Background: Allergic diseases are on the rise in many parts of the world, including the Asia–Pacifc (APAC) region.
Second-generation antihistamines are the frst-line treatment option in the management of allergic rhinitis and urticaria. International guidelines describe the management of these conditions; however, clinicians perceive the additional need to tailor treatment according to patient profles. This study serves as a consensus of experts from several countries in APAC (Hong Kong, Malaysia, the Philippines, Singapore, Thailand, Vietnam), which aims to describe the unmet needs, practical considerations, challenges, and key decision factors when determining optimal secondgeneration antihistamines for patients with allergic rhinitis and/or urticaria.
Methods: Specialists from allergology, dermatology, and otorhinolaryngology were surveyed on practical considerations and key decision points when treating patients with allergic rhinitis and/or urticaria.
Results: Clinicians felt the need for additional tools for diagnosis of these diseases and a single drug with all preferred features of an antihistamine. Challenges in treatment include lack of clinician and patient awareness and compliance, fnancial constraints, and treatment for special patient populations such as those with concomitant disease. Selection of optimal second-generation antihistamines depends on many factors, particularly drug safety and efcacy, impact on psychomotor abilities, and sedation. Country-specifc considerations include drug availability and cost-efectiveness. Survey results reveal bilastine as a preferred choice due to its high efcacy and safety, suitability for special patient populations, and the lack of sedative efects.
Conclusions: Compliance to the international guidelines is present among allergists, dermatologists and otorhinolaryngologists; however, this is lower amongst general practitioners (GPs). To increase awareness, allergy education programs targeted at GPs and patients may be benefcial. Updates to the existing international guidelines are suggested in APAC to refect appropriate management for diferent patient profles and varying symptoms of allergic rhinitis and urticaria.
Keywords: Allergic rhinitis, Antihistamines, Bilastine, Treatment algorithm, Urticaria.
(a) Department of Dermatology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
(b) Department of Dermatology, School of Medicine, Fujita Health University, Aichi, Japan
(c) Clinical Development Division, Taiho Pharmaceutical Co., Ltd., Tokyo, Japan
(d) Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Methods: We conducted a multicenter, randomized, double-blind, placebo-controlled phase II/III study (trial registration No. JapicCTI-142574). Patients (age, 18e74 years) were randomly assigned to receive bilastine 20 mg, 10 mg or placebo once daily for 2 weeks. The primary efficacy endpoint was the change from baseline (Day 3 to 0) in total symptom score (TSS) at 2 weeks (Day 8e14), consisting of the itch and rash scores.
Results: A total of 304 patients were randomly allocated to bilastine 20 mg (101 patients), bilastine 10 mg (100 patients), and placebo (103 patients). The changes in TSS at 2 weeks were significantly decreased by bilastine 20 mg than did placebo (p < 0.001), demonstrating the superiority of bilastine 20 mg. Bilastine 10 mg also showed a significant difference from placebo (p < 0.001). The TSS changes for the bilastine showed significant improvement from Day 1, and were maintained during the treatment period. The Dermatology Life Quality Index scores were also improved in bilastine than in placebo. The bilastine treatments were safe and well tolerated.
Conclusions: Two-week treatment with bilastine (20 or 10 mg) once daily was effective and tolerable in Japanese patients with CSU, demonstrating an early onset of action. Read More
(1) Consultant Dermatologist, Sakhiya Skin Clinic, Surat, Gujarat, India
(2) Professor of Dermatology, D Y Patil Hospital, Navi Mumbai, Maharashtra, India
(3) Shree Skin Centre, Navi Mumbai, Maharashtra, India
Bilastine is a new second generation H1‐antihistamine approved for the symptomatic treatment of allergic rhinitis (AR) and chronic urticaria (CU) in patients older than 12 years of age. AR and urticaria are very common clinical conditions that represent one of the most frequent reasons for a patient to visit their general practitioner or allergist or dermatologist. Bilastine, with its efficacy and safety profile epitomizes the evolution of research on antihistamines.
(1)Medical Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain; (2)Clinical Research Department, Faes Farma SA, 48940-Leioa, Bizkaia, Spain
It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs).
Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances.