Occupational Rhinosinusitis Due to Etoposide, an Antineoplastic Agent

• Published in: Scandinavian Journal of Work, Environment ＆ Health Vol. 36; no. 3; pp. 266 - 267
• Main Authors: Meyer, Harald W, Skov, Per Stahl
• Format: Journal Article
• Language: English
• Published: Helsinki Scandinavian Journal of Work, Environment ＆ Health 01.05.2010; Finnish Institute of Occupational Health; National Institute of Occupational Health; National Research Centre for the Working Environment; Scandinavian journal of work, environment & health; Scandinavian Journal of Work, Environment & Health; Nordic Association of Occupational Safety and Health (NOROSH)
• Subjects: Allergies; allergy; antineoplastic agent; Antineoplastic Agents, Phytogenic - poisoning; Antineoplastics; Biological and medical sciences; Case report; Case reports; Chemotherapy; cytostatica; Drug Hypersensitivity - diagnosis; Drug Hypersensitivity - etiology; Drug Hypersensitivity - immunology; Etoposide; Etoposide - poisoning; Female; Health participants; Histamine; Histamine release; Histamine Release - drug effects; histamine release test; histamines; Hospital units; Hospitals; Humans; Hypersensitive response; Hypersensitivity; Immunoglobulin E; Irritation; Medical personnel; Medical sciences; Middle Aged; Non tumoral diseases; nurse; Nurses; nursing; occupation; Occupational Diseases - chemically induced; Occupational Diseases - diagnosis; Occupational Diseases - immunology; Occupational exposure; Occupational Exposure - adverse effects; occupational rhinosinusitis; Oncology; Oncology Nursing; Otorhinolaryngology. Stomatology; Pharynx; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rhinitis - chemically induced; Rhinitis - diagnosis; Rhinitis - immunology; rhinosinusitis; Sinusitis; Sinusitis - chemically induced; Sinusitis - diagnosis; Sinusitis - immunology; Symptoms; University hospitals; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Denmark; Europe; nurse; allergy; cytostatica; occupation; histamine release test; Antineoplastic agent; Allergy; Nose disease; Rhinitis; Podophyllotoxin derivatives; Occupational exposure; Sinusitis; Isomerases; ENT disease; Antimitotic; Human; DNA topoisomerase (ATP-hydrolysing); Immunopathology; Enzyme; Health staff; Enzyme inhibitor; Etoposide; Topoisomerase II inhibitor; Case study; Histamine; Profession; Paranasal sinus disease; Occupational medicine; Nurse
• ISSN: 0355-3140; 1795-990X
• DOI: 10.5271/sjweh.2903

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.