BACKGROUND: Churg-Strauss syndrome (CSS) is a rare granulomatous small vessel vasculitis that occurs against a background of longstanding asthma. Leukotriene antagonists (LTAs) are used in the management of asthma and may facilitate a reduction in steroid dosage. Reports of the development of CSS in patients with asthma following the initiation of LTA therapy suggest either a causal association or an unmasking of latent CSS as steroid doses fall. We have undertaken a systematic review to establish whether evidence of a drug induced syndrome exists. METHODS: Systematic review searching Medline from database inception to August 2007 to identify cases with a possible association between LTAs and CSS. Hill's criteria of causation were used to assess strength of causality. RESULTS: 62 cases in which CSS developed after the introduction of LTA therapy were identified. Patients were divided into three groups: group 1 had received no previous steroid therapy; group 2 had been treated with oral and/or inhaled corticosteroids, but had no change in steroid therapy following LTA introduction; and group 3 had a clear reduction in steroid therapy following introduction of LTA therapy. The majority of patients from each group exhibited a clear temporal relationship between initiation of LTA and development of CSS, with no evidence of pre-existing disease. CONCLUSIONS: Currently available evidence suggests an association between LTA and CSS that may be causal.
BACKGROUND:Churg-Strauss syndrome (CSS) is a rare granulomatous small vessel vasculitis that occurs against a background of longstanding asthma. Leukotriene antagonists (LTAs) are used in the management of asthma and may facilitate a reduction in steroid dosage. Reports of the development of CSS in patients with asthma following the initiation of LTA therapy suggest either a causal association or an unmasking of latent CSS as steroid doses fall. We have undertaken a systematic review to establish whether evidence of a drug induced syndrome exists. METHODS: Systematic review searching Medline from database inception to August 2007 to identify cases with a possible association between LTAs and CSS. Hill's criteria of causation were used to assess strength of causality. RESULTS: 62 cases in which CSS developed after the introduction of LTA therapy were identified. Patients were divided into three groups: group 1 had received no previous steroid therapy; group 2 had been treated with oral and/or inhaled corticosteroids, but had no change in steroid therapy following LTA introduction; and group 3 had a clear reduction in steroid therapy following introduction of LTA therapy. The majority of patients from each group exhibited a clear temporal relationship between initiation of LTA and development of CSS, with no evidence of pre-existing disease. CONCLUSIONS: Currently available evidence suggests an association between LTA and CSS that may be causal.
Authors: Zachary M Dong; Edwin Lin; Michael E Wechsler; Peter F Weller; Amy D Klion; Bruce S Bochner; Don A Delker; Mark W Hazel; Keke Fairfax; Paneez Khoury; Praveen Akuthota; Peter A Merkel; Anne-Marie Dyer; Carol Langford; Ulrich Specks; Gerald J Gleich; Vernon M Chinchilli; Benjamin Raby; Mark Yandell; Frederic Clayton Journal: Am J Pathol Date: 2020-04-03 Impact factor: 4.307
Authors: Scott R Henderson; Anand Shah; Susan J Copley; H Terence Cook; C D Pusey; Alan D Salama; Philip W Ind Journal: Thorax Date: 2015-12-23 Impact factor: 9.139
Authors: Salomi Paul; Shreyas Yakkali; Sneha Teresa Selvin; Sonu Thomas; Viktoriya Bikeyeva; Ahmed Abdullah; Aleksandra Radivojevic; Anas A Abu Jad; Anvesh Ravanavena; Chetna Ravindra; Emmanuelar O Igweonu-Nwakile; Safina Ali; Pousette Hamid Journal: Cureus Date: 2022-08-14