The case report by Tuggey and Hosker1 is similar to many of the cases of Churg-Strauss syndrome (CSS) which we have reported in association with zafirlukast,2 montelukast, and fluticasone/salmeterol.3 It also shares many similarities with the reports of CSS with inhaled steroid monotherapy.4 ,5

While a temporal relationship with the use of leukotriene modifiers is being reported with increased frequency in association with CSS, a review of this case and others in the literature does not suggest a direct causal relationship with the leukotriene modifiers. Rather, two probable mechanisms seem to predominate. In …