montelukast and Churg-Strauss-Syndrome

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Drug Eruptions; Female; Humans; Middle Aged; Quinolines; Respiratory Function Tests; Sulfides; Treatment Outcome

Churg-Strauss syndrome is a systemic necrotizing vasculitis involving small and medium-sized vessels. Classic features include asthma and hypereosinophilia. Antineutrophil cytoplasm antibodies (ANCA) are detected in about 40% of patients. Churg-Strauss syndrome has been reported in patients receiving leukotriene modifiers for asthma, in particular, leukotriene receptor antagonists (LTRA) (montelukast, zafirlukast or pranlukast). Clinical manifestations cases do not differ in these cases from those in Churg-Strauss syndrome without antileukotriene exposure. It is increasingly less likely that LTRA is the direct cause of this syndrome in those patients, although this hypothesis has not been completely ruled out. In many patients, LTRA treatment is prescribed because of worsening asthma, which is an early sign of Churg-Strauss syndrome. LTRA for asthma patients should be prescribed with great care, especially in cases of atypical or rapidly aggravated asthma. The onset of Churg-Strauss syndrome in patients treated with LTRA usually requires that they stop this treatment. Prescription of LTRA In patients with Churg-Strauss syndrome should be discussed with specialists.

Topics: Acetates; Adult; Anti-Asthmatic Agents; Antibodies, Antineutrophil Cytoplasmic; Asthma; Chromones; Churg-Strauss Syndrome; Cohort Studies; Cyclopropanes; Humans; Incidence; Indoles; Leukotriene Antagonists; Leukotrienes; Phenylcarbamates; Quinolines; Retrospective Studies; Sulfides; Sulfonamides; Tosyl Compounds

Effective asthma treatment requires long-term inflammation control. Patient adherence to corticosteroid treatment regimens remains problematic. Leukotriene modifiers, a newer drug class, add to the pharmacologic approaches to asthma management. Here, we review the role of leukotrienes in asthma pathogenesis and appropriate uses for leukotriene modifiers in asthma management.

Topics: Acetates; Asthma; Child; Churg-Strauss Syndrome; Cyclopropanes; Forced Expiratory Volume; Humans; Indoles; Leukotriene Antagonists; Leukotrienes; Phenylcarbamates; Quinolines; Severity of Illness Index; Sulfides; Sulfonamides; Tosyl Compounds

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.. We describe two patients who developed CSS after starting treatment with montelukast, a new antileukotriene drug.. 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.. 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.

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclophosphamide; Cyclopropanes; Drug Therapy, Combination; Glucocorticoids; Humans; Immunosuppressive Agents; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides

Since antileukotriene treatment for asthma was introduced, there has been debate about whether such therapy can lead to Churg-Strauss Syndrome (CSS) or whether CSS is simply inhibited by the use of steroids, as various authors have suggested. We report a case in which we suspected CSS in a patient with bronchopulmonary, cutaneous and analytical signs and whom we treated with oral steroids. After clinical improvement, one year later, steroids were replaced by antileukotrienes, after which the same clinical picture developed. The vasculitis characteristic of CSS was confirmed pathologically.

Topics: Acetates; Adult; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

Topics: Acetates; Adult; Anti-Asthmatic Agents; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Quinolines; Sulfides

The tolerability of a medication, especially in children with asthma, is linked to a number of key factors. These include clinical effectiveness, adverse effects, frequency of drug regimen, ease and route of administration. and taste. Montelukast is unusual in that, in most countries, a licence for children aged > or =6 years was granted at the same time as the adult licence. This is related to a variety of evidence. which includes pharmacological and adult studies suggesting the specificity and safety of the drug at many times the licensed dose, and a tolerability profile similar to that with placebo or inhaled corticosteroids in both adult and paediatric studies. The most common adverse effects in paediatric studies were headache, asthma and upper respiratory tract infection at rates not statistically significantly different from those with placebo. Up to July 1999, more than 2 million patients worldwide have received montelukast, of whom nearly 220,000 have received the paediatric formulation. In the UK, one prescribing database suggests that, of children who commenced montelukast therapy, less than 25% discontinued the drug. This implies that montelukast is effective and well tolerated in most children. Adverse effect monitoring by regulatory bodies has revealed little that would not be expected on the basis of the results of clinical trials. Montelukast has been associated with Churg-Strauss syndrome in a very small number of adults. In most. the syndrome was associated with corticosteroid withdrawal, which may have unmasked the condition. Churg-Strauss syndrome has not been reported in children. Its clinical effectiveness, lack of major adverse effects, oral route of administration, palatability and the once-daily regimen combine to make montelukast a generally well tolerated medication in children.

Topics: Acetates; Adolescent; Anti-Asthmatic Agents; Asthma; Child; Churg-Strauss Syndrome; Controlled Clinical Trials as Topic; Cyclopropanes; Humans; Leukotriene Antagonists; Product Surveillance, Postmarketing; Quinolines; Sulfides

Montelukast, a selective leukotriene receptor antagonist, is recommended in guidelines for the treatment of asthma in both children and adults. However, its effectiveness is debated, and recent studies have reported several adverse events such as neuropsychiatric disorders and allergic granulomatous angiitis. This study aims to obtain more insight into the safety profile of montelukast and to provide prescribing physicians with an overview of relevant adverse drug reactions in both children and adults. We retrospectively studied all adverse drug reactions on montelukast in children and adults reported to the Netherlands Pharmacovigilance Center Lareb and the WHO Global database, VigiBase

Topics: Acetates; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Child; Child, Preschool; Churg-Strauss Syndrome; Cyclopropanes; Databases, Factual; Depression; Dreams; Female; Headache; Humans; Infant; Male; Middle Aged; Netherlands; Pharmacovigilance; Quinolines; Retrospective Studies; Sulfides; Young Adult

To report a case of Churg-Strauss syndrome who had asthma and allergic rhinitis treated with montelukast.. A nonsmoking 59-year-old woman presented with fever, hemoptysis and dyspnea. Past medical history included allergic rhinitis and asthma which were diagnosed 18 years ago. The asthma was treated successfully with inhaled salmeterol and beclamethasone. She also received montelukast (10 mg/day) for 3 years. Although her chest X-ray was normal a week earlier, she had widespread bilateral pulmonary infiltrates on admission. She had leukocytosis (12.5 × 10(9)/l) with eosinophilia (15.6%). Her total IgE count was 550 U/ml. Testing for protoplasmic-staining antineutrophil cytoplasmic antibodies was positive. Bronchoalveolar lavage could not be performed due to bronchospasm and severe hypoxemia; however, mucosal biopsies were obtained, which revealed eosinophil leukocytes in the lumen and walls of small vessels. She was diagnosed to have Churg-Strauss syndrome and had remarkable clinical improvement on day 5 with high-dose of oral prednisolone (50 mg/day). Radiological improvement was detected at the end of the second week.. This case shows the importance of being aware that leukotriene receptor antagonists could cause Churg-Strauss syndrome, in spite of the uncertainty about its mechanism.

Topics: Acetates; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Middle Aged; Quinolines; Sulfides

A young male with complaints of cough, dyspnea and hemoptysis was admitted. He was using fluticasone propionate and salmeterol for two years for his asthma. Leukotriene receptor antagonist was prescribed two weeks prior to his admission and no reduction of his inhaled steroid therapy was performed. Eosinophil count was detected as 1460/mm³ (15%) and immunoglobulin E level was 547 IU/mL. Thorax computerized tomography revealed patchy infiltration. Increased eosinophilic inflammation were detected in bronchoalveolar lavage fluid and transbronchial biopsy. He received prednisolone treatment for Churg-Strauss syndrome. Improvement was observed on three months follow up period. He has no complaint in his follow up.

Topics: Acetates; Adolescent; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cough; Cyclopropanes; Dyspnea; Hemoptysis; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

A 77-year-old Japanese female developed Churg-Strauss syndrome (CSS), showing fever and numbness in bilateral hands. She was being treated for bronchial asthma with combination inhalant of corticosteroid with beta(2)-agonist, and an oral leukotriene receptor antagonist (LTRA), montelukast, for 15 months. She presented fever up to 38°C with microscopic hematuria and proteinuria, serum creatinine level of 0.7 mg/dl, and C-reactive protein of 11 mg/dl. After referral to our hospital, eosinophilia and high myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) level were observed together with hematuria and proteinuria; renal biopsy examination was performed to clarify the disorder. Renal biopsy specimens showed necrotizing crescent formation, severe granulomatous angiitis in an interlobular artery, and interstitial eosinophilic infiltration. It was noted that nearly intact glomeruli were infiltrated with eosinophils. After treatment with oral prednisolone at initial dose of 40 mg (1 mg/kg body weight), urinary findings rapidly became normal with mild elevation of serum creatinine to 1.5 mg/dl and trace level of serum C-reactive protein in 1 month. Because she was previously treated with montelukast without oral corticosteroid, linkage between CSS and LTRA was highly suspected.

Topics: Acetates; Aged; Antibodies, Antineutrophil Cytoplasmic; Asthma; C-Reactive Protein; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Prednisolone; Quinolines; Sulfides; Vasculitis, Central Nervous System

Topics: Acetates; Adult; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cough; Cyclopropanes; Eosinophils; Female; Humans; Quinolines; Skin; Sulfides

This report describes the Churg-Strauss syndrome (CSS) in a 23-year-old asthmatic man treated with a leukotriene antagonists-montelukast. The Churg-Strauss syndrome is now defined as one of the ANCA-associated vasculitis and is characterised by eosinophilia, asthma, chronic sinusitis, cardiomyopathy, pulmonary infiltrates, cutaneous vasculitis, gastrointestinal complaints and a muliplex neuropathy. The pathogenesis is not clear, but it has been reported in patients treated with leukotriene antagonists. We describe a case of CSS with severe pulmonary and cardiovascular complications.

Topics: Acetates; Adult; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Pericarditis; Pneumonia; Quinolines; Sulfides

Churg-Strauss syndrome is a rare form of eosinophilic vasculitis associated with asthma. Several cases of eosinophilic conditions including Churg-Strauss syndrome have recently been reported in asthmatic patients being treated with antileukotriene receptor antagonists. However, whether these drugs have a direct pathogenic role remains controversial. We describe two patients who developed Churg-Strauss syndrome after starting treatment with montelukast.

Topics: Acetates; Adult; Aged, 80 and over; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Male; Pulmonary Eosinophilia; Quinolines; Sulfides

Topics: Acetates; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Drug Eruptions; Female; Glucocorticoids; Humans; Leukotriene Antagonists; Quinolines; Sulfides; Vasculitis, Leukocytoclastic, Cutaneous; Young Adult

Topics: Acetates; Anti-Asthmatic Agents; Churg-Strauss Syndrome; Cyclopropanes; Evidence-Based Medicine; Humans; Quinolines; Sulfides

Topics: Acetates; Adult; Anti-Asthmatic Agents; Asthma; Biopsy; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Lung; Male; Quinolines; Sulfides

A 47 year old woman who had a history of asthma for 15 years referred to our hospital because of infiltrates on her chest radiograph that not responded to antibiotic treatment. We found that she had eosinophilia in peripheral blood (38%) and bronchoalveolar lavage (54%), nasal polyposis, and transient pulmonary infiltrates, and in the base of these findings we diagnosed as Churg-Strauss Syndrome (CSS). She has been using montelukast for 2 years. By examining her previous medical records, we observed that while eosinophil rates in peripheral blood were normal before montelukast usage, after this therapy eosinophil rates were greater 10 percent. Therefore, we thought that CSS was to be associated with montelukast usage. After just montelukast therapy was discontinued, clinical and radiographic parameters and the eosinophil counts (20%) improved. We present this case of CSS associated with montelukast in whom spontaneous remission was observed without using corticosteroids and cytotoxic agents.

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Eosinophilia; Eosinophils; Female; Humans; Middle Aged; Quinolines; Sulfides

There has been some concern that leucotriene receptor antagonists might precipitate the onset of Churg-Strauss syndrome (CSS). A study was undertaken to investigate the relationship between the leucotriene receptor antagonist montelukast and the onset of CSS.. Medication histories of 78 patients with CSS from France and Germany were retraced by questioning the patients, treating physicians and dispensing pharmacists, and from medical records. Using a case-crossover research design, exposures to montelukast and other asthma medications during the 3-month "index" period immediately preceding the onset of CSS were compared with those of four previous 3-month "control" periods. Odds ratios (ORs) were computed by conditional logistic regression.. The ORs for CSS onset were 4.5 (95% CI 1.5 to 13.9) for montelukast, 3.0 (95% CI 0.8 to 10.5) for inhaled long-acting beta(2) agonists, 1.7 (95% CI 0.5 to 5.4) for inhaled corticosteroids and 4.0 (95% CI 1.3 to 12.5) for oral corticosteroids. Montelukast exposure during control periods increased temporally over three consecutive calendar periods of CSS onset from 1999 to 2003 (p(trend) <0.0001).. Montelukast use was associated with a 4.5-fold higher risk of CSS onset within 3 months. However, the positive estimates obtained for other long-term asthma control medications suggest that this link might be confounded by a general escalation of asthma therapy before CSS onset. The association between montelukast and CSS observed in this study is probably also explained by the increasing use of this medication over time.

Topics: Acetates; Acute Disease; Anti-Asthmatic Agents; Antibodies, Antineutrophil Cytoplasmic; Asthma; Case-Control Studies; Churg-Strauss Syndrome; Cross-Over Studies; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides

A 75-year-old woman with a history of asthma, rhinitis and nasal polyps was admitted due to petechial lesions on the lower left leg and weakness of the right foot. Six weeks prior to admission, she had started treatment with montelukast 10 mg daily. Based on the asthma, eosinophilia, mononeuritis of the right leg and a skin biopsy showing small vessel vasculitis with eosinophilic granulocytes, the patient was diagnosed with Churg-Strauss syndrome (CSS). After consulting with the pulmonologist, montelukast therapy was discontinued and replaced with a combined preparation of a parasympatholytic and a P2-sympathomimetic. The patient was also given prednisone 60 mg daily, which resulted in prompt clinical improvement and resolution of the eosinophilia. Development of CSS has been associated with the use of montelukast and should be considered in patients with asthma who develop new symptoms, such as neuritis, vasculitis of the skin or pulmonary infiltrates with an increase in eosinophilia during montelukast therapy. In these patients, treatment with montelukast should be discontinued, although whether a causal relationship exists between montelukast and CSS continues to be debated in the literature.

Topics: Acetates; Aged; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Eosinophilia; Female; Humans; Quinolines; Sulfides

Topics: Acetates; Adult; Churg-Strauss Syndrome; Cyclopropanes; Electromyography; Female; Glucocorticoids; Humans; Leukotriene Antagonists; Peripheral Nervous System Diseases; Quinolines; Sulfides; Treatment Outcome

A case of a 58-year-old woman with Churg-Strauss syndrome is reported. After therapy with steroids clinical improvements were obtained. The discussion concerning the pathogenesis of disease was performed.

Topics: Acetates; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Antihypertensive Agents; Churg-Strauss Syndrome; Combined Modality Therapy; Cyclopropanes; Female; Humans; Hypertension; Methylprednisolone; Middle Aged; Quinolines; Sulfides

Topics: Acetates; Adrenal Cortex Hormones; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Radiography, Thoracic; Recurrence; Sulfides; Time Factors; Tomography, X-Ray Computed

Churg-Strauss syndrome (CSS) is a disseminated small vessel vasculitis characterized by late-onset asthma, upper airways disease, eosinophilia and late neurological manifestations such as peripheral neuropathy. Recently, several cases of CSS have been reported in patients treated with leukotriene antagonists after weaning corticosteroids. We describe a case of CSS developed while the patient was receiving montelukast for asthma treatment, after corticosteroids withdrawal. A causal relationship between montelukast therapy and CSS is hypothesized.

Topics: Acetates; Aged; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Electrophysiology; Female; Humans; Leukotriene Antagonists; Pain; Peripheral Nervous System Diseases; Quinolines; Sulfides

Bronchial asthma can be associated with Churg Strauss syndrome (CSS). A peripheral neuropathy may be the initial manifestation of CSS. There is also some evidence that leucotriene receptor antagonists (LTAs) may trigger CSS in asthmatic patients, especially when steroids are tapered previously. However, the pathogenesis is unclear and the association between CSS and LTAs remains a matter of controversy. The aim of this report is to clarify this issue. A 79-year-old male patient with bronchial asthma for twenty years was admitted due to progressing gait disorder developing within the last two weeks. Asthma had been treated with a leucotriene receptor antagonist (Montelukast) for four years, as well as low doses of inhaled steroids and beta-2-agonists. On admission, neurological examination revealed a mild ataxia on both upper limbs and multifocal sensory disturbances without motor deficits. Nerve conduction velocity studies demonstrated normal results for the upper limbs and an axonal sensorimotor neuropathy of the lower limbs. Electromyography exhibited no spontaneous activity in the right tibialis anterior and rectus femoris muscle. Nerve-muscle biopsy revealed an eosinophilic vasculitis in both nerve and muscle. Laboratory examination showed leucocytosis and marked eosinophilia. A diagnosis of CSS was made. This case demonstrates a severe neuropathy in an asthmatic patient, during long lasting treatment with a LTA and continuous low doses of inhaled steroid, as the initial clinical feature of CSS.

Topics: Acetates; Aged; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Muscle, Skeletal; Quinolines; Sulfides; Sural Nerve

The association of leukotriene receptor antagonists and Churg-Strauss Syndrome (CSS) has been recognised for several years. However, whether these drugs have a direct pathogenic role remains controversial. The present case describes an asthmatic patient, who developed severe obstructive symptoms and progressive heart failure after two sequential exposures to montelukast. As the patient exhibited a markedly raised blood eosinophil count with diffuse infiltrates on chest x-ray and signs of myocarditis, CSS was suspected. The disease was confirmed by open lung biopsy. The symptoms improved rapidly after administration of high dose immunosuppression with methylprednisolone and cyclophosphamide. This case is noteworthy because the time course of events strongly suggests a direct aetiological role for montelukast in the development of CSS. The pathophysiological mechanism of the association remains unknown.

Topics: Acetates; Asthma; Biopsy, Needle; Churg-Strauss Syndrome; Cyclopropanes; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunohistochemistry; Immunosuppressive Agents; Leukotriene Antagonists; Male; Middle Aged; Pulmonary Eosinophilia; Quinolines; Radiography, Thoracic; Risk Assessment; Severity of Illness Index; Sulfides; Switzerland; Treatment Outcome

Topics: Acetates; Acute Disease; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Male; Middle Aged; Quinolines; Skin Diseases; Sulfides

A 68-year-old asthmatic presented markedly unwell with arthralgia, mononeuritis multiplex, peripheral neuropathy, and eosinophilia. His past medical history included perennial rhinitis, and nasal polyps. Three months prior to admission his prednisolone was stopped and Montelukast was started. The diagnosis of Montelukast-associated Churg-Strauss syndrome was made. The drug was stopped and steroids started with general improvement and reduction of eosinophilia; however, the neurological deficit persisted.

Topics: Acetates; Aged; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

To determine the association of antineutrophil cytoplasmic antibodies (ANCA) and leukotriene receptor antagonists with disease activity in a large series of patients with Churg-Strauss syndrome.. Potential subjects were identified by a computerized search of the Mayo Clinic Rochester database for the years 1990 to 2000. Patients meeting one of three classification schemes for Churg-Strauss syndrome were included.. Ninety-one patients met the inclusion criteria. Clinical manifestations were similar to those in previous reports. Mortality was similar to that in the general population. ANCA testing was performed in 74 patients. Seventy-three percent (n = 22) of the 30 patients tested before therapy were ANCA positive, as were 75% (n = 12) of the 16 patients tested during a disease flare. In comparison, 16% (n = 8) of the 49 tested during remission were ANCA positive. Serial measurements indicated a correlation of ANCA levels with disease activity. Central nervous system involvement was the only clinical manifestation that correlated with ANCA status (P = 0.05). Twenty-three patients received leukotriene receptor antagonists, of whom 16 (70%) began treatment before diagnosis and 6 (27%) began during remission. Two of those treated after diagnosis relapsed. In 1 patient the relation between disease and leukotriene receptor antagonist use could not be determined. Use of leukotriene receptor antagonists did not affect the time between onset of asthma and manifestations of vasculitis, and was not correlated with organ manifestations, except sinus disease.. No one classification scheme identified all patients. Churg-Strauss syndrome has a better prognosis than other ANCA-associated vasculitides. ANCA status correlates with disease activity, whereas a pathogenic role for leukotriene receptor antagonists in the development of Churg-Strauss syndrome was not noted.

Topics: Acetates; Adolescent; Adult; Aged; Antibodies, Antineutrophil Cytoplasmic; Asthma; Biopsy; Central Nervous System Diseases; Child; Churg-Strauss Syndrome; Cyclopropanes; Electromyography; Eosinophilic Granuloma; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Indoles; Leukotriene Antagonists; Male; Middle Aged; Minnesota; Peroxidase; Phenylcarbamates; Predictive Value of Tests; Quinolines; Statistics as Topic; Sulfides; Sulfonamides; Survival Analysis; Tosyl Compounds; Treatment Outcome

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Drug Eruptions; Humans; Leg Dermatoses; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides

Topics: Acetates; Adult; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Quinolines; Sulfides

Several cases of eosinophilic conditions including Churg-Strauss syndrome (CSS) have recently been reported in asthmatic patients being treated with antileukotriene receptor antagonists. One patient with CSS who experienced a clinical relapse after treatment with montelukast and two asthmatic patients who developed CSS while receiving montelukast treatment are described. In one case reduction in the dose of oral steroid preceded the onset of CSS. To our knowledge, no case of CSS relapse has previously been reported in association with leukotriene antagonists.

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides

Montelukast is the only available antileukotriene drug in Norway. It works against the inflammation, bronchospasm and airway oedema caused by leukotrienes. In the literature there are some reports on an association between the use of the leukotriene antagonists zafirlukast, pranlukast, montelukast and the appearance of Churg-Strauss syndrome. This rare syndrome is a systemic vasculitis characterized by allergic rhinitis, asthma and prominent peripheral blood eosinophilia.. This is a case report of the appearance of Churg-Strauss syndrome in a 20-year-old asthmatic woman treated with montelukast and with no recent oral corticosteroid use.. To our knowledge, this is the first report in a Nordic country of an association between montelukast and Churg-Strauss syndrome. Although this is a rare association, the clinicians need to be vigilant in all patients who develop systemic symptoms when starting treatment with leukotriene antagonists.

Topics: Acetates; Adult; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Quinolines; Sulfides

Topics: Acetates; Adult; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides; Time Factors

Topics: Acetates; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Quinolines; Sulfides

Topics: Acetates; Administration, Inhalation; Androstadienes; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Dose-Response Relationship, Drug; Eosinophilia; Fluticasone; Humans; Nebulizers and Vaporizers; Prednisolone; Quinolines; Sulfides

Topics: Acetates; Administration, Inhalation; Aged; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Glucocorticoids; Humans; Leukotriene Antagonists; Male; Quinolines; Sulfides

Topics: Acetates; Anti-Asthmatic Agents; Churg-Strauss Syndrome; Cyclopropanes; Humans; Quinolines; Sulfides

Churg-Strauss syndrome (CSS) has recently been reported in patients with asthma receiving leukotriene receptor antagonists (LTRAs). In this paper a case of CSS after treatment with montelukast is described. As in other LTRA treated cases, prior withdrawal of maintenance oral steroid may have unmasked a previously occult CSS in the patient, but a dramatic improvement in his eosinophilia after withdrawing montelukast implied that the drug also had a direct effect in activating this condition.

Topics: Acetates; Anti-Asthmatic Agents; Churg-Strauss Syndrome; Cyclopropanes; Follow-Up Studies; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Sulfides

This article presents information on the safety of zafirlukast, montelukast, and zileuton, three antileukotrienes (anti-LTs) approved in the United States for the prophylaxis and treatment of asthma. After reading this article, readers should have an understanding both of the general safety of anti-LTs and their specific adverse effects.. Relevant and appropriate controlled clinical studies on the safety of anti-LTs in asthma were used. Only literature in the English language was reviewed.. Material was taken from academic/scholarly journals and appropriate reviews.. Antiasthma agents, including corticosteroids, beta2-agonists, and methylxanthines, may be categorized into two classes: those used for the long-term control and prevention of persistent asthma and those used for the prompt relief of acute symptoms and exacerbations of the disease. Although most agents are safe and well tolerated when used properly, adverse effects may occur with use at higher dose levels. The anti-LTs, including zafirlukast, montelukast, and zileuton, are the first new pharmacologic class in the therapeutic armamentarium for asthma management to be approved in the United States in the past 20 years. Both zafirlukast and montelukast carry pregnancy category B classification whereas zileuton carries pregnancy category C classification. The most common adverse effects observed in clinical trials were headache, pharyngitis, abdominal pain, dyspepsia, and cough.. The results of clinical trials and real-world experience indicate that these agents are generally safe and well tolerated, with an incidence of adverse effects comparable with placebo.

Topics: Acetates; Asthma; Churg-Strauss Syndrome; Clinical Trials as Topic; Cyclopropanes; Humans; Hydroxyurea; Indoles; Leukotriene Antagonists; Phenylcarbamates; Quinolines; Sulfides; Sulfonamides; Tosyl Compounds

Topics: Acetates; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Duodenum; Female; Humans; Middle Aged; Pyloric Antrum; Quinolines; Sulfides

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.. Case series.. Outpatient and hospital practices of pulmonologists in the United States and Belgium.. Four adults (one man, three women) who received montelukast as treatment for asthma; two women who received salmeterol/fluticasone therapy, but not montelukast.. 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.. 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.

Topics: Acetates; Adrenal Cortex Hormones; Adult; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Risk Factors; Sulfides

Topics: Acetates; Adult; Churg-Strauss Syndrome; Cyclopropanes; Female; Humans; Leukotriene Antagonists; Quinolines; Sulfides

Churg-Strauss syndrome is a rare form of eosinophilic vasculitis associated with asthma. There have been several recent case reports of the condition in association with leukotriene antagonists and it has been speculated that the Churg-Strauss syndrome was unmasked when oral corticosteroids were withdrawn. We report a case of Churg-Strauss syndrome associated with montelukast therapy in an asthmatic patient in whom there had been no recent oral corticosteroid use. We believe that this is the first such reported case and would suggest that clinicians need to be vigilant in all patients who develop systemic symptoms when starting treatment with leukotriene antagonists.

Topics: Acetates; Aged; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Female; Forced Expiratory Volume; Humans; Leukotriene Antagonists; Quinolines; Radiography; Sulfides; Vital Capacity

Topics: Acetates; Adult; Androstadienes; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Diagnosis, Differential; Diarrhea; Fluticasone; Glucocorticoids; Heart Failure; Humans; Leukotriene Antagonists; Lung; Male; Muscle Hypotonia; Prednisone; Quinolines; Radiography; Sulfides

Topics: Acetates; Anti-Asthmatic Agents; Biopsy; Churg-Strauss Syndrome; Cyclopropanes; Diagnosis, Differential; Follow-Up Studies; Humans; Lung; Quinolines; Sulfides; Treatment Outcome

Topics: Acetates; Administration, Inhalation; Adrenal Cortex Hormones; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Humans; Indoles; Leukotriene Antagonists; Phenylcarbamates; Quinolines; Sulfides; Sulfonamides; Tosyl Compounds

Topics: Acetates; Anti-Asthmatic Agents; Churg-Strauss Syndrome; Cyclopropanes; Humans; Leukotriene Antagonists; Male; Middle Aged; Quinolines; Status Asthmaticus; Sulfides; Time Factors

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Autoimmune Diseases; Chromones; Churg-Strauss Syndrome; Cyclopropanes; Drug Hypersensitivity; Eosinophilia; Humans; Indoles; Leukotriene Antagonists; Leukotrienes; Lupus Erythematosus, Systemic; Phenylcarbamates; Quinolines; Sulfides; Sulfonamides; Th2 Cells; Tosyl Compounds

Antileukotriene drugs are new therapeutic agents that have recently been approved for the treatment of asthma. Several cases of eosinophilic conditions including Churg-Strauss syndrome have been reported to be associated with zafirlukast, a cysteinyl leukotriene type 1 receptor antagonist. So far no other leukotriene modifier has been associated with the syndrome. The case history is presented of a man with allergic rhinitis and asthma who had received intermittent pulse therapy with oral corticosteroids. Pulmonary eosinophilia developed while he was receiving treatment with montelukast, a chemically distinct cysteinyl leukotriene type 1 receptor antagonist. After discontinuation of montelukast therapy and administration of systemic corticosteroids the patient's symptoms reversed rapidly and there was prompt resolution of the pulmonary infiltrates. We believe that cysteinyl leukotriene type 1 receptor antagonists are safe and effective drugs for most patients with asthma but caution is needed for those with more severe disease who require systemic corticosteroids, especially if they show characteristics of the atypical allergic diathesis seen in the prodromal phase of Churg-Strauss syndrome.

Topics: Acetates; Adult; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Fever; Humans; Leukotriene Antagonists; Male; Pulmonary Eosinophilia; Quinolines; Respiratory Sounds; Sulfides

Zafirlukast, montelukast and pranlukast are all cysteinyl leukotriene receptor antagonists that have recently been approved for the treatment of asthma. Within 6 months of zafirlukast being made available on the market, 8 patients who received the agent for moderate to severe asthma developed eosinophilia, pulmonary infiltrates, cardiomyopathy and other signs of vasculitis; the syndrome that these patients developed was characteristic of the Churg-Strauss syndrome. All of the patients had discontinued systemic corticosteroid use within 3 months of presentation and all developed the syndrome within 4 months of zafirlukast initiation. The syndrome dramatically improved in each patient upon reinitiation of corticosteroid therapy. Since the initial report, there have been multiple similar cases reported to the relevant pharmaceutical companies and to federal drug regulatory agencies in association with zafirlukast as well as with pranlukast, montelukast, and with use of high doses of inhaled corticosteroids, thus leading to an increased incidence rate of the Churg-Strauss syndrome. Many potential mechanisms for the association between these drugs and the Churg-Strauss syndrome have been postulated including: increased syndrome reporting due to bias; potential for allergic drug reaction; and leukotriene imbalance resulting from leukotriene receptor blockade. However, careful analysis of all reported cases suggests that the Churg-Strauss syndrome develops primarily in those patients taking these asthma medications who had an underlying eosinophilic disorder that was being masked by corticosteroid treatment and unmasked by novel asthma medication-mediated corticosteroid withdrawal, similar to the forme fruste of the Churg-Strauss syndrome. It remains unclear what the exact mechanism for this syndrome is and whether this represents an absolute increase in cases of vasculitis, but it appears that none of the asthma medications implicated in leading to the development of Churg-Strauss syndrome was directly causative of the syndrome. These agents remain well tolerated and effective medications for the treatment of asthma, although physicians must be wary for the signs and symptoms of the Churg-Strauss syndrome, particularly in patients with moderate to severe asthma in whom corticosteroids are tapered.

Topics: Acetates; Adrenal Cortex Hormones; Asthma; Chromones; Churg-Strauss Syndrome; Cyclopropanes; Eosinophils; Female; Humans; Indoles; Leukotriene Antagonists; Leukotrienes; Middle Aged; Phenylcarbamates; Quinolines; Sulfides; Sulfonamides; Tosyl Compounds