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June 24, 1998

Zafirlukast and Churg-Strauss Syndrome

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(24):1949-1950. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-24-jac80011

To the Editor.—The article by Dr Wechsler and colleagues1addresses the surprise development of an eosinophilic vasculitis (Churg-Strauss syndrome). The authors suspect that these patients had a primary eosinophilic infiltrate disorder that was masked by steroid treatment and was unmasked when steroids were withdrawn.

I believe there is a more plausible explanation. We have seen this syndrome develop in patients who have been treated with zafirlukast, a leukotriene (LT) type 1 receptor antagonist. However, this syndrome has not yet been seen in patients treated with zileuton, a drug that inhibits LT production by blocking 5-lipoxygenase. The LT type 1 receptor antagonists such as zafirlukast do not oppose the action of LTB4. The 5-lipoxygenase–inhibiting drugs inhibit LTB4, LTC4, LTD4, and LTE4. Leukotriene B4has been shown to be a chemoattractant for eosinophils and neutrophils.2

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