Abstract

Occupational allergy due to cytostatics are scarce and mainly concern allergic contact dermatitis and allergic contact urticaria (1,2). To our knowledge, there is no published case report on mitoxantrone-induced allergic asthma. We present the case of a 41-year-old nurse who had worked
for 13 years in an oncology ward with exposure to antineoplastic drugs. For three years she had suffered from rhinorrhea, dyspnea and cough attacks, occurring 1–2 h after beginning work. For the first two years the patient presented only work-related symptoms; in the third year she developed
dyspnea also away from work. Clinical examinations, as well as routine
laboratory parameters, remained normal. The total IgE (CAP System, Pharmacia, Sweden) level was low (4.89 km/l). No specific IgE antibodies against latex, disinfectants and b-lactams were detected. Also skin prick tests to common allergens, latex (Allergopharma, Germany) chloramine and chlorhexidine (0.001, 0.01 and 0.1% solutions) were negative. The histamine provocation test showed unremarkable bronchial hyperreactivity (PC20=0.093 mg/ml). The patient was subjected to a number of single-blind bronchial challenge tests with subsequent cytostatics monitored by spirometry and
peak expiratory flow (PEFR) measurements.

The provocation with mitoxantrone induced a 15% fall in forced expiratory volume (FEV1) at 1 h, with a 20% decrease 4 h later. One week later the
challenge with mitoxantrone was repeated. Bronchoalveolar lavage fluid (BAL) was taken before and at 6 and 18 h after the provocation. Significant increase in lymphocytes and neutrophil proportion was observed, especially at 18 h after the challenge. We also noted eosinophil influx, up to 4%, and more than a two-fold increase (from 8.0% before to 18.2%) in the permeability index. The same provocation test was performed in an asthmatic volunteer not exposed to antineoplastic drugs. There were no significant changes in cell proportions apart from a slight increase in neutrophils
(from 1% to 6% at 18 h).

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