Marked Peripheral Edema Associated with Montelukast and Prednisone

Mario Geller

doi:10.7326/0003-4819-132-11-200006060-00022

Letters |6 June 2000

Marked Peripheral Edema Associated with Montelukast and Prednisone

Mario Geller, MD

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TO THE EDITOR:

Cysteinyl leukotriene-receptor antagonists are new drugs for the treatment of persistent asthma (1). They may be used as alternatives to corticosteroids or adjuncts to corticosteroids in some patients with asthma. They are available orally and provide safe and effective therapy as long as compliance is good (2).

A 23-year-old man with persistent severe perennial allergic asthma and rhinoconjunctivitis was evaluated for acute respiratory symptoms. He also had exercise-induced asthma and was sensitive to house dust mites, Dermatophagoides pteronyssinus, D. farinae, and Blomia tropicalis. From age 1 to 7 years, he had minimal-change nephrotic syndrome that completely resolved without sequelae. At presentation, renal function and findings on cardiovascular examination were normal. The patient was treated with oral metered-dose inhalers that delivered salmeterol, fluticasone propionate (2000 µg/d), oral cetirizine (10 mg), and, for 1 week, a prednisone burst of 40 mg/d (in divided doses); this dosage was followed by 20 mg every morning for another week. When oral prednisone therapy was stopped, severe asthma recurrences required additional prednisone bursts of 60 mg/d (in divided doses) for 1 week followed by 40 mg/d for another week. The patient was also given oral montelukast, 10 mg/d, at night. A chest radiograph was normal, and results of Aspergillus fumigatus skin testing were negative.

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2000 American College of Physicians

Letters |6 June 2000

Marked Peripheral Edema Associated with Montelukast and Prednisone

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Letters |6 June 2000

Marked Peripheral Edema Associated with Montelukast and Prednisone

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