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Bilastina

Efficacy and safety of bilastine in reducing pruritus in patients with chronic spontaneous urticaria and other skin diseases: an exploratory study

Efficacy and safety of bilastine in reducing pruritus in patients with chronic spontaneous urticaria and other skin diseases: an exploratory study

By | Eprint, New

Esther Serra, Cristina Campo, Zoltan Novak, Bernadetta Majorek-Olechowska, Grazyna Pulka, Aintzane García-Bea and Luis Labeaga

Pruritus is a common symptom associated with different skin diseases, including urticaria, atopic dermatitis, eczema and prurigo. Pruritus may have a significant impact on the quality of life and psychosocial wellbeing of patients with skin urticaria. Bilastine is a H1-antihistamine with demonstrable efficacy for the symptomatic treatment of chronic spontaneous urticaria.

 

A phase IV, multicentre, open-label, exploratory study to evaluate the efficacy and safety of bilastine in reducing pruritus in patients with chronic spontaneous urticaria and other skin diseases was conducted at 10 European Centres.

 

115 patients between 18 and 74 years diagnosed with chronic spontaneous urticaria, eczema/dermatitis, prurigo or cutaneous pruritus who had not responded to placebo during a run-in period of 7-14 days and with, at least 4 points for the sum of itch score during the last 3 days of the run-in period were included. Patients received bilastine 20 mg once daily for 8 weeks and non-responders (<30% improvement in pruritus score at week 2), received 40 mg daily from week 2.

 

Bilastine reduced the mean change in weekly pruritus severity score from baseline to week 8 (primary endpoint) (overall and by disease group). Up dosed non-responders (n = 31) improved weekly pruritus severity scores from baseline to week 8. Bilastine improved the Dermatology Life Quality Index at weeks 4 and 8 (p < 0,001) in all disease groups, and the 7-day Urticaria Activity Score in CSU patients (p <0 ,001).

 

In conclusion, bilastine has demonstrated efficacy for the relief of pruritus associated with urticaria and other skin diseases in adults, with a very good safety profile. Also, bilastine up dosing to 40mg (double dose), for patients who did not achieve a significant improvement after 2 weeks of treatment, was efficacious without any safety concerns.

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La urticaria crónica (CUR) contribuye a la comprensión y el conocimiento de la enfermedad en la región.

Latin American chronic urticaria registry (CUR) contribution to the understanding and knowledge of the disease in the region

By | Artículos seleccionados, New, Selected articles

Gómez RM, Jares E, Borges MS, Baiardini I, Canonica GW, Passalacqua G, Kaplan A, Latour P, Costa E, Dias G, Lavrut J; SLAAI CUR group.

Chronic urticaria (CU) has a widespread spectrum on causal or exacerbating factors, clinical manifestations, therapeutic response and quality of life affectation. Registries are useful tools in several real-life diagnosis and management approach.We aimed to evaluate the characteristics of CU patients living in Latin America through an original cross-sectional registry with data entered by regional allergologists.

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The Role of Mobile Health Technologies in Allergy Care: an EAACI Position Paper.

The Role of Mobile Health Technologies in Allergy Care: an EAACI Position Paper

By | Artículos seleccionados, New, Selected articles

Matricardi PM, (…)

Mobile Health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data flow and information, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology.

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Diagnosis and treatment of urticaria in primary care

Diagnosis and treatment of urticaria in primary care

By | Artículos seleccionados, New, Selected articles

Kayiran MA, Akdeniz N.

Urticaria, also known as hives among people, is a very common disease characterized by erythematous, edematous, itchy, and transient plaques that involve skin and mucous membranes. It is classified as acute spontaneous urticaria, chronic spontaneous urticaria, chronic inducible urticaria, and episodic chronic urticaria. Many factors such as infections, medicines, food, psychogenic factors, and respiratory allergens are accused of etiology, but sometimes, it is idiopathic. Clinical presentation involves red, swelling, and itchy plaques. The lesions usually resolve spontaneously within 2-3 h without a trace.

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Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis

Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis

By | Artículos seleccionados, New, Selected articles

Pantin CT, Southworth T, Wetzel K, Singh D.

Allergic rhinitis is characterized by nasal inflammation that occurs in response to allergen exposure. Reproducibility of nasal secretion cytokine responses and physiological measurements are needed to determine the optimum measurements and power calculations for future studies. A group of investigators have investigated the reproducibility of nasal cytokine measurements, using ready-to-use polyvinyl acetate sponges to collect nasal secretions, and measurements of nasal physiological responses.

This study included twelve participants with allergic rhinitis and no history of respiratory disease, and twelve with asthma and allergic rhinitis. They were submitted to a nasal allergen challenge which was repeated 7-14 days later. Participants had an increase in IL-5, and in cytokines CCL11 and CXCL8 responses post-challenge (all P<0.05). Acoustic rhinometry provided good to excellent reproducibility and rhinomanometry had lower reproducibility with greater variation, with some participants unable to perform the measurement. Multiplex immunoassays provided greater sensitivity for cytokine CCL11 measurements. There were no differences between allergic rhinitis patients with and without asthma.

They concluded that polyvinyl acetate sponges are a practical and reproducible way to sample nasal secretions and acoustic rhinometry is a practical and reproducible method for assessing physiological responses

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Treatment of urticaria: a clinical and mechanistic approach

Treatment of urticaria: a clinical and mechanistic approach

By | Artículos seleccionados, New, Selected articles

Kaplan AP.

Urticaria can be divided into three general subtypes. Acute urticaria is defined as urticaria of relatively short duration that can be as brief as a day or two or can last up to 6 weeks. “Physical urticarias or inducible urticarias” consist of cold urticaria, cholinergic urticaria, and dermatographism as the most common, plus solar urticaria, local heat urticaria, aquagenic urticaria, vibratory urticaria/angioedema, and delayed pressure urticaria. The third subtype is chronic spontaneous urticaria (CSU) where the urticaria is present for over a minimum of 6 weeks up to many years.

Antihistamines are effective in about 50% of patients with CSU by interacting with the H1 receptor rendering it unresponsive to histamines. Omalizumab is effective in 65–80% of antihistamine-resistant patients and acts by binding IgE, thereby eliminating IgE directed to an autoantigen, downregulating IgE receptors, so that antireceptor antibodies are blocked, and ultimately leading to unresponsiveness of cutaneous mast cells and basophils. The addition of omalizumab represents a major advance because of its efficacy, easy utility, and favourable side-effect profile. Cyclosporine inhibits not only T cells but also histamine release from basophils and mast cells, has a success rate of about 70%, and is recommended third-line with care directed to potential side effects affecting blood pressure and renal function.

In conclusion, the use of antihistamines in high dosage (at least four times a day) is effective in close to half the patients with chronic spontaneous urticaria. For antihistamine resistance, the use of omalizumab has revolutionized therapy of antihistamine-resistant cases because of its efficacy and excellent side-effect profile. If the response is insufficient, cyclosporine is the next choice. Patients should be monitored regarding any adverse effects on blood pressure or renal function. All these are far safer than extended use of corticosteroid.

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Second generation antihistamines: an update

Second generation antihistamines: an update

By | Artículos seleccionados, New, Selected articles

Allergic rhinoconjuntivitis, rhinitis and urticaria are major health problems that affect a sizable portion of the population of all ages, interfering with quality of life and resulting in an important burden for the health system.

First generation antihistamines have major unwanted effects, including sedation, weight gain and anticholinergic effects. Second generation H1-antihistamines (SGAHs) are free from the unacceptable side effects of the first-generation ones and are now preferred by physicians and patients as first line therapies.

SGAHs have a good absorption profile, whenever administered orally, with effective plasma concentrations being reached in most of them within 3 hours after dosing. Their liposolubility permits the crossing of cell membranes, helping their bioavailability.

Regarding their metabolism and elimination, H1-antihistamines bind to transporter plasmatic proteins, with plasma protein binding varying from 60 to 95%. The higher plasma protein binding, the less persistent antihistamine effects. Benzodiazepines may decrease H1-antihistamines plasma concentrations. Macrolides, antifungals and calcium antagonists may increase plasmatic concentrations.

H1-antihistamines are well tolerated for allergic rhinoconjunctivitis at the usual dosage. In respect to urticaria, their efficacy is attributed to their H1-antihistaminic activity on small unmyelinated afferent C-fibers to reduce itching, on axonic reflexes to reduce erythema and on the endothelial cells of the post-capillary venules to reduce extravasion and wheal formation. Most H1-antihistamines appear to have anti-inflammatory effects including the reduction of production of preformed and neoformed mediators, cytokines, chemokines and adherence molecules, inflammatory cell recruitment and inflammation in general.

This article summarizes an update on the clinical pharmacology, mechanisms of action and safety of the second-generation antihistamines.

chrnic spontaneous urticaria

The impact of omalizumab on quality of life and its predictors in patients with chronic spontaneous urticaria: Real-life data

By | Selected articles

Salman A, Demir G, Bekiroglu N.

A retrospective cohort study was performed to investigate the impact of omalizumab on quality of life and its predictors in chronic spontaneous urticaria.

Omalizumab is an effective and well-tolerated treatment alternative for people with chronic urticaria, however there aren’t studies that assess omalizumab impact on quality of life.

The response to omalizumab therapy was evaluated in 42 patients using urticaria activity score over 7 days and urticaria control test. The impairment in quality of life was assessed using Dermatology Life Quality Index and Chronic Urticaria and Quality of Life Questionnaire.

All scores improved from baseline to first month, remaining stable at the third month. Complete responders had better improvement rates in all scores in all scores compared to others. Gender, age and angioedema had no significant effect on quality of life.

Better scores at baseline might be a predictor of a better response to omalizumab and therefore, more improvement in quality of life of patients with chronic urticaria.

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ácaros del polvo

Determination of the minimally important difference in a nasal symptom score in house dust mite allergy

By | Artículos seleccionados, Selected articles

Devillier P, Brüning H, Bergmann KC.

House dust mite (HDM) allergens are responsible for the most prevalent persistent respiratory allergies. Clinical trials in this field often use a four-component nasal symptom score (T4NSS) as a measure of efficacy.

The MID for improvement in the T4NSS is at least -0.90 units in children, adolescents and adults suffering from HDM-induced AR. This value could be rounded up to -1 unit for convenience.

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Urticaria crónica

Systematic reviews of pharmacological and nonpharmacological treatments for patients with chronic urticaria: An umbrella systematic review

By | Artículos seleccionados, Selected articles

Shi Y, Zhou S, Zheng Q, Huang Y, Hao P, Xu M, Zhang L, Xiao X, Zheng H, Li Y.

A wide range of pharmacological and nonpharmacological interventions for chronic urticaria (CU) have been evaluated in systematic reviews (SRs). We conducted an umbrella review of SRs of the effectiveness and safety of pharmacological and nonpharmacological interventions for CU.

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