Introduction: Churg-Strauss syndrome (CSS) is a rare, systemic, necrotizing, small- and middle-sized vessel vasculitis which is accompanied by blood eosinophilia, eosinophil infiltration of various tissues and bronchial asthma. Leukotriene receptor antagonists (LTRAs) may participate in the pathogenesis of the disease.
Aim of the study: The aim of this study was a retrospective evaluation of the influence of LTRAs on the development of CSS and its later course.
Patients and methods: Hospital charts of 24 patients from the southern Poland region with diagnosed CSS between 1999-2010 were retrospectively analyzed. Additional questionnaire concerning the LTRAs treatment was obtained from all patients. The diagnosis of the disease was reassessed and confirmed with the current guidelines.
Results: In the studied group, before the development of CSS, 16 patients (66.7%) used LTRAs--namely montelukast. The average time from the beginning of treatment to the development of CSS symptoms was 14 months. Tapering down corticosteroid treatment was not observed. Patients treated with montelukast at the time of diagnosis had higher blood eosinopilia (7254 vs 2105, p<0.05), and more common nasal polyposis (68.75% vs 12.5%, p<0.05) with a need for polipectomy (62.5% vs 0%, p<0.05) when compared to patients not receiving the drug. Also the course of the disease was more severe in the LTRAs treated patients: more common exacerbations (5.93 vs 1.62, p<0.01) with the need for hospitalizations (1.6 vs 0.36/year, p<0.001) and need for higher base corticosteroids doses (9.75 vs 5 mg, p<0.05) and additional immunosuppressive therapy (81.25% vs 50%, p>0.05) to maintain the disease remission.
Conclusions: Patients receiving LTRAs before diagnosis of CSS had more severe course of the disease. Prescribing LTRAs for patients with asthma accompanied by nasal polyposis, and high blood eosinophilia needs special precautions. Further studies on the influence of LTRAs on CSS are needed.