Etanercept is a biologic TNF-α inhibitor, acting as a soluble TNF receptor, which binds to TNF-α and blocks its effect.4 It is unclear how treatment with TNF-α inhibitors can lead to eosinophilia; it has been suggested that suppression of TNF-α leads to a shift of the Th1–Th2 balance, leading ultimately to eosinophilia.5 Here, TNF is linked to Increased total eosinophil count.