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Pediatrics International (2014) 56, 802
doi: 10.1111/ped.12459
Letter to the Editor
Leukotriene receptor antagonists in Henoch–Schönlein syndrome: Friends or foes? Pietro Camozzi,1 Gregorio Paolo Milani2 and Mario Giovanni Bianchetti1 1 Pediatric Department of Southern Switzerland, Bellinzona, Switzerland and 2Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
Henoch–Schönlein syndrome is a systemic small-vessel vasculitis that primarily affects children between the ages of 3 and 15 years, with an estimated annual incidence of approximately 20 per 100 000 in children aged ≤17 years, and a peak incidence of 70 per 100 000 in children between the ages of 4 and 6 years.1 There is a male predominance, with reported male : female ratios of 1.5:1.0–2.0:1.0. The disease is seen less frequently in black compared to white or Asian children. The disease is characterized by a tetrad of clinical manifestations including palpable purpura, arthritis–arthralgia, abdominal pain and renal disease.1 Very recently, add-on therapy with the leukotriene receptor antagonist montelukast significantly alleviated the signs of vasculitis such as purpura, abdominalgia, hematochezia, arthritis, proteinuria and hematuria in Chinese children.2 The study was well designed and the results promising. Surprisingly, the authors Correspondence: Mario G. Bianchetti, MD, Ospedale San Giovanni, 6500 Bellinzona, Switzerland. Email: mario.bianchetti@pediatrician .ch The authors have no financial relationships relevant to this article, or conflicts of interest, to disclose. Received 25 June 2014; accepted 15 July 2014.
© 2014 Japan Pediatric Society
of that report failed to mention that treatment with montelukast has been reported to cause Churg–Strauss syndrome, a severe small-vessel vasculitis.3 More importantly, treatment with montelukast was followed by Henoch–Schönlein syndrome in a 20-year-old Indian man.4 Most pediatric cases of Henoch–Schönlein syndrome follow an acute respiratory infection with onset an average of 10 days after the start of respiratory symptoms.1 Despite this wellrecognized causal link, the possible occurrence of vasculitides associated with montelukast should be kept in mind.
References 1 Trnka P. Henoch-Schönlein purpura in children. J. Paediatr. Child Health 2013; 49: 995–1003. 2 Wu SH, Liao PY, Chen XQ, Yin PL, Dong L. Add-on therapy with montelukast in the treatment of Henoch–Schönlein purpura. Pediatr. Int. 2014; 56: 315–22. 3 Hauser T, Mahr A, Metzler C et al. The leucotriene receptor antagonist montelukast and the risk of Churg-Strauss syndrome: A casecrossover study. Thorax 2008; 63: 677–82. 4 Khanna S, Uniyal B, Kumar D, Vij J. Henoch-Schönlein purpura probably due to montelukast presenting as subacute intestinal obstruction. Indian J. Gastroenterol. 2005; 24: 86.
Pediatrics International (2014) 56, 802
doi: 10.1111/ped.12459
Letter to the Editor
Leukotriene receptor antagonists in Henoch–Schönlein syndrome: Friends or foes? Pietro Camozzi,1 Gregorio Paolo Milani2 and Mario Giovanni Bianchetti1 1 Pediatric Department of Southern Switzerland, Bellinzona, Switzerland and 2Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
Henoch–Schönlein syndrome is a systemic small-vessel vasculitis that primarily affects children between the ages of 3 and 15 years, with an estimated annual incidence of approximately 20 per 100 000 in children aged ≤17 years, and a peak incidence of 70 per 100 000 in children between the ages of 4 and 6 years.1 There is a male predominance, with reported male : female ratios of 1.5:1.0–2.0:1.0. The disease is seen less frequently in black compared to white or Asian children. The disease is characterized by a tetrad of clinical manifestations including palpable purpura, arthritis–arthralgia, abdominal pain and renal disease.1 Very recently, add-on therapy with the leukotriene receptor antagonist montelukast significantly alleviated the signs of vasculitis such as purpura, abdominalgia, hematochezia, arthritis, proteinuria and hematuria in Chinese children.2 The study was well designed and the results promising. Surprisingly, the authors Correspondence: Mario G. Bianchetti, MD, Ospedale San Giovanni, 6500 Bellinzona, Switzerland. Email: mario.bianchetti@pediatrician .ch The authors have no financial relationships relevant to this article, or conflicts of interest, to disclose. Received 25 June 2014; accepted 15 July 2014.
© 2014 Japan Pediatric Society
of that report failed to mention that treatment with montelukast has been reported to cause Churg–Strauss syndrome, a severe small-vessel vasculitis.3 More importantly, treatment with montelukast was followed by Henoch–Schönlein syndrome in a 20-year-old Indian man.4 Most pediatric cases of Henoch–Schönlein syndrome follow an acute respiratory infection with onset an average of 10 days after the start of respiratory symptoms.1 Despite this wellrecognized causal link, the possible occurrence of vasculitides associated with montelukast should be kept in mind.
References 1 Trnka P. Henoch-Schönlein purpura in children. J. Paediatr. Child Health 2013; 49: 995–1003. 2 Wu SH, Liao PY, Chen XQ, Yin PL, Dong L. Add-on therapy with montelukast in the treatment of Henoch–Schönlein purpura. Pediatr. Int. 2014; 56: 315–22. 3 Hauser T, Mahr A, Metzler C et al. The leucotriene receptor antagonist montelukast and the risk of Churg-Strauss syndrome: A casecrossover study. Thorax 2008; 63: 677–82. 4 Khanna S, Uniyal B, Kumar D, Vij J. Henoch-Schönlein purpura probably due to montelukast presenting as subacute intestinal obstruction. Indian J. Gastroenterol. 2005; 24: 86.
