Environmental Medicine Biomonitoring

Biomonitoring (German: Bioüberwachung; synonym: biological monitoring) is a method used in occupational and environmental medicine to detect a patient’s exposure to pollutants by measuring both the concentration of pollutants and the concentration of metabolites (metabolic products) in various cell structures of the body. First research approaches for the determination of pollutants in blood and urine were already realized in the 1930s. Since the 1960s, biomonitoring has been an important factor in environmental medicine in Germany, as analytical techniques improved dramatically at that time. The introduction of permissible limits for substances hazardous to health (occupational exposure limits (AGW); formerly: (MAK value) maximum workplace concentration) were not introduced until the 1970s and are now set by the Federal Ministry of Labor and Social Affairs (biological exposure limits (BGW); formerly: (BAT value) biological occupational tolerance value).

Indications (areas of application)

  • A given contact with contaminants absorbable through the skin (“H-substances”).
  • Immunocompromised persons
  • Individuals with increased exposure to carcinogenic (cancer-causing), teratogenic (fertility-damaging), or reproductive toxicants in the workplace

The procedure

The principle of environmental medicine biomonitoring consists of the quantitative determination of pollutants or their metabolites. Based on the intracorporeal (located in the body) pollutant determination, the measured exposure reflects the exposure of the foreign substances sensitively (the sensitivity expresses the proportion of polluted patients correctly detected by monitoring) and specifically (the specificity refers to the proportion of correctly detected non-exposed individuals). In biomonitoring, short-term effects must be distinguished from long-term effects. Short-term effects are those that lead to spontaneous behavioral changes and possibly rapid mortality – as a result of acute toxicity. Long-term effects, on the other hand, usually lead to chronic damage and even mortality as a result of permanently high background levels of exposure. The following aspects should be emphasized in the implementation of environmental medical biomonitoring:

  • Measurement of exposure in cellular structures and fluids of the individual such as:
    • Blood
    • Blood plasma – cell-free portion of blood, which still contains clotting factors.
    • Urine
    • Hair
    • Breast milk
    • Teeth
  • Example markers of the patient’s “internal stress”:
    • Benzene – Benzene is a chemical compound from the group of aromatic hydrocarbons. It is an inhalation as well as a contact poison and has a carcinogenic effect. Among other things, it is a component of gasoline.
    • Polybrominated diphenyl ethers – Polybrominated diphenyl ethers (PBDE) are organic chemicals containing bromine, which are used as flame retardants in many plastics and textiles.
    • Lead – Lead and its chemical compounds are absorbed through food, inhalation, or direct exposure to the skin. The effect of lead on the body is evident as damage to the central and peripheral nervous systems. It also negatively affects blood formation (hypochromic sideroachrestic anemia) and causes kidney damage (pathological changes in the kidneys leading to functional impairment – called “lead shrunken kidney”).
    • Nickel – as the most common trigger of contact allergies, even a small intake through food poses a risk of triggering an allergic reaction. Moreover, inhalation of nickel fumes is associated with an increased risk of carcinoma of the lung (bronchial carcinoma) and upper respiratory tract.
    • Mercury – toxic heavy metal that liquefies and forms toxic fumes even at room temperature. The symptoms of mercury poisoning are manifold. A distinction is made between acute, from subacute and from chronic mercury poisoning.
    • Cotinine – degradation product of nicotine; it is also found in the blood and urine of passive smokers as N-glucuronide conjugate. Cotinine is suitable as a measure of tobacco consumption and thus allows a statement about smoking behavior.

The choice of the test material (eg.B. blood or urine) is directly dependent on the given problem. For example, long-lasting mercury intoxication is primarily detected in urine. A modification of the standard procedure is achieved by using the so-called effect biomonitoring. Here, substances that bind either to DNA structures or protein structures are used in particular as markers of exposure. Due to the marker properties, this specialized method is suitable for detecting genome-damaging substances (substances that cause damage to a person’s genetic material). Further information on biomonitoring

  • Biomonitoring information system of the Federal Institute for Occupational Safety and Health: information system.
  • Commission “Human Biomonitoring” of the Federal Environment Agency: www.umweltbundesamt.de/themen/gesundheit/kommissionen-arbeitsgruppen/kommission-human-biomonitoring
  • Occupational and environmental medicine guidelines of the German Society for Occupational and Environmental Medicine (including “Environmental Medicine Guideline Human Biomonitoring”): www.dgaum.de/leitlinien-qualitaetssicherung

Benefit

Environmental medical biomonitoring has the advantage over environmental examinations that the exact physical exposure to a pollutant can be detected and the measurement is not made by determining the concentration of a pollutant in the ambient air. As a result, the application of the method is part of the occupational health screening, as far as occupationally recognized analytical methods and suitable values for assessment are available for this purpose.