title: Leukotriene receptor antagonists and Churg-Strauss syndrome: cause, trigger or merely an association?
abstract: Concern has been raised in the medical literature that the use of leukotriene receptor antagonists for the treatment of asthma may be associated with an increased incidence of Churg-Strauss syndrome, a rare small-vessel vasculitic syndrome. This review provides a critical appraisal of the literature to address this question. The incidence of Churg-Strauss syndrome in the general population is one to four cases per million. In patients with asthma it is 20-60 cases per million patient-years, which is similar to that seen in a population receiving leukotriene receptor antagonists. There is no evidence for a direct causative role of leukotriene receptor antagonists in the development of Churg-Strauss syndrome. There may be multiple other non-causative reasons for an association, including the fact that these agents may be initiated in patients who are already in the process of developing Churg-Strauss syndrome, or that the use of leukotriene receptor antagonists leads to a reduction in corticosteroid use, which in turn allows the Churg-Strauss syndrome to be 'unmasked'.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. keogh.karina@mayo.edu
authors.forename: Karina A
authors.initials: KA
authors.lastname: Keogh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D015267:Churg-Strauss Syndrome / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists