Guilpain Philippe, Pagnoux Christian, Lhote François, Mouthon Luc, Guillevin Loïc
Service de médecine interne, AP-HP, Hôpital Cochin, Université Paris V, Paris, France.
Presse Med. 2007 May;36(5 Pt 2):890-4. doi: 10.1016/j.lpm.2007.01.034. Epub 2007 Mar 23.
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.
变应性肉芽肿性血管炎是一种累及中小血管的系统性坏死性血管炎。典型特征包括哮喘和嗜酸性粒细胞增多。约40%的患者可检测到抗中性粒细胞胞浆抗体(ANCA)。在接受白三烯调节剂治疗哮喘的患者中,尤其是白三烯受体拮抗剂(LTRA)(孟鲁司特、扎鲁司特或普仑司特)治疗的患者中,已有变应性肉芽肿性血管炎的报道。这些病例的临床表现与未接触抗白三烯药物的变应性肉芽肿性血管炎患者并无不同。尽管这一假说尚未被完全排除,但在这些患者中,LTRA越来越不太可能是该综合征的直接病因。在许多患者中,由于哮喘恶化(变应性肉芽肿性血管炎的早期迹象)而开具LTRA治疗。对于哮喘患者,应谨慎开具LTRA,尤其是在非典型或快速加重哮喘的情况下。接受LTRA治疗的患者发生变应性肉芽肿性血管炎通常需要停用该治疗。对于变应性肉芽肿性血管炎患者开具LTRA应与专科医生讨论。