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We read the review of Churg-Strauss syndrome (CSS) by Conron and Beynon1 with interest. The studies they quote are all reported from tertiary or national referral centres with inevitable referral bias. We have published our experience of 23 patients with CSS2—the only study from a district general hospital which may be more representative of the natural history of this systemic vasculitis in the general population. The mean age of onset was 57 years, significantly older than the 40 years reported in patients from tertiary centres and quoted by Conron and Beynon. We found there was a slight male preponderance (65%), also shown in many previous studies. The commonest sites of extrarespiratory involvement were, in descending frequency, the nervous system, joints and muscles, kidneys, skin, heart, and gastrointestinal tract. Involvement of the gastrointestinal tract occurred in only 30% and abdominal pain was uncommon. Cardiac involvement occurred in 44% and was the cause of death in two. Renal involvement, although occurring in nearly half the patients, was usually mild and none had severe renal failure.
The mean age of onset of asthma was 50 years and, although not reported, the asthma was not usually troublesome or severe when the systemic vasculitis developed. Indeed, very few patients were on oral steroids for their asthma at that time. Very rarely, patients present with CSS who do not have asthma. In our series there was one such patient who satisfied the original histological features of Churg and Strauss.
We found that the criteria developed by Lanhamet al 3 were the most useful, particularly an eosinophil count of ⩾1.5 × 109/l. While this is arbitrary, only one of our patients had a level below this and that was 1.4 × 109/l.
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