Macrolide-induced Churg-Strauss syndrome in patient with atopy

Hübner, C; López, Ana María Bringas; Stremmel, W; Stiehl, A.; Andmssy, K

doi:10.1016/s0140-6736(05)63985-2

Cited by 4 publications

(3 citation statements)

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“…Mild elevations of liver enzymes (0.3 to 1.7%) and transient neutropenia (1.5%) or neutrophilia (1.5%) have been documented (11). Significant hepatotoxicity (e.g., hypersensitivity hepatitis, cholestasis) is rare (4, 15), as are anaphylaxis, pseudomembranous colitis, erythema multiforme, and Churg-Strauss syndrome (12,13,22).…”

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confidence: 99%

Tolerability of Azithromycin as Malaria Prophylaxis in Adults in Northeast Papua, Indonesia

Taylor

Richie

Fryauff

et al. 2003

Antimicrob Agents Chemother

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Drug tolerability affects compliance. We evaluated the tolerability levels of azithromycin (750-mg loading dose plus 250 mg/day; n ‫؍‬ 148 subjects), doxycycline (100 mg/day; n ‫؍‬ 75), and placebo (n ‫؍‬ 77) as prophylaxis against malaria in Indonesian adults over 20 weeks. Self-reported and elicited symptoms, health perception, hearing, hematology, and biochemistry were assessed. The loading dose was well tolerated. Prolonged drug use for disease prophylaxis, treatment, or suppression should be well tolerated. This is especially true for healthy recipients of prophylaxis, such as travelers and pregnant women, for whom the risk-to-benefit ratio requires both safe and easily tolerable regimens.Azithromycin has several clinical indications that include the treatment and prophylaxis of Mycobacterium avium-M. intracellulare complex (MAC) infection and the treatment of community-acquired pneumonia and genital or ocular Chlamydia trachomatis infection (25). The standard doses of azithromycin (30 mg/kg of body weight for children and 1.5 g total dose for adults) are well tolerated. Up to 12% of patients report any symptom, Ͻ10% report gastrointestinal symptoms, and 0.7 to 1.3% discontinue therapy. Such tolerability compares favorably to that of other antibiotics (7,11,12,22). High doses of azithromycin, 1 g/kg for adults and 20 mg/kg for children, are also well tolerated (2, 16). However, doses used for MAC infections (1.2 g/week or 300 to 600 mg/day) are less well tolerated (3, 9, 10, 17). Gastrointestinal symptoms are reported by a high proportion of patients (e.g., by 71 [78.9%] of 85 recipients of weekly azithromycin, resulting in six [7%] withdrawals [17]). Hearing loss in the speech frequency range has also been reported in 13 to 17% of patients with MAC infections. It is dose dependent and recovers within 2 to 11 weeks after discontinuation of the drug (3,9,23,24). Irreversible high-frequency-hearing loss has also been reported following treatment with 750 mg of oral azithromycin in a 37-year-old woman (19). Biochemical and hematological assessments in large clinical series have been unremarkable. Mild elevations of liver enzymes (0.3 to 1.7%) and transient neutropenia (1.5%) or neutrophilia (1.5%) have been documented (11). Significant hepatotoxicity (e.g., hypersensitivity hepatitis, cholestasis) is rare (4, 15), as are anaphylaxis, pseudomembranous colitis, erythema multiforme, and Churg-Strauss syndrome (12,13,22).One trial has previously assessed azithromycin as prophylaxis against malaria. Azithromycin was administered daily (250 mg) or weekly (1 g) for 13 weeks to Kenyan adults. The reported symptoms were similar to those of placebo recipients, and there was no evidence of toxicity on routine hematological or biochemical testing (1).We report the tolerability of daily-administered azithromycin as prophylaxis against malaria in Indonesian adults. MATERIALS AND METHODSSubjects and study conduct. This double-blind, placebo-controlled trial assessed the prophylactic efficacy and tolerability of azithromycin ...

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confidence: 99%

Tolerability of Azithromycin as Malaria Prophylaxis in Adults in Northeast Papua, Indonesia

Taylor

Richie

Fryauff

et al. 2003

Antimicrob Agents Chemother

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“…A variety of studies have described the development of EGPA after treatment with different drugs such as macrolide antibiotics and particularly leukotriene receptor antagonists (LRAs) [29,30]. Different hypotheses have been proposed to explain how LRAs induce EGPA in asthmatic patients: (a) they may unmask silent forms of EGPA since their use reduces the need for corticosteroids; (b) they have a direct pathogenic role or may cause idiosyncratic allergic reactions; and (c) the association between LRAs and EGPA, although temporarily related, may simply be a coincidence, and the progression from asthma to EGPA may reflect the natural course of the disease which initially displays an allergic manifestation and subsequent eosinophilic and vasculitic complications.…”

Section: Genetic and Environmental Factorsmentioning

confidence: 99%

Churg-Strauss Syndrome or Eosinophilic Granulomatosis with Polyangiitis

et al. 2015

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Eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA) is a systemic small-to-medium-sized vasculitis associated with asthma and eosinophilia. Histologically EGPA presents tissue eosinophilia, necrotizing vasculitis, and granulomatous inflammation with eosinophil tissue infiltration. EGPA commonly involves the upper airway and lung parenchyma, peripheral neuropathy, cardiac disorders, and skin lesions. The anti-neutrophil cytoplasmic antibodies (ANCA) are positive in 40% of cases, especially in those patients with clinical signs of vasculitis. The pathogenesis of EGPA is multifactorial. The disease can be triggered by exposure to a variety of allergens and drugs, but a genetic background has also been described, particularly an association with HLA-DRB4. Th2 response is of special importance in the upregulation of different interleukins such as IL-4, IL-13, and IL-5. Th1 and Th17 responses are also of significance. Activated eosinophils have a prolonged survival and probably cause tissue damage by releasing eosinophil granule proteins, while their tissue recruitment can be regulated by chemokines such as eotaxin-3 and CCL17. Humoral immunity is also OPEN ACCESSSinusitis 2016, 1 25 abnormally regulated, as demonstrated by excessive responses of IgG4 and IgE. EGPA has a good respond to glucocorticoids, although the combination of glucocorticoids and immunosuppressants (e.g., cyclophosphamide, azathioprine) is needed in most of cases. Newer treatment options include anti-IL-5 antibodies (mepolizumab), whose efficacy has been described in clinical trials, and anti-CD-20, a B cell-depleting agent (rituximab), reported in several case series.

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“…The term leukocytoclastic vasculitis is often used interchangeably with the term small vessel or cutaneous vasculitis, e\7en though biopsy reveals that not all examples of a cutaneous small vessel vasculitis are leukocytoclastic.' The C H C C identifies Schonlein-Henoch purpura (SHP), essential cryoglobulinaemic vasculitis and cutaneous leukocytoclastic angiitis as three distinct entities and presumably considers that the vast majority of cases would fall into the 67 latter heterogenous category.' The nosology of small vessel vasculitis is, in addition, confused by the fact that on occasions the cause is quite clearly apparent.…”

Section: Small Vessel Vasculitismentioning

confidence: 99%

Vasculitis ‐ diagnosis and treatment

Gatenby

1999

Australian and New Zealand Journal of Medicine

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Macrolide-induced Churg-Strauss syndrome in patient with atopy

Cited by 4 publications

References 5 publications

Tolerability of Azithromycin as Malaria Prophylaxis in Adults in Northeast Papua, Indonesia

Tolerability of Azithromycin as Malaria Prophylaxis in Adults in Northeast Papua, Indonesia

Churg-Strauss Syndrome or Eosinophilic Granulomatosis with Polyangiitis

Vasculitis ‐ diagnosis and treatment

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