Churg-Strauss Disease Treatment & Management

  • Author: Robert Stanley Rust Jr, MD, MA; Chief Editor: Amy Kao, MD   more...
 
Updated: Jan 20, 2010
 

Medical Care

Medical management of cardiovascular, cardiac, renal, and gastrointestinal complications of Churg-Strauss disease falls under the purview of subspecialty consultation. Drugs used in the treatment of Churg-Strauss disease are described in Medication.

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Surgical Care

  • Surgical procedures in patients with Churg-Strauss disease most commonly entail biopsy of affected tissues.
  • In addition, surgical intervention may be indicated in patients who experience catastrophic complications, such as acute abdomen or intracranial hemorrhage.
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Consultations

  • Consultations for patients with Churg-Strauss disease depend on the manifestations of the disease. The cardiopulmonary manifestations typically are most important. Consultations with the following may be required:
    • Pulmonologist
    • Cardiologist
    • Rheumatologist
    • Gastroenterologist
    • Urologist
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Diet

No dietary factors are clearly known to assist in the management of Churg-Strauss disease, except as are related to the management of congestive heart failure, renal failure, or gastrointestinal complications. The management of these factors falls under the purview of subspecialists involved in the care of these organ systems.

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Activity

No clear evidence suggests that particular activities influence the course of the illness once it is established. Environmental exposures and medical treatment of asthma that may influence the chances for development of Churg-Strauss disease are discussed in Causes.

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Contributor Information and Disclosures
Author

Robert Stanley Rust Jr, MD, MA  Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Baumann, MD  Professor of Neurology and Pediatrics, Department of Neurology, University of Kentucky College of Medicine

Robert J Baumann, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Kenneth J Mack, MD, PhD  Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Ortho McNeil Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Speaking, consulting

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center, Washington DC

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

References

  1. Davies DJ, Moran JE. Segmental necrotizing glomerulonephritis with antineutrophil antibody: possible arbovirus aetiology?. BMJ. 1982;285:606.

  2. Churg J, Strauss L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol. Mar-Apr 1951;27(2):277-301. [Medline].

  3. Chumbley LC, Harrison EG Jr, DeRemee RA. Allergic granulomatosis and angiitis (Churg-Strauss syndrome). Report and analysis of 30 cases. Mayo Clin Proc. Aug 1977;52(8):477-84. [Medline].

  4. Lanham JG. Churg-Strauss syndrome. Br J Hosp Med. May 6-19 1992;47(9):667-73. [Medline].

  5. Masi AT, Hunder GG, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum. Aug 1990;33(8):1094-100. [Medline].

  6. Jennette JC, Falk RJ, Andrassy K, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. Feb 1994;37(2):187-92. [Medline].

  7. Lie JT. Nomenclature and classification of vasculitis: plus ça change, plus c'est la même chose. Arthritis Rheum. Feb 1994;37(2):181-6. [Medline].

  8. Kallenberg CG, Brouwer E, Weening JJ, Tervaert JW. Anti-neutrophil cytoplasmic antibodies: current diagnostic and pathophysiological potential. Kidney Int. Jul 1994;46(1):1-15. [Medline].

  9. Cohen P, Guillevin L, Baril L, Lhote F, Noel LH, Lesavre P. Persistence of antineutrophil cytoplasmic antibodies (ANCA) in asymptomatic patients with systemic polyarteritis nodosa or Churg-Strauss syndrome: follow-up of 53 patients. Clin Exp Rheumatol. Mar-Apr 1995;13(2):193-8. [Medline].

  10. Tervaert JW, Goldschmeding R, Elema JD, von dem Borne AE, Kallenberg CG. Antimyeloperoxidase antibodies in the Churg-Strauss syndrome. Thorax. Jan 1991;46(1):70-1. [Medline].

  11. Tervaert JW, Goldschmeding R, Elema JD, et al. Association of autoantibodies to myeloperoxidase with different forms of vasculitis. Arthritis Rheum. Aug 1990;33(8):1264-72. [Medline].

  12. Watts RA, Scott DG. Classification and epidemiology of the vasculitides. Baillieres Clin Rheumatol. May 1997;11(2):191-217. [Medline].

  13. Capizzi SA, Specks U. Does infection play a role in the pathogenesis of pulmonary vasculitis?. Semin Respir Infect. Mar 2003;18(1):17-22. [Medline].

  14. Wiik A. Autoantibodies in vasculitis. Arthritis Res Ther. 2003;5(3):147-52. [Medline].

  15. Arm JP, Lee TH. Sulphidopeptide leukotrienes in asthma. Clin Sci (Lond). May 1993;84(5):501-10. [Medline].

  16. Drazen JM, Israel E. Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? Yes. Am J Respir Crit Care Med. Dec 1998;158(6):1697-8. [Medline].

  17. Drazen JM, Israel E, O'Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med. Jan 21 1999;340(3):197-206. [Medline].

  18. Wechsler ME, Garpestad E, Flier SR, et al. Pulmonary infiltrates, eosinophilia, and cardiomyopathy following corticosteroid withdrawal in patients with asthma receiving zafirlukast. JAMA. Feb 11 1998;279(6):455-7. [Medline].

  19. Churg A, Brallas M, Cronin SR, Churg J. Formes frustes of Churg-Strauss syndrome. Chest. Aug 1995;108(2):320-3. [Medline].

  20. D'Cruz DP, Barnes NC, Lockwood CM. Difficult asthma or Churg-Strauss syndrome?. BMJ. Feb 20 1999;318(7182):475-6. [Medline].

  21. Garcia-Marcos L, Schuster A, Perez-Yarza EG. Benefit-risk assessment of antileukotrienes in the management of asthma. Drug Saf. 2003;26(7):483-518. [Medline].

  22. Kemp JP. Recent advances in the management of asthma using leukotriene modifiers. Am J Respir Med. 2003;2(2):139-56. [Medline].

  23. Finkel TH, Hunter DJ, Paisley JE, Finkel RS, Larsen GL. Drug-induced lupus in a child after treatment with zafirlukast (Accolate). J Allergy Clin Immunol. Mar 1999;103(3 Pt 1):533-4. [Medline].

  24. Haim DY, Lippmann ML, Goldberg SK, Walkenstein MD. The pulmonary complications of crack cocaine. A comprehensive review. Chest. Jan 1995;107(1):233-40. [Medline].

  25. Orriols R, Munoz X, Ferrer J, Huget P, Morell F. Cocaine-induced Churg-Strauss vasculitis. Eur Respir J. Jan 1996;9(1):175-7. [Medline].

  26. Guillevin L, Cohen P, Gayraud M, Lhote F, Jarrousse B, Casassus P. Churg-Strauss syndrome. Clinical study and long-term follow-up of 96 patients. Medicine (Baltimore). Jan 1999;78(1):26-37. [Medline].

  27. Shanks M, Ignaszewski AP, Chan SY, Allard MF. Churg-Strauss syndrome with myocarditis manifesting as acute myocardial infarction with cardiogenic shock: case report and review of the literature. Can J Cardiol. Sep 2003;19(10):1184-8. [Medline].

  28. Tatsukawa H, Nagano S, Umeno Y, Oribe M. Churg-strauss syndrome with cholecystitis and renal involvement. Intern Med. Sep 2003;42(9):893-6. [Medline].

  29. Lane SE, Watts R, Scott DG. Epidemiology of systemic vasculitis. Curr Rheumatol Rep. Aug 2005;7(4):270-5. [Medline].

  30. Booth AD, Almond MK, Burns A, et al. Outcome of ANCA-associated renal vasculitis: a 5-year retrospective study. Am J Kidney Dis. Apr 2003;41(4):776-84. [Medline].

  31. Kawakami T, Soma Y, Kawasaki K, Kawase A, Mizoguchi M. Initial cutaneous manifestations consistent with mononeuropathy multiplex in Churg-Strauss syndrome. Arch Dermatol. Jul 2005;141(7):873-8. [Medline].

  32. Sharma BK, Daga MK, Sharma M. A limited form of Churg-Strauss syndrome presenting without asthma and eosinophilia. Med J Aust. Nov 1 2004;181(9):498-9. [Medline].

  33. Abril A, Calamia KT, Cohen MD. The Churg Strauss syndrome (allergic granulomatous angiitis): review and update. Semin Arthritis Rheum. Oct 2003;33(2):106-14. [Medline].

  34. Azzopardi C, Montefort S, Mallia C. Cardiac involvement and left ventricular failure in a patient with the Churg-Strauss syndrome. Adv Exp Med Biol. 1999;455:547-9. [Medline].

  35. Barry C, Davis S, Garrard P, Ferguson IT. Churg-Strauss disease: deterioration in a twin pregnancy. Successful outcome following treatment with corticosteroids and cyclophosphamide. Br J Obstet Gynaecol. Jun 1997;104(6):746-7. [Medline].

  36. Berger JR, Wei T, Wilson D. Idiopathic granulomatous angiitis of the CNS manifesting as diffuse white matter disease. Neurology. Dec 1998;51(6):1774-5. [Medline].

  37. Bili A, Condemi JJ, Bottone SM, Ryan CK. Seven cases of complete and incomplete forms of Churg-Strauss syndrome not related to leukotriene receptor antagonists. J Allergy Clin Immunol. Nov 1999;104(5):1060-5. [Medline].

  38. Boggi U, Mosca M, Giulianotti PC, Naccarato AG, Bombardieri S, Mosca F. Surviving catastrophic gastrointestinal involvement due to Churg-Strauss syndrome: report of a case. Hepatogastroenterology. Jul-Aug 1997;44(16):1169-71. [Medline].

  39. Brooklyn TN, Prouse P, Portmann B, Ramage JK. Churg-Strauss syndrome and granulomatous cholangiopathy. Eur J Gastroenterol Hepatol. Jul 2000;12(7):809-11. [Medline].

  40. Bruce IN, Bell AL. A comparison of two nomenclature systems for primary systemic vasculitis. Br J Rheumatol. Apr 1997;36(4):453-8. [Medline].

  41. Burke AP, Sobin LH, Virmani R. Localized vasculitis of the gastrointestinal tract. Am J Surg Pathol. Mar 1995;19(3):338-49. [Medline].

  42. Caballero J, Zayas R, Arana R, Cano L, Berruezo A, Pinero C. [Churg-Strauss syndrome with pericardial and myocardial involvement]. Rev Esp Cardiol. Sep 1999;52(9):745-7. [Medline].

  43. Chen KR, Su WP, Pittelkow MR, Leiferman KM. Eosinophilic vasculitis syndrome: recurrent cutaneous eosinophilic necrotizing vasculitis. Semin Dermatol. Jun 1995;14(2):106-10. [Medline].

  44. Cho KH, Kim YG, Yang SG, Lee DY, Chung JH. Inflammatory nodules of the lower legs: a clinical and histological analysis of 134 cases in Korea. J Dermatol. Aug 1997;24(8):522-9. [Medline].

  45. Davis MD, Daoud MS, McEvoy MT, Su WP. Cutaneous manifestations of Churg-Strauss syndrome: a clinicopathologic correlation. J Am Acad Dermatol. Aug 1997;37(2 Pt 1):199-203. [Medline].

  46. Dietz A, Hubner C, Andrassy K. [Macrolide antibiotic-induced vasculitis (Churg-Strauss syndrome)]. Laryngorhinootologie. Feb 1998;77(2):111-4. [Medline].

  47. Dillon MJ. Childhood vasculitis. Lupus. 1998;7(4):259-65. [Medline].

  48. Dinç A, Soy M, Pay S, Simsek I, Erdem H, Sobaci G. A case of Churg-Strauss syndrome presenting with cortical blindness. Clin Rheumatol. 2000;19(4):318-20. [Medline].

  49. Eustace JA, Nadasdy T, Choi M. Disease of the month. The Churg Strauss Syndrome. J Am Soc Nephrol. Sep 1999;10(9):2048-55. [Medline].

  50. Falk RJ, Nachman PH, Hogan SL, Jennette JC. ANCA glomerulonephritis and vasculitis: a Chapel Hill perspective. Semin Nephrol. May 2000;20(3):233-43. [Medline].

  51. Ferro JM. Vasculitis of the central nervous system. J Neurol. Dec 1998;245(12):766-76. [Medline].

  52. Gross WL, Csernok E. Immunodiagnostic and pathophysiologic aspects of antineutrophil cytoplasmic antibodies in vasculitis. Curr Opin Rheumatol. Jan 1995;7(1):11-9. [Medline].

  53. Guillevin L, Fain O, Lhote F, et al. Lack of superiority of steroids plus plasma exchange to steroids alone in the treatment of polyarteritis nodosa and Churg-Strauss syndrome. A prospective, randomized trial in 78 patients. Arthritis Rheum. Feb 1992;35(2):208-15. [Medline].

  54. Hagen EC, Andrassy K, Csernok E, et al. Development and standardization of solid phase assays for the detection of anti-neutrophil cytoplasmic antibodies (ANCA). A report on the second phase of an international cooperative study on the standardization of ANCA assays. J Immunol Methods. Sep 13 1996;196(1):1-15. [Medline].

  55. Hauschild S, Csernok E, Schmitt WH, Gross WL. Antineutrophil cytoplasmic antibodies in systemic polyarteritis nodosa with and without hepatitis B virus infection and Churg-Strauss syndrome--62 patients. J Rheumatol. Jun 1994;21(6):1173-4. [Medline].

  56. Hellemans S, Dens J, Knockaert D. Coronary involvement in the Churg-Strauss syndrome. Heart. Jun 1997;77(6):576-8. [Medline].

  57. Hellmich B, Csernok E, Gross WL. Proinflammatory cytokines and autoimmunity in Churg-Strauss syndrome. Ann N Y Acad Sci. Jun 2005;1051:121-31. [Medline].

  58. Hellmich B, Ehlers S, Csernok E, Gross WL. Update on the pathogenesis of Churg-Strauss syndrome. Clin Exp Rheumatol. Nov-Dec 2003;21(6 Suppl 32):S69-77. [Medline].

  59. Hellmich B, Gross WL. Recent progress in the pharmacotherapy of Churg-Strauss syndrome. Expert Opin Pharmacother. Jan 2004;5(1):25-35. [Medline].

  60. Hoffman PM, Godfrey T, Stawell RJ. A case of Churg-Strauss syndrome with visual loss following central retinal artery occlusion. Lupus. 2005;14(2):174-5. [Medline].

  61. Jennette JC, Wilkman AS, Falk RJ. Anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis and vasculitis. Am J Pathol. Nov 1989;135(5):921-30. [Medline].

  62. Kim Y, Lee KS, Choi DC, Primack SL, Im JG. The spectrum of eosinophilic lung disease: radiologic findings. J Comput Assist Tomogr. Nov-Dec 1997;21(6):920-30. [Medline].

  63. Klemmer PJ, Chalermskulrat W, Reif MS, Hogan SL, Henke DC, Falk RJ. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis. Am J Kidney Dis. Dec 2003;42(6):1149-53. [Medline].

  64. Lamprecht P. Off balance: T-cells in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Clin Exp Immunol. Aug 2005;141(2):201-10. [Medline].

  65. Lamprecht P. TNF-alpha inhibitors in systemic vasculitides and connective tissue diseases. Autoimmun Rev. Jan 2005;4(1):28-34. [Medline].

  66. Langford CA, Sneller MC. New developments in the treatment of Wegener's granulomatosis, polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome. Curr Opin Rheumatol. Jan 1997;9(1):26-30. [Medline].

  67. Lhote F, Cohen P, Genereau T, Gayraud M, Guillevin L. Microscopic polyangiitis: clinical aspects and treatment. Ann Med Interne (Paris). 1996;147(3):165-77. [Medline].

  68. Lie JT. Histopathologic specificity of systemic vasculitis. Rheum Dis Clin North Am. Nov 1995;21(4):883-909. [Medline].

  69. Martin-Suarez I, D'Cruz D, Mansoor M, Fernandes AP, Khamashta MA, Hughes GR. Immunosuppressive treatment in severe connective tissue diseases: effects of low dose intravenous cyclophosphamide. Ann Rheum Dis. Aug 1997;56(8):481-7. [Medline].

  70. Matsuo K, Tomioka T, Tajima Y, et al. Allergic granulomatous angitis (Churg-Strauss syndrome) with multiple intestinal fistulas. Am J Gastroenterol. Oct 1997;92(10):1937-8. [Medline].

  71. Metzler C, Lamprecht P, Hellmich B, Reuter M, Arlt AC, Gross WL. Leucoencephalopathy after treatment of Churg-Strauss syndrome with interferon {alpha}. Ann Rheum Dis. Aug 2005;64(8):1242-3. [Medline].

  72. Muschen M, Warskulat U, Perniok A, et al. Involvement of soluble CD95 in Churg-Strauss syndrome. Am J Pathol. Sep 1999;155(3):915-25. [Medline].

  73. Niles JL. Antineutrophil cytoplasmic antibodies in the classification of vasculitis. Annu Rev Med. 1996;47:303-13. [Medline].

  74. Pellissier JF, Figarella-Branger D, Serratrice G. [Neuromuscular diseases with eosinophilia]. Med Trop (Mars). 1998;58(4 Suppl):471-6. [Medline].

  75. Primack SL, Müller NL. Radiologic manifestations of the systemic autoimmune diseases. Clin Chest Med. Dec 1998;19(4):573-86, vii. [Medline].

  76. Reid AJC, Harrison RA, Watkin SW, McCann BG, and Scott DGI. Churg-Strauss syndrome in a district hospital. Q J Med. 1998;91:219-229.

  77. Rutgers A, Heeringa P, Tervaert JW. The role of myeloperoxidase in the pathogenesis of systemic vasculitis. Clin Exp Rheumatol. Nov-Dec 2003;21(6 Suppl 32):S55-63.

  78. Sable-Fourtassou R, Cohen P, Mahr A, et al. Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome. Ann Intern Med. Nov 1 2005;143(9):632-8. [Medline].

  79. Sakamoto S, Ohba S, Eguchi K, et al. Churg-Strauss syndrome presenting with subarachnoid hemorrhage from ruptured dissecting aneurysm of the intracranial vertebral artery. Clin Neurol Neurosurg. Aug 2005;107(5):428-31. [Medline].

  80. Sanders JS, Stegeman CA, Kallenberg CG. The Th1 and Th2 paradigm in ANCA-associated vasculitis. Kidney Blood Press Res. 2003;26(4):215-20. [Medline].

  81. Somogyi A, Muzes G, Molnar J, Tulassay Z. Drug-related Churg-Strauss syndrome?. Adverse Drug React Toxicol Rev. Jun-Sep 1998;17(2-3):63-74. [Medline].

  82. Sonneville R, Lagrange M, Guidoux C, et al. [The association of cardiac involvement and ischemic stroke in Churg Strauss syndrome]. Rev Neurol (Paris). Feb 2006;162(2):229-32. [Medline].

  83. Steinfeld S, Golstein M, De Vuyst P. Chronic eosinophilic pneumonia (CEP) as a presenting feature of Churg-Strauss syndrome (CSS). Eur Respir J. Nov 1994;7(11):2098. [Medline].

  84. Sudo K, Tashiro K. Idiopathic granulomatous angiitis of the CNS manifesting as diffuse white matter disease. Neurology. Dec 1998;51(6):1774; author reply 1775. [Medline].

  85. Sullivan EJ, Hoffman GS. Pulmonary vasculitis. Clin Chest Med. Dec 1998;19(4):759-76, ix. [Medline].

  86. Tatsis E, Schnabel A, Gross WL. Interferon-alpha treatment of four patients with the Churg-Strauss syndrome. Ann Intern Med. Sep 1 1998;129(5):370-4. [Medline].

  87. Terasaki F, Hayashi T, Hirota Y, et al. Evolution to dilated cardiomyopathy from acute eosinophilic pancarditis in Churg-Strauss syndrome. Heart Vessels. 1997;12(1):43-8. [Medline].

  88. Thuy GN, Cuguilliere A, Arteaga C, Miltgen J, Bonnet D. [Idiopathic chronic eosinophilic pneumonia]. Med Trop (Mars). 1998;58(4 Suppl):455-8. [Medline].

  89. Vital C, Vital A, Canron MH, et al. Combined nerve and muscle biopsy in the diagnosis of vasculitic neuropathy. A 16-year retrospective study of 202 cases. J Peripher Nerv Syst. Mar 2006;11(1):20-9. [Medline].

  90. Watts RA, Lane SE, Bentham G, Scott DG. Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom. Arthritis Rheum. Feb 2000;43(2):414-9. [Medline].

  91. Weissler JC. Syndromes of severe asthma. Am J Med Sci. Mar 2000;319(3):166-76. [Medline].

  92. Wolf M, Rose H, Smith RN. Case records of the Massachusetts General Hospital. Case 28-2005. A 42-year-old man with weight loss, weakness, and a rash. N Engl J Med. Sep 15 2005;353(11):1148-57. [Medline].

  93. Yoshihara K, Arimura Y, Kobayashi O, et al. [Clinical study on five myeloperoxidase specific anti-neutrophil cytoplasmic antibody (MPO-ANCA) positive Churg-Strauss syndrome cases]. Ryumachi. Oct 1998;38(5):696-704. [Medline].

  94. Zhao MH, Short AK, Lockwood CM. Antineutrophil cytoplasm autoantibodies and vasculitis. Curr Opin Hematol. Jan 1995;2(1):96-102. [Medline].

 
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