Free full text available from Review www.ijoem.com Article TThehe eexposurexposure ttoo aandnd hhealthealth eeffectsffects ooff aantimonyntimony noxious gas stibine (SbH ) is formed Ross G. Cooper, Abstract 3 when antimony reacts with nascent Adrian P. Harrison1 Context: This minireview describes the health effects of [2] Division of Physiology, hydrogen. The trichloride (SbCl3) is very antimony exposure in the workplace and the environment. toxic as it dissociates into its oxide and Birmingham City University, 704 Baker Aim: To collate information on the consequences of chlorine.[1] The element is used in occupational and environmental exposure to antimony Building, Franchise alloys, as a constituent of paint Street, Perry Barr, on physiological function and well-being. Methods: pigments, and in rubber compounding. Birmingham B42 The criteria used in the current minireview for selecting Very pure antimony is used to make 2SU, UK, 1Section articles were adopted from proposed criteria in The certain types of semiconductor devices for Biochemistry International ClassiÞ cation of Functioning, Disability and such as diodes and infrared detectors. and Physiology, Health. Articles were classiÞ ed from an acute and chronic Workers exposed to airborne dust can Department of Animal exposure and toxicity thrust. Results: The proportion of have respiratory problems. Exposure and Veterinary Basic utilised and non-utilised articles was tabulated. Antimony Sciences, Faculty can also occur via contaminated toxicity is dependent on the exposure dose, duration, of Life Sciences, water, food, and soil contact. In 1916, route (breathing, eating, drinking, or skin contact), other Copenhagen University, chemical exposures, age, sex, nutritional status, family antimony exposure was associated 1870 Frederiksberg C, traits, life style, and state of health. Chronic exposure to with lead intoxication, with symptoms Denmark antimony in the air at levels of 9 mg/m3 may exacerbate including headache, abdominal pain, For correspondence: irritation of the eyes, skin, and lungs. Long-term inhalation constipation, colic, distaste for Dr. Ross G. Cooper, of antimony can potentiate pneumoconiosis, altered food, loss of appetite, small mouth ulcers with salivation, dizziness, Division of Physiology, electrocardiograms, stomach pain, diarrhea, vomiting, Birmingham City loss of weight, albuminuria, and and stomach ulcers, results which were conÞ rmed in University, 704 Baker [3] laboratory animals. Although there were investigations glycosuria. The lack of importance Building, Franchise of the effect of antimony in sudden infant death of antimony compounds in terms Street, Perry Barr, syndrome, current Þ ndings suggest no link. Antimony of their mutagenic, carcinogenic, Birmingham B42 trioxide exposure is predominant in smelters. Mining and teratogenic risks in pregnant 2SU, UK. E-mail: and exposure via glass working, soldering, and brazing women has negated the need for rgcooperuk@yahoo. are also important. Conclusion: Antimony has some studies of the like.[4] Exposure to com useful but undoubtedly harmful effects on health and antimony concentrations of 9 mg/m3 well-being and measures need to be taken to prevent of air will result in eye, skin, and lung hazardous exposure of the like. Its biological monitoring irritation.[5] Long-term exposure in the workplace is essential. to antimony in smelting plants may result in the formation of Key words: Antimony, environment, exposure, health, antimoniosis, a particular form of occupation pneumoconiosis.[6] Chronic exposure will potentiate lung, heart, and DOI: 10.4103/0019-5278.50716 gastrointestinal diseases. The effects on health are inducement of vomiting and eye and mucous membrane irritation. Stibine is a INTRODUCTION hemolytic agent. In some cases, cardiac arrhythmias and mild jaundice Antimony (Sb) (atomic number 51; atomic mass 121.75 may occur necessitating treatment g/mol; density 6.684 g/cm3; melting point 631ºC) occurs with intramuscular dimercaprol.[2] [1] naturally as a sulphide ore, stibnite (Sb2S3) and valentinite McCallum describes the effect of (Sb203). The traditional method of treating the ore is to antimony in potentiating antimony roast it with charcoal or coke and collect the volatile oxide spots, heart disease, pneumoconiosis, [1] fume (Sb4O6) from which pure antimony is refined. A and lung cancer. Other authors suggest 3 Indian Journal of Occupational and Environmental Medicine - April 2009 - Volume 13 - Issue 1 Cooper, et al.: Antimony and human health an increased mortality from lung cancer and associated non- in order to induce vomiting until the stomach was void of its malignant respiratory heart diseases in workers exposed contents.[14] If necessary, manual stimulation of the back of to antimony.[7] Antimony in conjunction with other metals the throat with a finger or feather ensured vomiting. Milk or may biologically alter several cellular defence mechanisms albumen could be administered if the poison had irritating thus potentiating carcinogenesis.[8] Reproductive disorders effects. This was followed by strong tea, a decoction of oak and chromosome damage may be associated with chronic bark, or an infusion of tannin.[14] antimony exposure with consequent mutagenic and oncogenic potential and should be avoided in pregnancy The aim of this minireview was to subjectively assess the and in patients with hepatic, renal, or cardiovascular literature on the material concerning the health benefits disease.[9] Measurement of antimony and particulate matter of antimony and to classify it according to the source and is via samples collected onto a cellulose acetate filter (pore publication date. size, 0.8 µm) at an air flow rate of ca. 21/min. Absorption spectrophotometry is used to analyse the concentration of MATERIALS AND METHODS antimony. The workplace exposure limit is 8-h Time Weighted Average (TWA) of 0.5 mg/m3.[2] The criteria used in the current minireview for selecting articles to be included were both theoretically and practically In 1467, at Beverley, Yorkshire, 19th and 20th century laws motivated and adopted from proposed criteria in The dealing with air pollution were anticipated.[10] Penalties were International Classification of Functioning, Disability and imposed on illegal kiln constructions in an attempt to alleviate Health – ICF.[15] These criteria were as follows: the air pollution[10] because antimony ores are frequently 1. Articles were chosen only with internationally recognised associated with arsenic or lead and exposure of workmen impact factors greater than 0.10. working with imported stibnite ore has been reported.[1] 2. Articles were chosen based on the impact of lifestyle, Antimonate ore has been reported to induce toxic effects and stress, and/or environmental factor/s predisposing activate some protective mechanisms, including phagocytosis, antimony exposure. immune responses, and inhibition of proteases.[11] Historically, 3. Criteria for selection of the literature used included antimony became a fashionable cure among the wealthy and yes–no responses to the appropriateness of methodology; was approved as a medicine in 1666.[12] Paracelsus described adequacy of subject numbers; specificity of sex and/or age antimony-disease as a specific condition caused by external of subjects, and statistically significant response rates to factors for which specific remedies were needed.[12] Drugs survey questionnaires. made from antimony were administered as purges.[13] The 4. The time frame used was principally 1900–2008 inclusive, successful curative effects of antimony on the sick King Louis although articles of extreme importance from earlier XIV of France in a concoction called vin émétique disposed of decades were used where appropriate. any controversy concerning its efficacy.[13] Although in 1566 5. A multifactorial overview of the factors eschewed and 1615 Paris banned the use of antimony as it was regarded concerning zinc exposure was elucidated. It was presumed as poisonous, it was officially reinstated by the parliament that collective articles detailing known factors of usage in 1666.[1] were not necessarily correlated with functionality and health. The ancient medical uses of antimony spanned nearly 600 6. Compilation of materials for the minireview started with years since its introduction as an internal treatment in the the published literature or easily accessible academic 14th century.[1] Antimony administered as a tartar emetic in the research. form of one and two grains in a child and adult, respectively, 7. The articles were accessible from on-line sources, may lead to death.[14] It should therefore be taken with including PubMed and Medline. copious amounts of water and fomentations placed over the chest two to three times per day, followed by a cool, moist RESULTS pack.[14] This was explained as reducing the exhausting effects of the drug. Goose livers were conditioned with deliberate The proportion of utilised and non-utilised articles by date is antimony administration in Strasbourg, Germany, an area shown in Table 1. There seemed to be a dearth of investigations which specialised in goose-liver pies (paté de foie gras). spanning the period 1900–1980, although some articles were The handling of the birds was horrific, often with their feet published in sources unobtainable through requests at the secured in planks and their eyes gorged out. Antimony was British library and some had no impact factor and were then force-fed. This was to satisfy