Difficult asthma or Churg-Strauss syndrome?

Inhaled corticosteroids and Churg-Strauss syndrome: a report of five cases

“…Interestingly, similar cases have been described with other medications in the past, emphasizing the fact that Churg-Strauss syndrome may be the mere consequence of corticosteroid withdrawal (or avoidance) in patients with an underlying vasculitis using an otherwise effective asthma drug [10,15]. Indeed, the number of asthmatic people at risk of developing Churg-Strauss syndrome after the introduction of corticosteroid-sparing drugs is substantial, and physicians should monitor patients carefully when such therapies are prescribed, especially in patients with a history of severe asthma, eosinophilia, and sinusitis [15].…”

Clinical safety and tolerability of montelukast, a leukotriene receptor antagonist, in controlled clinical trials in patients aged ≥ 6 years

“…CSS, or allergic granulomatous vasculitis, has been reported in association with zafirlukast treatment in at least 11 patients [22–24]. CSS has also been reported in at least one patient following the introduction of fluticasone [25], as well as in montelukast post‐marketing surveillance [15]. Post‐marketing reports of CSS with multiple different anti‐asthma therapies makes any mechanism–based association with a single drug or class of drugs less likely [15].…”

Churg-Strauss syndrome associated with montelukast therapy

“…In many cases this has been linked with the withdrawal of oral corticosteroids and previous authors have speculated that the Churg-Strauss syndrome was unmasked when oral steroids were withdrawn following the successful introduction of leukotriene receptor antagonists 27 8 In other reports Churg-Strauss syndrome has been associated with zafirlukast and there has been no association with withdrawal of corticosteroids 34 The Committee on Safety of Medicines (CSM) has received 12 reports of Churg-Strauss syndrome and one of pulmonary eosinophilia possibly associated with montelukast.…”