title: Leukotriene antagonists and the Churg-Strauss syndrome.
abstract: OBJECTIVE
  Leukotriene antagonists (LTAs), or antileukotrienes, are a new group of anti-inflammatory drugs used for the treatment of asthma. They might substitute for or allow tapering of corticosteroids in asthmatic patients. These drugs have been associated with the development of Churg-Strauss syndrome (CSS), a rare form of vasculitic angiitis. It is unclear whether the development of CSS is a direct drug effect or an unmasking of a preexisting condition on withdrawal of steroids for asthma. We present a case of CSS in a patient treated with montelukast and review the literature to analyze the association between LTAs and the development of CSS.
  
  
  METHODS
  We reviewed the literature using MEDLINE from February 1966 to October 2000. To the cases identified, we present an additional case of a patient who underwent a diagnostic lung biopsy.
  
  
  RESULTS
  Twenty-two case reports of patients receiving LTAs who developed CSS were identified. The onset of CSS occurred 2 days to 10 months after starting treatment with LTAs. All patients had received inhaled or oral steroids for asthma. The interval between the last oral corticosteroid treatment and CSS onset ranged from 3 days to 8 months.
  
  
  CONCLUSIONS
  To date, there is no compelling evidence that the development of CSS in asthmatic patients receiving LTAs results from a direct drug effect. Rather, it appears that tapering of corticosteroids in these patients unmasks the multiorgan manifestations of the disease. We believe that the use of LTAs should not be influenced by the apparent increase in the incidence of CSS and that these are still safe drugs for asthma.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. ghassanj@aub.edu.lb
authors.forename: Ghassan
authors.initials: G
authors.lastname: Jamaleddine
authors.forename: Karim
authors.initials: K
authors.lastname: Diab
authors.forename: Zuhayr
authors.initials: Z
authors.lastname: Tabbarah
authors.forename: Ayman
authors.initials: A
authors.lastname: Tawil
authors.forename: Thurayya
authors.initials: T
authors.lastname: Arayssi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy; D015267:Churg-Strauss Syndrome / Q000139:chemically induced*; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists