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Communications to the Editor |

Follow-up in Montelukast Treatment Follow-up in Montelukast Treatment FREE TO VIEW

Gerald N. Cohen, MD, FCCP
Author and Funding Information

Affiliations: St. Francis Hospital Evanston, IL,  Brigham and Women’s Hospital Harvard Medical School Boston, MA

Correspondence to: Gerald N. Cohen, MD, FCCP, Chief, Section of Allergy, Department of Medicine, St. Francis Hospital, 335 Ridge Ave, Evanston, IL 60202



Chest. 2000;118(4):1228-1229. doi:10.1378/chest.118.4.1228
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To the Editor:

Regarding the very interesting article,“ Churg-Strauss Syndrome in Patients Receiving Montelukast as Treatment for Asthma” (March 2000),1 the findings do point to this syndrome.

I would like to know why a more involved workup was not performed in these and other referenced patients? I would suggest: (1) any atopic nature in all these patients could be involved; (2) workup for parasitic diseases; and (3) aspirin intolerance syndrome investigation.

I look forward for the authors’ comments.

Wechsler, ME, Finn, D, Gunawardena, D, et al (2000) Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma.Chest117,708-713. [CrossRef] [PubMed]
 

Follow-up in Montelukast Treatment

To the Editor:

Thank you for allowing us the opportunity to reply to the letter of Dr. Cohen in response to our article about the occurrence of Churg-Strauss syndrome in patients receiving montelukast. While Dr. Cohen agrees with our findings, he raises some interesting questions about further workup that could be undertaken in such patients. While such details were beyond the scope of our series, several of our patients did receive such an extensive workup. In fact, all of these patients had a history of atopy, although not all had skin tests to document such. We also agree that physicians should explore for other eosinophilic conditions in addition to the Churg-Strauss syndrome. Dr. Cohen raises the specter of the potential for parasitic disease and aspirin intolerance, but other vasculitides, as well as drug reactions, eosinophilic pneumonia, idiopathic eosinophilia, and malignancy, are some of the diagnoses that should be entertained when a physician encounters a patient with the triad of airway obstruction, eosinophilia, and systemic disease. While some patients may require lung biopsy, diagnosis can often be made by clinical criteria alone. It is best to tailor the workup for each patient on an individual basis, but a workup to establish the diagnosis with certainty is usually appropriate.


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References

Wechsler, ME, Finn, D, Gunawardena, D, et al (2000) Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma.Chest117,708-713. [CrossRef] [PubMed]
 
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