Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma.
OBJECTIVE
We previously reported eight patients who developed Churg-Strauss syndrome in association with zafirlukast treatment for asthma and postulated that the syndrome resulted from unmasking of a previously existing condition due to corticosteroid withdrawal and not from a direct drug effect. The availability of montelukast, a new leukotriene receptor antagonist with a different molecular structure, permitted us to test this hypothesis. Our goals were to ascertain whether the Churg-Strauss syndrome developed in patients taking montelukast and other novel asthma medications, and to describe potential mechanisms for the syndrome.


METHODS
Case series.


METHODS
Outpatient and hospital practices of pulmonologists in the United States and Belgium.


METHODS
Four adults (one man, three women) who received montelukast as treatment for asthma; two women who received salmeterol/fluticasone therapy, but not montelukast.


RESULTS
Churg-Strauss syndrome developed in the four asthmatic patients who received montelukast. In each case, there was a long history of difficult-to-control asthma characterized by multiple exacerbations that had required frequent courses of oral systemic corticosteroids or high doses of inhaled corticosteroids for control. Two other asthmatics who received fluticasone and salmeterol but not montelukast therapy developed the same syndrome with tapering doses of oral or high doses of inhaled corticosteroids.


CONCLUSIONS
The occurrence of Churg-Strauss syndrome in asthmatic patients receiving leukotriene modifiers appears to be related to unmasking of an underlying vasculitic syndrome that is initially clinically recognized as moderate to severe asthma and treated with corticosteroids. Montelukast does not appear to directly cause the syndrome in these patients.
Wechsler
M E
ME
Departments of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Finn
D
D
Gunawardena
D
D
Westlake
R
R
Barker
A
A
Haranath
S P
SP
Pauwels
R A
RA
Kips
J C
JC
Drazen
J M
JM
D000085:Acetates / Q000009:adverse effects* / Q000627:therapeutic use; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D015267:Churg-Strauss Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D003521:Cyclopropanes; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011804:Quinolines / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D013440:Sulfides
D000085:Acetates; D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; C093875:montelukast