Rare earth elements (REEs) such as cerium and lanthanum are utilized in oil refining and as catalytic additives in the production of diesel fuel aimed at optimizing fuel combustion. Background reports from animal studies demonstrated several REE-associated adverse effects, some of which following REE inhalation of diesel exhaust particulate. This study was aimed at evaluating the occupational exposure to REEs in diesel exhaust among two groups of mechanic workers; the first group involving 20 workers from artisanal workshops lacking exhaust abatement devices in Avellino province (Italy) and the second treatment group encompassing 82 workers (controls) from two industrial industrial-shaped workshops in Como (Italy) equipped with exhaust abatement devices. The evaluated endpoints in the two donor groups were: a) urine concentrations of 1-hydroxypyrene (1-OHP), as an indicator of exposure to polycyclic aromatic hydrocarbons (PAHs); b) urine REE concentrations, and c) REE concentrations in scalp hair. The results showed significantly higher urine 1-OHP concentrations in the first treatment group vs. controls (0.28 ± 0.07 mg/L vs. 0.12 ± 0.35 mg/L) (p<0.05), along with significantly higher frequency of smokers in these workers cases vs. controls (47.6% vs. 11.1%;) (p<0.05), and significantly higher urine REE concentrations in the same cases vs. controls (0.14 ± 0.04 mg/L vs. 0.07 ± 0.04 mg/L; ) (p<0.001). REE concentrations in scalp hair were not significantly different between the two donor groups suggesting that REEs might not be sequestered to hair during detoxification pathways.