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H1-antihistamines archivos - Bilastina

Bilastina

Multidisciplinary Real-World Experience With Bilastine, a Second Generation Antihistamine

By | Eprint, News

Lynde CW, Sussman G, Dion PL, Guenther L, Hébert J, Rao J, Leek TV, Waserman S.

J Drugs Dermatol. 2020 Feb 1;19(2):145-154. doi: 10.36849/JDD.2020.4835.

Allergic conditions, such as seasonal allergic rhinitis, perennial allergic rhinitis (PAR), and urticaria (both acute and chronic) are frequently treated with H1-antihistamines. However, first-generation H1-antihistamines cause impairment and potentially interfere with restful sleep, cause hangovers or “morning after” effects, impair learning and memory, and reduce work efficiency. Second generation antihistamines, such as bilastine have shown to decrease allergy symptoms effectively without causing night-time sleep disturbances and related adverse events.

Bilastine is a prescription medicine. It is not derived from nor is it a metabolite of another antihistamine, has a rapid one-hour onset of action and provides sustained efficacy. Bilastine does not penetrate the brain, is scarcely metabolized and does not interact with cytochrome P450. For the treatment of allergic conditions in adults and children over 12 years of age, a daily oral dose of bilastine 20 mg is recommended.

This real world case project was developed to help optimize patient care and supported with evidence from the literature. It included patients between 9 and 76 years old with seasonal allergic rhinitis, perennial allergic rhinitis and chronic and acute urticaria as well as urticarial vasculitis and pruritus associated with inflammatory skin conditions.

The presented cases using bilastine showed positive outcomes for the patients, relieving symptoms with safety and good tolerance.

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urticaria y antihistaminicos H1

Current and emerging pharmacotherapy for chronic spontaneous urticaria: a focus on nonbiological therapeutics

By | Artículos seleccionados, Selected articles

Kam Lun Hon, Joyce T. S. Li, Alexander K.C. Leung, Vivian Lee

Expert Opin Pharmacother. 2020 Sep 29. doi: 10.1080/14656566.2020.1829593. Online ahead of print.

Urticaria is characterized by pruritic wheals of the skin’s superficial layers, which occurs for six weeks or longer, with no apparent cause. It is a condition that reduces the quality of life of the patient and may have a significant economic and social burden. The objective of this revision was to review the guidelines for urticaria management.

According to the joint initiative of the EU-founded network of excellence, the Global Allergy and Asthma European Network, the European Academy of Allergology and Clinical Immunology, the World Allergy Organization, and the European Dermatology Forum, management of urticaria should be done in a stepwise manner. Second-generation H1-antihistamines are considered first-line treatment. Whenever symptoms are not adequately controlled, treatment should follow the algorithm. This algorithm includes an increase of the dose of second-generation H1-antihistamines, alongside first-generation H1-antihistamines, H2 antagonists, omalizumab, ciclosporin A, or short-term corticosteroids if needed. New treatments on development include spleen tyrosine kinase inhibitor, Bruton tyrosine kinase inhibitor, prostaglandin D2 receptor inhibitor, H4-antihistamines, and biologics. Alternative agents include leukotriene receptor antagonists, anticoagulant and antifibrinolytic agents, antidepressants, vitamin D, and other anti-inflammatory or immune-suppressing agents.

According to the authors, second-generation H1-antihistamines should always be considered the first-line therapeutic option for urticaria management. For those who do not respond to a higher dose of H1-antihistamines, guidelines recommend adding omalizumab. Well-designed trials are required to draw clear conclusions.

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Clinical Control of CSU with Antihistamines Allows for Tolerance of NSAID-Exacerbated Cutaneous Disease

By | Selected articles

Jorge Sánchez

J Allergy Clin Immunol Pract . 2020 Jul 14;S2213-2198(20)30700-5. doi: 10.1016/j.jaip.2020.06.057. Online ahead of print.

A great number of patients with chronic spontaneous urticaria experience exacerbations after treatment with non-steroidal anti-inflammatory drug (NSAID). Although international guidelines suggest that people with urticaria avoid NSAIDs, this is sometimes difficult. Some case reports recommend that H1-antihistamines can help prevent these exacerbations.

The objective of this study was to evaluate if H1-antihistamines can help prevent NSAID-exacerbated reactions in people with chronic spontaneous urticaria.

This was a cross-over, multi-center, and ambispective study in 3 centers in Medellín, Colombia that included 121 participants with chronic spontaneous urticaria and a history of NSAIDs exacerbations. A diagnostic challenge test without the use of antihistamines and a challenge test using antihistamines were performed using the NSAID reported in the medical record. The order in which test were performed in each participant was determined by the investigator: participants with a positive first diagnostic challenge, were subject to a second challenge using H1-antihistamines, those with a negative first challenge using H1-antihistamines, were subject to a second one without the use of H1-antihistamines, and those with a negative first diagnostic challenge or a positive first challenge using H1-antihistamines, did not undergo a second challenge. Some patients were subject to an alternative NSAID before the diagnostic challenge test or the challenge test using H1-antihistamines.

The diagnostic challenge test retrieved 96 participants testing positive, with 75 % (72 participants) tolerating the NSAID involved in the reaction when they added H1-antihistamines.

In conclusion, although NSAID may represent some restrictions for people with chronic spontaneous urticaria, the use of H1-antihistamines can help control further urticaria exacerbations due to NSAID treatment.

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skin microdyalisis

Chronic urticaria in the real-life clinical practice setting in the UK: results from the non-interventional multicentre AWARE study.

By | Selected articles

Savic S, Leeman L, El-Shanawany T, Ellis R, Gach JE, Marinho S, Wahie S, Sargur R, Bewley AP, Nakonechna A, Randall R, Fragkas N, Somenzi O, Marsland A.

Clin Exp Dermatol. 2020 Apr 4. doi: 10.1111/ced.14230. [Epub ahead of print]

Chronic urticaria is a group of skin conditions that include chronic spontaneous urticaria and chronic inducible urticaria. Symptoms include itchy wheals and/or angioedema for a period longer than 6 weeks. The objective of this study was to provide information demonstrating the real-life burden of chronic urticaria in the UK.

The non-interventional AWARE study (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) collected data from a representative sample of chronic urticaria patients worldwide. A subset of UK patients aged 18-75 diagnosed with H1-antihistamine-refractory chronic spontaneous urticaria was analysed.

Baseline analysis included 252 UK patients, mostly female (77,8%) with moderate-to-severe disease activity and a spontaneous component to their chronic urticaria. Comorbidities included depression/anxiety (24,6%), asthma (23,8%) and allergic rhinitis (12,7%). 57,9% of the patients had undergone a treatment. Their mean Dermatology Life Quality Index score was 9,5 with report of reduction in work productivity and activity. These patients referred a high need to use healthcare resources. Chronic spontaneous urticaria severity was linked to gender, obesity, anxiety and diagnosis.

Only 28,5% of UK patients completed all nine study visits, which limits analysis of long-term treatment patterns and disease impact. Chronic urticaria patients reported high rates of healthcare resource use and impairment in quality of life, work productivity and activity at baseline, which highlights the need to ensure appropriate management to optimise patient quality of life and reduce the socioeconomic burden of chronic urticaria in the UK.

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Bilastine: a lifetime companion for the treatment of allergies

By | Eprint

Martin K Church, Marysia Tiongco-Recto, Erminia Ridolo & Zoltán Novàk.

(2019) Current Medical Research and Opinion, DOI: 10.1080/03007995.2019.1681134

Bilastine is a potent and highly selective H1-antihistamine for the treatment of urticaria and allergic rhinoconjunctivitis.

This is a review article that gathers information available up to 25 February 2019 on the use of the H1-antihistamine bilastine in the treatment of allergic disorders in different age groups, from children to adults.

Teenagers and adults bilastine dose is usually 20 mg daily and children up to 12 years old is 10 mg of bilastine once daily. Bilastine has demonstrated efficacy at improving allergic rhinitis symptoms, such as nasal and ocular symptoms and at improving wheals and itching in urticaria. It has a rapid onset of action and a long duration of action.

Bilastine does not interact with the CYP450 system, making it a H1-antihistamine free from drug-drug interactions. Patients with renal or hepatic impairment or elderly ones don’t need dosage adjustment. Bilastine is well tolerated, even at above standard doses and doesn’t exhibit anticholinergic or cardiotoxic effects. It has minimal sedative properties due to its inexistence central nervous system penetration. Patients on bilastine show an overall improvement of health-related quality of life.

In conclusion, bilastine is a suitable option of H1-antihistamins for the treatment of allergic rhinoconjunctivitis or urticaria in all patients.

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posición declaración c

CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

By | Selected articles

Fein MN, Fischer DA, O’Keefe AW, Sussman GL.

Allergy Asthma Clin Immunol. 2019 Oct 1;15:61. doi: 10.1186/s13223-019-0375-9. eCollection 2019. Review.

H1-antihistamines are the most used class of medications for the treatment of allergic rhinitis and urticaria. The first generation of antihistamines has been available since 1946, however its common side effects, such as sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness and orthostatic hypotension led to the development of newer, less-sedating second and third generation antihistamines, which became available in the 1980s. These newer generations of H1-antihistamines have a better safety profile and improved potency and efficacy. They are the recommended first-line treatment for mild allergic rhinitis and acute and chronic urticaria.

The Canadian Society of Allergy Clinical Immunology (CSACI) recommends that second and third generations of H1-antihistamines are preferred over first generation antihistamines for the treatment of allergic rhinitis and urticaria. CSACI also recommends that first generation antihistamines should only be sold behind the counter in pharmacies and as a last resort due to the risks of their use.

To help change practice and improve patient health and safety, the CSACI recommends that efforts are needed to disseminate this information to healthcare providers and patients.

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seguridad tolerabilidad bilastina

The safety and tolerability profile of bilastine for chronic urticaria in children

By | Articles about Bilastine

Papadopoulos NG, Zuberbier T.

Clin Transl Allergy. 2019 Oct 23;9:55. doi: 10.1186/s13601-019-0294-3. eCollection 2019. Review.

Urticaria is characterized by the development of pruritic wheals, angioedema or both. Guidelines from early 2018 recommend that urticaria is classified based on its duration as acute (< 6 weeks) or chronic (> 6 weeks). In addition, they also classify chronic urticaria as spontaneous or inducible. Chronic urticaria is less frequent than acute in children, but is a condition that requires treatment, as it affects children’s daily activities, disturbs sleep, causes emotional distress and influences negatively learning and cognition.

Bilastine is a H1-antihistamine that has been studied in children at the dose of 10mg/daily and is licensed for the symptomatic relief of urticaria symptoms in children > 6 to 11 years.

Investigation in paediatric population included bilastine and rupatadine among the second-generation antihistamines. A phase III, doubleblind, randomized, placebo-controlled, parallel-group clinical trial was carried out to assess the safety and tolerability of bilastine 10 mg once daily for 12 weeks in 509 children aged 2–11 years with allergic rhinitis or chronic urticaria. The primary endpoint was the proportion of children in each treatment group without treatment-emergent adverse events (TEAEs). Secondary endpoints included the assessment of somnolence/sedation with the Pediatric Sleep Questionnaire (PSQ). No statistically significant differences were found between treatment groups for incidences of TEAEs or related TEAEs in the population overall or by age subgroup. The majority of related TEAEs were mild to moderate in intensity. PSQ scores for somnolence/sedation decreased slightly from baseline to week 12 in both the bilastine 10 mg and placebo groups.

In conclusion, bilastine is a suitable for treatment of urticaria in children, due to its efficacy and good tolerability profile that were proven in well-controlled studies. Specifically, lack of potential to induce sedation allows prolonged administration without impairment of performance and learning abilities.

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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 | 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 | 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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Second generation antihistamines: an update

Second generation antihistamines: an update

By | 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.

H1 antihistaminico Rinitis Alergica

Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

By | Selected articles

Seresirikachorn K, Chitsuthipakorn W, Kanjanawasee D, Khattiyawittayakun L, Snidvongs K.

Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA.

For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

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Rinitis Alérgica

Is Quantitative sIgE Serology Suitable for Distinguishing Between Silent Sensitization and Allergic Rhinitis to Dermatophagoides pteronyssinus?

By | Selected articles

Gellrich D, Högerle C, Becker S, Gröger M.

Objective: Our study aimed to analyze the concordance between a nasal provocation test with Dermatophagoides pteronyssinus and specific IgE measurements based on real-life data.

Despite the high correlation between sIgE levels and symptoms, no serologic parameter is sufficiently accurate to distinguish between silent sensitization and clinically relevant allergy. Therefore, nasal provocation tests remain the gold standard for assessing clinical relevance in sensitization to D pteronyssinus.

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H1 antihistaminico Rinitis Alergica

Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

By | Selected articles

Seresirikachorn K, Chitsuthipakorn W, Kanjanawasee D, Khattiyawittayakun L, Snidvongs K.

Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA.

For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

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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 | Articles about Bilastine

Esther Serra, Cristina Campo, Zoltan Novák, Bernardetta Majorek-Olechowska, G Pulka, Aintzane García-Bea & Luis Labeaga (2019)

Journal of Dermatological Treatment

An exploratory, international and multicenter study to evaluate the efficacy of bilastine in the relief of pruritus associated with urticaria and other skin diseases was performed in patients diagnosed of Chronic Spontaneous Urticaria (CSU), eczema/dermatitis, prurigo or cutaneous pruritus.

The first 2 weeks, they were treated with bilastine 20 mg daily. The daily pruritus severity score was assessed. Responders patients stayed on this treatment for the remaining 6 weeks while non-responders were updosed to 40 mg.

The mean change in weekly pruritus severity score from baseline to week 8 was -1.63 ± 0.77 for all patients (p<0.001). The mean change per group was: CSU (-2.1 ± 0.44), cutaneous pruritus (-1.66 ± 0.63), eczema/dermatitis (-1.36 ± 0.79) and prurigo (-1.30 ± 0.92) (all p-values <0.001).

Bilastine at 20 mg and 40 mg showed an excellent profile for both efficacy and safety in reducing pruritus in patients with CSU and other skin disorders.

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The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria – the Vietnamese Experience

By | Selected articles

Thi HT, Thi LP, Van TN, et al..

Vietnamese investigators evaluated the efficacy of increased H1-antihistamine doses in people with chronic urticaria.

Chronic urticaria is a common, debilitating and hard to treat condition. H1-antihistamines are the first line treatment but frequently patients do not get satisfactory relief with the recommended dose. Antihistamine doses may be increased up to four-fold as recommended by European guidelines.

This experience included 102 participants with chronic urticaria who were divided in two groups and treated with 5 mg of levocetirizine or 180 mg of fexofenadine for two weeks, and then increased to 10 mg of levocetirizine or 360 mg of fexofenadine for two more weeks. Wheal, pruritus, size of the wheal, total symptom scores and associated side-effects were measured at beginning, week 2 and week 4.

With the conventional dose, total symptom scores decreased significantly at week 2 and 4 in both groups. However, 26 participants who did not improve at week 2, experienced a two-fold increase in dose, with 11,5% and 38,5% becoming symptom-free at week 4 in levocetirizine and fexofenadine group, respectively. None of the treatments had negative side effects between the conventional dose and the double one.

In conclusion, this study showed that increasing H1-antihistamines dosage by two-fold does not increase the rate of side effects while improving chronic urticaria symptoms.

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