Reactions 893 - 16 Mar 2002

Antiasthmatics: unmaskingsymptoms of Churg-Strauss

syndrome?An increasing number of cases of Churg-Strauss

syndrome (CSS) are being reported in patients with ahistory of moderate or severe asthma, followingmodification or discontinuation of corticosteroidtherapy, according to Dr Craig Lilly and colleagues fromthe US and Canada.

They reviewed the literature and analysed individualcases to assess the role of leukotriene modifiers andinhaled and oral corticosteroids in the emergence ofCSS. Leukotriene modifiers, such as montelukast,pranlukast and zafirlukast, and inhaled corticosteroidshave been implicated in the onset of CSS in patients withlong histories of asthma. However, Dr Lilly andcolleagues found no evidence to suggest thatleukotriene modifiers were causative agents in CSS.

A review of 4 selected cases of CSS associated withinhaled corticosteroids, zafirlukast or montelukastrevealed that, in all cases, the onset of CSS waspreceded by a reduction or withdrawal of oralcorticosteroids. Dr Lilly and colleagues suggest that theuse of high potency inhaled corticosteroids andleukotriene modifiers, and the subsequent reduction ordiscontinuation of oral corticosteroids, has unmaskedunderlying formes frustes CSS in some patients. In suchpatients, the symptoms of CSS may be inadvertentlysuppressed by corticosteroids.

Dr Lilly and colleagues say that the use of inhaledcorticosteroids and leukotriene modifiers, and theavoidance of oral corticosteroids, may permit CSS toprogress to vasculitis in some patients before diagnosis.They say that some patients may be treated withincreasing doses of inhaled corticosteroids orleukotriene modifiers for what is perceived to be severeasthma, but is in fact incipient CCS.Lilly CM, et al. Asthma therapies and Churg-Strauss syndrome. Journal of Allergyand Clinical Immunology 109: 1-20, Jan 2002 800900122

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Reactions 16 Mar 2002 No. 8930114-9954/10/0893-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved