Article Text

other Versions


The leukotriene-receptor antagonist montelukast and the risk of Churg-Strauss syndrome: a case-crossover study
  1. Thomas Hauser (thomas.hauser{at}
  1. Hôpital Cochin, Université Paris 5, Paris, France
    1. Alfred Mahr (amahr{at}
    1. Hôpital Cochin, Université Paris 5, Paris, France
      1. Claudia Metzler (claudia.metzler{at}
      1. Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
        1. Joel Coste (coste{at}
        1. Hôpital Cochin, UniversitéParis 5, Paris, France
          1. Rami Sommerstein (rami.sommerstein{at}
          1. University Hospital Zurich, Switzerland
            1. Wolfgang L Gross (gross{at}
            1. Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
              1. Loic Guillevin (loic.guillevin{at}
              1. Hôpital Cochin, Université Paris 5, Paris, France
                1. Bernhard Hellmich (hellmich{at}
                1. Universitätsklinikum Schleswig-Holstein, Lübeck, Germany


                  Background: There has been some concern that leukotriene-receptor antagonists might precipitate the onset of Churg-Strauss syndrome (CSS). Objective: To investigate the relationship between the leukotriene-receptor antagonist montelukast and CSS onset.

                  Methods: Medication histories of 78 CSS patients from France and Germany were retraced by questioning the patients, treating physicians and dispensing pharmacists, and from medical records. Using a case-crossover research design, we compared exposures to montelukast and other asthma medications during the 3-month 'index' period immediately preceding CSS onset with those of 4 previous 3-month 'control' periods. Odds ratios (OR) were computed by conditional logistic regression.

                  Results: OR (95% CI) for CSS onset were 4.5 (1.5-13.9) for montelukast, 3.0 (0.8-10.5) for inhaled long-acting β2-agonists, 1.7 (0.5-5.4) for inhaled corticosteroids and 4.0 (1.3–12.5) for oral corticosteroids. Montelukast exposure during control periods increased temporally over 3 consecutive calendar periods of CSS onset from 1999 to 2003 (Ptrend <.0001).

                  Conclusion: Montelukast use was associated with a 4.5-fold higher risk of CSS onset within 3 months. However, the positive estimates obtained for other long-term asthma-control medications suggest that this link is confounded by a general escalation of asthma therapy before CSS onset. The montelukast-CSS association observed herein is likely also explained by the increasing use of this medication over time.

                  • Churg–Strauss syndrome
                  • asthma
                  • leukotriene-receptor antagonists
                  • montelukast
                  • pharmacoepidemiology

                  Statistics from

                  Request Permissions

                  If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.