMed, Scopus and JSTOR. The risk of bias was assessed for all included studies. Sensitivity analyses stratified by study quality were conducted to evaluate the robustness of the findings and potential bias. To assess publication bias, a funnel plot was used when more than six studies were included in the analysis. RESULTS: Five categories of toxic particles were identified to be associated with increased risk of the onset of sarcoidosis: chemicals, inorganic dusts, metals, mixed dusts and fumes and organic dusts. The quantitative analysis includes data from 13 studies. The results suggested that occupational silica, pesticides, mould/mildew and World Trade Center ((WTC) dust exposures were associated with increased odds of pulmonary sarcoidosis. Sensitivity analysis confirmed the robustness of the association for WTC dust and mould, whereas the risk associated with silica appeared attenuated in high-quality studies. However, gold exposure was identified as a protective factor. CONCLUSION: Pulmonary sarcoidosis is associated with occupational silica, pesticides, WTC dust and mould. Future research should prioritise gene-environment interactions and granuloma mineralogy to refine preventive strategies and disease management.
References
- 1.Kotti, N., Kchaou, A., Feki, W., Daoud, A., Dhouib, F., Rmadi, N., Feki, W., Snoussi, M., Kammoun, R., Omrane, F., Charfi, S., Moussa, N., Sahnoun, R., Hajjaji, M., & Hammami, K. J. (2026). Occupational exposure to toxic particles and risk of pulmonary sarcoidosis: a systematic review and meta-analysis. BMJ Open Respiratory Research, 13(1), e003961. https://doi.org/10.1136/bmjresp-2025-003961
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