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Occup Med (Lond)
Occup Med (Lond)
occmed
Occupational Medicine (Oxford, England)
0962-7480
1471-8405
Oxford University Press UK

10.1093/occmed/kqae062
kqae062
Letters to the Editor
AcademicSubjects/MED00640
Occupational exposures and sarcoidosis: a rapid review of the evidence
https://orcid.org/0000-0002-1866-2163
Oliver L Christine Dalla Lana School of Public Health, University of Toronto, 2 St. Thomas St., Toronto, Ontario M5S 2Z1, Canada

Sampara Paul Occupational Health Clinics for Ontario Workers Sudbury Clinic, Sudbury, Ontario P3A 5Z8, Canada

Zarnke Andrew Occupational Health Clinics for Ontario Workers Sudbury Clinic, Sudbury, Ontario P3A 5Z8, Canada

Martell Janice Occupational Health Clinics for Ontario Workers Sudbury Clinic, Sudbury, Ontario P3A 5Z8, Canada

e-mail: coliver@ohiinc.com
7 2024
23 9 2024
23 9 2024
74 6 461461
© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
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pmcWe write regarding a rapid review (RR) of sarcoidosis and occupational exposures published in Occupational Medicine on 22 May 2024 (2024, XX, 1–8). The authors of this article are affiliated with the Policy and Consultation Services Division, Workplace Safety and Insurance Board in Ontario, Canada. We are employed by or have an affiliation with Occupational Health Clinics for Ontario Workers, Inc.

This article is of great interest to us as we have responsibility for the evaluation of workers in Ontario with known or suspected occupational disease, including workers with sarcoidosis. The purpose of our letter is to bring attention to potential shortcomings of the RR that may adversely impact scientific thinking about sarcoidosis and occupational aetiology and, in turn, the care and compensation of individuals at risk for or diagnosed with sarcoidosis.

We have two major concerns. First, the authors do not adequately explain or provide a clear rationale for why they chose to conduct a RR versus a more comprehensive systematic review (SR), particularly since the RR was conducted in part to provide basis for ‘occupational disease policy development’ [1]. Tricco et al., whom they cite, advise that ‘Further research on rapid reviews is warranted’ and suggest a prospective study comparing results of RRs and those of SRs of the same subject [2]. To our knowledge, such a prospective study has not been carried out.

Second, this RR is limited in scope. The following are excluded from consideration: cross-sectional studies, case series and case reports. So too are studies of sarcoidosis in first responders exposed to World Trade Center dust. Each can provide valuable information about sarcoidosis. Our case series of sarcoidosis in Ontario hard rock miners is an example; it is unique in its inclusion of semi-quantitative silica exposure data [3].

In August 2023, a paper by Huntley et al. entitled ‘Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis’ was published [4]. This SR/meta-analysis (MA) is broader in scope than the RR and its findings are notably different. The MA reveals statistically significant associations between sarcoidosis and occupational exposures to silica (six studies), pesticides (three studies) and mould or mildew (two studies). Risk estimates were significantly elevated for five other agents in single case–control studies. The RR reveals statistically significant associations for silica (two studies).

The authors of the RR conclude only that their RR suggests ‘a developing body of research’ supporting an association between occupational exposure to silica and sarcoidosis [1]. Huntley et al. conclude that given the number of antigens positively associated with sarcoidosis in their study, ‘… the onset [of sarcoidosis] is far more likely the result of a complex genetic-environmental-immunological interaction’ [4]. We agree and we suggest that the use of RR methodology for developing occupational disease policy for rare diseases such as sarcoidosis be held in abeyance until equivalency with SRs has been shown.
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References

1. Rezai M , NayebzadehA, CatliS, McBrideD. Occupational exposures and sarcoidosis: a rapid review of the evidence. Occup Med (Lond) 2024;74 :266–273. doi: 10.1093/occmed/kqae016 38776441
2. Tricco AC , AntonyJ, ZarinW et al . A scoping review of rapid review methods. BMC Med 2015;13 :1–15.25563062
3. Oliver LC , SamparaP, PearsonD, MartellJ, ZarnkeAM. Sarcoidosis in Northern Ontario hard-rock miners: a case series. Am J Ind Med 2022;65 :268–280. doi: 10.1002/ajim.23333 35156713
4. Huntley CC , PatelK, MughalAZ et al . Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis. Occup Environ Med 2023;80 :580–589. doi: 10.1136/oemed-2022-108632 37640537
