Bilastina, autor en Bilastina

Sep 26

Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta‑analysis

By Bilastina Selected articles

Gerasimos N. Konstantinou and George N. Konstantinou

(2019) Clin Transl Allergy

Chronic urticaria may affect the quality of life, namely in respect to an increase of psychiatric disorders.

This study aimed at evaluating the published evidence of psychiatric disorders that may coexist with chronic urticaria and the effect of psychiatric treatments on people with urticaria.

A systematic literature search for studies that investigated the existence of psychiatric comorbidity in patients with chronic urticaria was conducted, and twenty-five studies that met all the criteria were identified. Studies to be included in the study had to possess the following features: distinction between chronic urticaria and allergic conditions, direct collection of diagnostic psychiatric data by using clinical interview and standardized questionnaires, International Classification of Disorders criteria or the Diagnostic and Statistical Manual of Mental Disorders criteria for the diagnosis of mental disorders and manuscripts written or publish in English.

Analysis of the included studies showed that almost one out of three patients with chronic urticaria have at least one underlying psychiatric disorder. However, no studies clarified if the psychiatric disorder pre-existed at chronic urticaria onset and no association between chronic urticaria severity and duration and psychological functioning. Only a case report and two case series referred to the psychiatric disorder treatment as improving of urticaria.

This study shows the importance of a multidisciplinary approach involving recognition and management of any psychiatric disorder in addition to urticaria treatment.

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Sep 26

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New treatments for chronic urticaria

By Bilastina Selected articles

Pavel Kolkhir, Sabine Altrichter, Melba Munoz, Tomasz Hawro, Marcus Maurer,

(2019) Annals of Allergy, Asthma and Immunology

Current international guideline classifies chronic urticaria as inducible or spontaneous, whether there is a defined trigger sign or not. However chronic urticaria is unpredictable in its course and duration and persists for several years in many patients.

Antihistamines and omalizumab are the most common treatments for chronic urticaria.

This study reviewed the off and beyond label use of licensed drugs, novel treatments under development and promising new targets.

A search was performed and some of the key messages include that omalizumab should be explored in chronic inducible urticaria, in children with chronic spontaneous urticaria and at higher doses. Off label treatments, such as dupilumab, reslizumab, mepolizumab and benralizumab are showing effectiveness in chronic urticaria. Ongoing clinical trials include more monoclonal antibodies, ligelizumab and UB-221. Other promising treatments under development for chronic urticaria include a CRTh2 antagonist, a monoclonal antibody to Siglec-8, bruton’s tyrosine kinase inhibitors, a Syk inhibitor and dupilumab.

New pathogenically important targets for chronic urticaria include Mas-related G-protein coupled receptor X2, the H4 receptor, C5a and its receptor, and other inhibitory mast cell receptors.

The ultimate goal remains the development of treatments that can prevent chronic urticaria, alter its course and cure it.

This document is only available for registered healthcare professionals

Sep 26

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Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity and poor response to treatment

By Bilastina Selected articles

Pavel Kolkhir, Martin K. Church, Sabine Altrichter, Per Stahl Skov, Tomasz Hawro, Stefan Frischbutter, Martin Metz, Marcus Maurer.

(2019) The Journal of Allergy and Clinical Immunology: In Practice

Chronic spontaneous urticaria is characterized by the degranulation of skin mast cells and the influx of basophils and eosinophils to affected skin sites. Blood basopenia has been linked to severe antihistamine-resistant urticaria and type IIb autoimmunity, whereas the role of eosinophils in chronic spontaneous urticaria is largely unknown.

This study analysed the prevalence, role and relevance of eosinopenia of 1613 patients with chronic spontaneous urticaria from two centres. Peripheral blood eosinophil and basophil counts were analysed, and patient files were screened for clinical characteristics, results of laboratory tests, the autologous serum skin test, the serum-induced basophil-histamine release assay, and response to second generation H1-antihistamines and omalizumab.

Ten percent of the patients analysed had eosinopenia. This was also associated with being female, high disease activity, autologous serum skin test and basophil-histamine release assay positivity, low total IgE and high levels of C-reative protein and IgG-anti-TPO. Non-responders to treatment had even lower eosinophils compared to responders. Blood eosinophil counts correlated with basophil counts and 81% of patients with undetectable eosinophils had basopenia.

Investigators concluded that the combination of eosinopenia and basopenia is a better predictor of non-response to sgAHs than eosinopenia alone and that eosinopenia in patients with chronic spontaneous urticaria is associated with type IIb autoimmunity, high disease activity and poor response to treatment. This makes eosinophils as excellent biomarkers for the management of people with chronic urticaria.

This document is only available for registered healthcare professionals.

Sep 26

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Mobile technology in allergic rhinitis: evolution in management or revolution in health and care?

By Bilastina Selected articles

Jean Bousquet, Ignacio J. Ansotegui, Josep M. Anto, Sylvie Arnavielhe, Claus Bachert, et al.

(2019) The Journal of Allergy and Clinical Immunology: In Practice

Mobile technology has spread rapidly around the globe. Over 5 billion people have mobile devices, with over half of which are smartphones. Mobile health (mHealth) is the use of information and communication technology for health services and information transfer. Internet-based applications and smart devices are already used in allergic rhinitis and may help to undress some unmet needs, including improving quality of life especially in those with asthma.

This study reviewed existing mHealth applications for allergic rhinitis with published studies, discussed applications that included risk factors of allergic rhinitis, examined its impact in phenotype discovery, provided real-word evidence and discussed mHealth tools that enable digital transformation.

WHO recognizes the significant role that digital technologies can play in strengthening the health systems in countries to achieve universal health coverage, the health-related Sustainable Development Goals and other health objectives. mHealth has the potential to profoundly impact healthcare as existing apps represent an important evolution of health and care for rhinitis. Real world evidence has identified patients’ behaviours and practices, and this will have a profound impact on current guidelines and care pathways. Allergic rhinitis is not a severe disease but it does have a major impact on social life, school and work productivity.

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Aug 26

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Clinical characteristics and epidemiology of chronic urticaria: a nationwide, multicentre study on 1091 patients

By Bilastina Selected articles

Jankowska-Konsur A, Reich A, Szepietowski J; Polish Chronic Urticaria Working Group.

Urticaria is one of the most common skin diseases. Depending on the length of symptoms, acute (< 6 weeks) and chronic urticaria (> 6 weeks) are distinguished. Chronic urticaria is divided into inducible urticaria and chronic spontaneous urticaria.

This was a nationwide, multicentre, cross-sectional, questionnaire-based study which objective was to assess the epidemiology and clinical characteristics of chronic urticaria in Poland. A total of 1091 patients with chronic urticaria were included. Among these patients, 383 (35,1%) had inducible urticaria and 667 (61,1%) chronic spontaneous urticaria. The remaining 41 patients (3.8%) suffered from both. Participants with chronic spontaneous urticaria were twice more likely to report family history of urticaria than those with inducible urticaria (12.1% vs. 6.0%, p = 0.001).

In conclusion, chronic spontaneous urticaria is about twice as frequent cause of chronic urticaria as compared to inducible urticaria and constitutes a significant economic burden on society in terms of the absence from work and production lost. It is the cause of absenteeism in almost every fifth patient with this condition. The treatment of chronic urticaria is a major challenge for physicians of various specialties and the treatment choice is closely associated with the specialist knowledge of current treatment guidelines.

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Aug 26

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VAS for assessing the perception of antihistamines use in allergic rhinitis

By Bilastina Selected articles

Ciprandi G, La Mantia I.

Antihistamines are commonly prescribed for the management of allergic rhinitis and urticaria. The quantification of their consumption is relevant in clinical practice, as their use is usually associated with severe symptoms. In addition, symptomatic use of antihistamines is a useful parameter for evaluating allergen immunotherapy effectiveness. However, the use of a diary for recording the number of tablets is frequently negligenced as patients forget to register the actual quantity of tablets taken.

A visual analogue scale (VAS) measures the patient’s perception of symptom severity, emotions and pain.

This study aimed at measuring the VAS for assessing the patient’s perception about antihistamines use in allergic rhinitis. A total of 103 patients with allergic rhinitis due to Parietaria pollen were retrospectively evaluated. They recorded monthly the number of antihistamine tablets taken during the pollen season.

There was a strong relationship between the number of tablets and the VAS score, which represents a possibility of using VAS to estimate the patient’s perception of antihistamines use in clinical practice.

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Aug 26

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ARIA masterclass 2018: From guidelines to real-life implementation

By Bilastina Selected articles

Hellings PW, Seys SF, Marien G, Agache I, Canonica W, Gevaert P, Haahtela T, Klimek L, Mullol J, Pfaar O, Scadding G, Scadding G, Valiulis A, Aria AMD, Bousquet J, Pugin B; ARIA masterclass discussants.

Around 20-30% of the European populations suffer from allergic rhinitis, which affects their social life, sleep and work productivity, indirectly rising the economic burden for society.

The ARIA (allergic rhinitis and its impact on asthma) initiative has been developing guidelines for the treatment of allergic rhinitis and asthma to ensure the highest level of best practices in real-life settings, and has evolved towards integrated care pathways using mobile technology and further to management as the key to provide an active and healthy life to all allergic rhinitis patients.

In September 2018, the first ARIA masterclass was held in Brussels with the following key objectives:

To provide unbiased education on the best-practices for allergic rhinitis diagnosis, treatment and follow-up
To update clinicians about recent research data in allergic rhinitis and asthma, from clinical trials to real-world evidence
To share next generation care pathways for the optimal management of patients with allergic rhinitis and asthma
To inform clinicians about change management and its impact on healthcare
To support clinicians with the adoption of digital solutions in daily practice.

A recent study showed that allergic rhinitis specialists behave like patients, showing a real disconnection between physician’s prescription and patient’s behavior for allergic rhinitis treatment.

The majority of allergists prescribe medications for the entire pollen season, but the vast majority of patients use their medications on-demand when their symptoms are not well controlled.

The objective of the ARIA masterclass was to anticipate a reconnection between physicians and patients, by promoting a patient-centered approach, with a therapeutic strategy tailored to the patient needs but also to their preferences. The use of integrated care pathways and mobile Apps can facilitate this change in care management. In turn, this would result in better symptoms controls for patients, and a substantial reduction of indirect cost for the society.

This document is only available for registered healthcare professionals

Aug 24

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Identifying an effective mobile health application for the self-management of allergic rhinitis and asthma in Australia

By Bilastina Selected articles

Tan R, Cvetkovski B, Kritikos V, O’Hehir RE, Lourenço O, Bousquet J, Bosnic-Anticevich S.

Up to 40% of the population worldwide is affected by allergic rhinitis, which carries a significant burden on individuals and society. Allergic rhinitis symptoms are often self-managed in the community pharmacy setting, with patients underestimating their symptoms and overestimating their ability for effective self-management. In the current technology world, the use of mobile Apps has become more and more popular and represents a promising tool for management of different conditions.

The objective of this study was to identify an effective App for the management of allergic rhinitis and/or asthma. All English and free of charge mobile health-related Apps from the Australian Apple store and Android Google Play store were included in this study and evaluated regarding three domains: accessibility in both App stores, alignment with theoretical principles of the self-management of allergic rhinitis and/or asthma and usability of the App using a mobile App rating scale.

Of a total of 418 Apps retrieved, 31 were evaluated. Many of the evaluated Apps fall short of the self-management principles and most within the field of allergic rhinitis and asthma only deal with either one or other condition. The MASK-air App achieved the highest mean rank and covered all self-management principles except a doctor appointment reminder, with a high rate of engagement.

This document is only available for registered healthcare professionals.

Aug 24

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Concomitant Bilastine and Montelukast as Additive Therapy for Seasonal Allergic Rhinoconjunctivits and Mild-to-Moderate Asthma. The SKY Study

By Bilastina Articles about Bilastine

Lavorini F, Matucci A, Rossi O, Pistolesi M; SKY study investigators.

A double-blind, double-dummy, randomised, active-controlled, parallel group design (The SKY study) compared the efficacy and efficacy of concomitant therapy with bilastine and montelukast with each substance alone in patients with seasonal allergic rhinoconjunctivitis and asthma for four weeks.

419 adults with seasonal allergic rhinoconjunctivitis and mild-to-moderate asthma partially controlled by beclomethasone dipropionate or equivalent were included. They had a forced expiratory volume (FEV1) >70%, a positive skin prick test to one or more allergens and nasal/ocular total symptom score (TSS) >3. Participants were screened for one week and then a twelve weeks treatment.

Allergic rhinoconjunctivitis score (TSS), daytime nasal and non-nasal symptom scores and use of rescue medications were registered.

Contrary to the original hypothesis, concomitant administration of bilastine with montelukast was as effective as either agent alone for allergic rhinoconjunctivitis symptoms, however bilastine alone improved allergic rhinoconjunctivitis symptoms more than montelukast in the first two weeks of treatment.

The SKY study investigators concluded that there is no benefit of using bilastine plus montelukast to provide relief of allergic rhinoconjunctivitis in patients with mild-to-moderate asthma.

This document is only available for registered healthcare professionals

Jul 26

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

By Bilastina Eprint

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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Jul 26

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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 Bilastina 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.

This document is only available for registered healthcare professionals.

Jul 26

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

By Bilastina 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.

This document is only available for registered healthcare professionals.

Jul 26

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Diagnosis and treatment of urticaria in primary care

By Bilastina 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.

This document is only available for registered healthcare professionals.

Jul 26

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Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis

By Bilastina 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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Jul 26

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Treatment of urticaria: a clinical and mechanistic approach

By Bilastina 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.

This document is only available for registered healthcare professionals

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Bilastina

Psychiatric comorbidity in chronic urticaria patients: a systematic review and meta‑analysis

New treatments for chronic urticaria

Eosinopenia, in chronic spontaneous urticaria, is associated with high disease activity, autoimmunity and poor response to treatment

Mobile technology in allergic rhinitis: evolution in management or revolution in health and care?

Clinical characteristics and epidemiology of chronic urticaria: a nationwide, multicentre study on 1091 patients

VAS for assessing the perception of antihistamines use in allergic rhinitis

ARIA masterclass 2018: From guidelines to real-life implementation

Identifying an effective mobile health application for the self-management of allergic rhinitis and asthma in Australia

Concomitant Bilastine and Montelukast as Additive Therapy for Seasonal Allergic Rhinoconjunctivits and Mild-to-Moderate Asthma. The SKY Study

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

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

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

Diagnosis and treatment of urticaria in primary care

Reproducibility of nasal allergen challenge responses in adults with allergic rhinitis

Treatment of urticaria: a clinical and mechanistic approach

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