Churg–Strauss syndrome in two patients receiving montelukast

Objective. Churg–Strauss syndrome (CSS) has been described in association with the treatment of asthmatic patients with leukotriene receptor antagonist. The main mechanism proposed to explain this condition is the unmasking of CSS after the leukotriene receptor antagonist has allowed corticosteroid...

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Bibliographic Details
Published in:Rheumatology (Oxford, England) England), 2002-05, Vol.41 (5), p.535-539
Main Authors: Guilpain, P., Viallard, J.‐F., Lagarde, P., Cohen, P., Kambouchner, M., Pellegrin, J.‐L., Guillevin, L.
Format: Article
Language:English
Subjects:
Acetates - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Asthma - complications
Asthma - drug therapy
Biological and medical sciences
Churg-Strauss Syndrome - drug therapy
Churg-Strauss Syndrome - etiology
Churg-Strauss Syndrome - pathology
Churg–Strauss syndrome
Cyclophosphamide - therapeutic use
Drug Therapy, Combination
Drug toxicity and drugs side effects treatment
Glucocorticoids - therapeutic use
Humans
Immunosuppressive Agents - therapeutic use
Leukotriene Antagonists - therapeutic use
Male
Medical sciences
Middle Aged
Miscellaneous (drug allergy, mutagens, teratogens...)
Montelukast
Pharmacology. Drug treatments
Quinolines - therapeutic use
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
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Summary:Objective. Churg–Strauss syndrome (CSS) has been described in association with the treatment of asthmatic patients with leukotriene receptor antagonist. The main mechanism proposed to explain this condition is the unmasking of CSS after the leukotriene receptor antagonist has allowed corticosteroid tapering. Other hypotheses might be proposed. Methods. We describe two patients who developed CSS after starting treatment with montelukast, a new antileukotriene drug. Results. Both patients presented with CSS after 4–5 months of treatment with montelukast. Neither patient received long‐term systemic steroids for asthma, but both were on inhaled steroids. One patient had a myocardial involvement and experienced a stroke. Our two patients were treated with systemic steroids and cyclophosphamide. Conclusions. CSS does not appear to relate to steroid tapering in our patients. The other hypotheses are a coincidence or a direct adverse effect of the antileukotriene. Long‐term data on these drugs are lacking and leukotriene's role in vasculitis remains to be elucidated.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/41.5.535