Occupational Rhinosinusitis Due to Etoposide, an Antineoplastic Agent

Objective This paper reports a rare case of an occupational hypersensitivity reaction to an antineoplastic agent. Methods This is a clinical case report of a 45-year-old nurse who developed throat irritation and chronic nasal congestion followed by sinusitis shortly after beginning work at an oncological out-patient clinic. The symptoms disappeared upon leaving the clinic two years later, but they returned when she resumed work at the oncology unit at Hillerød Hospital, Denmark, handling chemotherapy on a daily basis. We performed in vitro histamine release tests against nine suspected antineoplastic agents. Results The patient's histamine release test against the antineoplastic agent etoposide was positive; the other test results were negative. The histamine release test against etoposide using passive sensitization was also negative. Upon leaving the oncology department, the symptoms of the nurse disappeared once again. She was given a diagnosis of rhinosinusitis. Conclusion This case of a hypersensitivity reaction to etoposide was judged to be of occupational origin. It was not clear whether it was immunoglobulin E (IgE) or non-IgE mediated.