From the authors

We would like to thank K. Inoue and H. Takano for their comments and questions regarding our paper entitled “Exposure to nanoparticles is related to pleural effusion, pulmonary fibrosis and granuloma” 1. We read with great interest the study mentioned by K. Inoue and H. Takano 2 with the knowledge that combined exposure to nanoparticles and endotoxin elicited devastating lung injury in comparison to nanoparticles or endotoxin alone. However, with regard to the patients in our study, no evidence was found to show that their symptoms might be related to endotoxin from their occupational exposure, our on-the-spot investigation, clinical observations and examinations, or long-term follow-up. If the patients had inhaled the endotoxin, some symptoms and signs of “endotoxin poisoning” would exist, such as fever, tiredness, …