Authors' objectives: To investigate whether occupational exposure to Sb2O3 [antimony trioxide] is causally associated with the development of lower respiratory tract irritation, changing in lung function, any other lung effect either malignant or non-malignant as well as cataract. In the event that such a (causal) association exists, what level of occupational exposure was associated with the development of the disease of interest.

Authors' results and conclusions: No published studies were identified on pneumonitis (search #13), lower respiratory tract irritation (search #15), respiratory tract irritation (search #17), lung pathology (search #18), non-malignant chronic effect (search #20), (any) chronic effect (search #21) as well as the search on NIOSHTIC-2 database (search #24). Seven , two , 31, one and 20 published studies were identified from search #14 (on pneumoconiosis), search #16 (on lung function), search #19 (on lung), search #22 (on cataracts) and on search #23 (on malignancy), respectively. Upon examination of these titles and abstracts of the 61 published studies, 11 studies were thought to be relevant and were retrieved in full. However, we were not able to retrieve one of these 11 studies. In this paper , Li et al reported an analysis of lung biopsy of a pneumoconiosis patient exposed to Sb2O3. It should be noted that no abstract was included in the bibliography regarding this reference. Considering that this paper4 by Li et al is only a case report 5 The Effects of Sb2O3 on Human Health February 2025 (https://pubmed.ncbi.nlm.nih.gov/18724902/) we believe the omission of this paper will not affect the overall conclusion of this systematic review. Of the 10 studies that were thought to be relevant and were retrieved in full, eight studies did not provide any new data, were not relevant to the objective of this systematic review or were in the form of expert reviews that were traced for their relevant primary studies. Hence, these eight studies will not be discussed further. Ten further studies were identified from manual searches. Of these 10 studies, two studies were in the form of expert reviews (level of evidence 5) in which we traced for their relevant primary studies and found that those primary studies were already identified in our search or were included in other systematic reviews, such as those of the Agency for Toxic Substances and Disease Registry (ATSDR)71 or IARC72 and will not be discussed further. The website of the International Antimony Association (i2a) (https://www.antimony.com/library/) provided some publications. As we examined these publications, we did not find any relevant data to the objective of this systematic review. Hence, none of the available documents in the i2a library (https://www.antimony.com/library/) will be discussed. Overall, there were 10 studies appraised and summarized in this systematic review. At present, there is some evidence, mainly coming from low-medium quality low/medium level of evidence, on the human health effects with regard to exposure to Sb2O3. The health effects identified so far included respiratory effects (irritation of epiglottis epithelium, increases in the number of alveolar/bronchiolar macrophages, decreases in lung clearance and pneumoconiosis), myocardial effects and EKG alterations as well as gastrointestinal effects (nausea, vomiting and forestomach ulceration). With regard to lung cancer, the available evidence on human studies had to be interpreted with caution due to the fact that bias (especially those associated with selection and exposure measurement bias), chance (due to multiple comparison) and unaccounted effect of confounding (especially those of smoking status and co-exposure to arsenic) cannot be discounted in affecting the observed outcomes. On the occupational level of exposure associated with these health effects, to this date, the exposure was higher than the recently proposed ACGIH TLV of 0.02 mg/m3 inhalable particulate matter.

Authors' methods: The EBPG began the investigation by exploring the chapter on Sb2O3 that is available in the ACGIH TLV/BEI (Biological Exposure Indices) Guidelines Documentation and Data. In this documentation, the ACGIH stated that a TLV-TWA of 0.02 mg/m3 in inhalable particulate matter was recommended based on extrapolation to humans from the dose causing lung pathology in experimental animals in chronic inhalation studies; and was expected to protect against non-malignant and malignant lung effects. With regard to other human health effects, this document identified Sb2O3 causing upper and lower respiratory tract irritation, cataracts, pneumonitis as well as pneumoconiosis. With this information, the EBPG set out to conduct a systematic review of the literature. A comprehensive and systematic literature search was conducted on February 11, 2025. The search was done on commercial medical literature databases as well as on non-commercial occupational health and safety databases. A combination of keywords was employed in these searches. On searching the commercial medical literature databases, various keywords were employed.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2025

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/effects-of-sb2o3-on-human-health?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3DThe%2520Effects%2520of%2520antimony%2520trioxide%2520(Sb2O3)%2520on%2520Human%2520Health%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=The%20Effects%20of%20antimony%20trioxide%20(Sb2O3)%20on%20Human%20Health

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC