Churg-Strauss Syndrome Development during Asthma Therapy with Leukotriene Receptor Antagonists: Just a Coincidental Association?:
2004
A report on our clinical experience based on 3 male patients who developed Churg-Strauss syndrome
(CSS) after standard oral montelukast use. All patients affected by moderate asthma and chronic
hyperplastic rhinosinusitis were treated with inhaled corticosteroids and s2 agonists. Systemic corticosteroid
treatment consisted in oral daily prednisone in case 1, in short courses of oral betamethasone in case 2, and
in remote and isolated administrations of oral betamethasone and intramuscular methylprednisolone in
case 3. Because of the improvement of the asthma symptoms after montelukast use, patient 1 decided to take
half the dose of prednisone for 10 days and patient 2 decided to discontinue systemic and inhaled
corticosteroids for 45 days. Overt CSS was heralded by vasculitic skin lesions and developed in each patient
with severe organ damage, consisting in renal, myocardial and gastrointestinal involvement. Remission
was obtained by standard CSS therapy after montelukast withdrawal.
According to the unmasking hypothesis, antileukotriene treatment, by enabling the reduction in systemic
corticosteroid therapy in case 1 and its discontinuation in case 2, might have only permitted the precipitation
of the vasculitis. However antileukotriene-associated CSS reportedly occurred in systemic corticosteroidnaive
patients and relapsed in one patient after antileukotriene treatment. These observations lend support
to the concept that the precipitation of the vasculitic phase may be associated with leukotriene modifier
deleterious effects. In conclusion there is not enough evidence to prove that antileukotriene treatment plays
a direct causative role in the pathogenesis of CSS. Further clinical and experimental research is required
to clarify the antileukotriene associated CSS controversy.
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