Antimony - Toxicology of Metals - page 353

forced expiratory fl ow rate in 16.7%. In addition, 61%
of the workers complained of chronic coughing.
Two other groups of investigators have also
observed lung changes among antimony workers
(Karajovic, 1958; Klucik et al ., 1962). Klucik et al . (1962)
reported on workers exposed to antimony trioxide for
up to 28 years (concentration and number of workers
were not given). The prevalence of pneumoconiosis
and symptoms of emphysema were given as 21 and
42%, respectively.
It thus seems that antimoniosis is commonly
regarded as a relatively benign condition, but never-
theless chronic respiratory effects have been reported
in a number of studies. Therefore, heavy antimony
exposure cannot, according to our interpretation, be
regarded as harmless.

7.2.2.2 Immunological Effects
Kim et al . (1999) reported altered cytokine and immu-
noglobulin levels in workers exposed to antimony. The
sera from exposed workers showed lower levels of
IgG1 and IgE compared with the sera from controls. A
positive correlation between IgG4 and urine serum Sb
levels in the exposed group was noted.

7.2.2.3 Hemolytic Effects of Stibine Gas
Stibine gas (SbH 3 ) is another important chemical
form of antimony (Andrewes et al ., 2004; Gallicchio et
al ., 2001; Hussain et al ., 1998) that has toxic properties
similar to those of arsine gas. Information on the car-
cinogenic or other toxic potential of stibine is currently
very limited (Andrewes et al ., 2004; Gallicchio et al .,
2001; Husain et al ., 1998) relative to that of arsine gas.
Stibine releases have been reported in the production of
lead automobile batteries (ATSDR, 1992), and it is also
currently used in the production of some III-V semicon-
ductors. Stibine has been reported to produce hemolysis
and hemoglobinuria, although it seems to be less acutely
toxic than arsine gas (Gallichio et al ., 2001).

7.2.1.3 Skin Effects
Pustular skin eruptions, “antimony spots,” are
sometimes seen in persons working with antimony
and antimony salts. These eruptions are transient and
mainly affect skin areas exposed to heat and those areas
where sweating occurs (McCallum, 1963; Paschoud,
1964; Potkonjak and Pavlovich, 1983; Renes, 1953;
Stevenson, 1965). Thirty-two (62.7%) of the antimony
smelter workers examined by Potkonjak and Pavlovich
(1983) had “antimony dermatosis.”

7.2.3 Adverse Effects During Antimony Treatment

Various side effects, and in several studies cases of
sudden death, have been recorded in connection with
clinical treatment of parasitic diseases with antimony
(El Halawani, 1968; Rugemalila, 1980). Nausea and
vomiting are common features (Hamad, 1969; Pedrique
et al ., 1970; Zaki et al ., 1964). Effects on the liver, with
rises in serum concentrations of two liver enzymes
(GOT and GPT) at the onset of therapy, were reported
by Woodruff (1969). As in animal studies, ECG changes,
particularly in the T wave, were frequently reported
during long-term treatment (Abdalla and Badran, 1963;
Davis, 1961; Mainzer and Krause, 1940; Sapire and
Silverman, 1970; Schroeder et al ., 1946). Mansour and
Reese (1965) have proposed that the infl uence of tartar
emetic is an augmenting factor in the development of
schistosomal myopathy.

7.2.2 Systemic Effects and Dose-Response
Relationships

7.2.2.1 Circulatory System Effects
Antimony is associated with ECG abnormalities
and an increased risk of sudden death that is likely
due to arrhythmias (Sullivan and Krieger, 1992).
Brieger et al . (1954) reported hypermortality and mor-
bidity among workers in an abrasive industry. In all,
124 workers were exposed to air concentrations of
antimony trisulfi de ranging from 0.6-5.5 mg/m 3 for
8-24 months. During this period, six workers died
suddenly and two others died of chronic heart dis-
ease. Of the deceased, four were under 45 years of
age. ECG changes, mostly of the T wave, were seen
in 37 of 75 examined. During the preceding 16 years
before introduction of antimony in the plant, only one
death had occurred in this department. No control
group was examined.
Renes (1953) reported abdominal cramps, diarrhea,
and vomiting among certain workers subject to heavy
exposure to antimony fumes in a smelter. A higher
prevalence of ulcer, 6% of 111 examined antimony
workers compared with that of the total plant popu-
lation, 1.5% of 3912 employees, was seen by Brieger
et al . (1954).

8 CARCINOGENIC AND GENOTOXIC
EFFECTS

There are few studies on the carcinogenicity of anti-
mony (Gebel, 1997; Hayes, 1997). One reason is that
the environmental distribution of antimony is low. In
an inhalation study using Wistar rats, antimony ore
concentrates and antimony trioxide have been linked
to lung cancer. After inhalation of 45 or 36-40 mg/m 3
Sb 2 O 3 or Sb, 7 hours per day, 5 days per week, for 52
weeks, followed by a 5-month observation period,