Reply on the comments of Ulla Vogel and colleagues on their recently published paper entitled "Re-evaluation of the occupational exposure limit for ZnO is warranted. Comments on 'Systemic inflammatory effects of zinc oxide particles: is a re-evaluation of exposure limits needed?' by Christian Monsé et al."

This document is a reply to comments made by Ulla Vogel and colleagues regarding the occupational exposure limit (OEL) for zinc oxide (ZnO). The authors disagree with the argument that small elevations of chronic acute phase proteins, such as C-reactive protein (CRP) and serum amyloid A (SAA), increase the risk of cardiovascular disease (CVD). They cite studies that question the causal link between CRP and SAA elevations and CVD. The authors also clarify that the term "zinc-specific mechanism of action" should be understood as a "metal-specific mechanism of action." They criticize studies that attribute acute phase protein responses to insoluble particles without investigating their composition. Additionally, they point out a misrepresentation of the MAK recommendation and highlight the technical challenges of complying with proposed concentration limits. The authors declare no conflict of interest. [Extracted from the article]