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

February 2020 | Volume 19 | Issue 2 | Original Article | 145 | Copyright © February 2020

Published online February 11, 2020

Charles W. Lynde MD FRCPC,a Gordon Sussman MD FRCPC,b Pierre-Luc Dion MD FRCPC,c Lyn Guenther MD FRCPC,d Jacques Hébert MD FRCPC,e Jaggi Rao MD FRCPC,f Tim Vander Leek MD FRCPC FAAAAI,g Susan Waserman MSc FRCPCh

aDepartment of Medicine, University of Toronto, Toronto, ON, Canada bDivision of Allergy/Clinical Immunology, University of Toronto, Toronto, ON, Canada cDivision of Dermatology, Université Laval, Québec, Québec, Canada; CISSS de Chaudière-Appalaches – Hôtel-Dieu de Lévis, Lévis, Québec, Canada dWestern University, London, ON. Royal College of Physicians and Surgeons of Canada, eDepartment of Medicine, Université Laval, Québec, Canada fDivision of Dermatology, University of Alberta, Edmonton, Alberta, Canada gDepartment of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada hDivision of Clinical Immunology & Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada

Abstract
Introduction: Allergic conditions frequently require treatment with antihistamines. First-generation antihistamines can potentially in-terfere with restful sleep, cause “morning after” effects, impair learning and memory, and reduce work efficiency. Second-generation antihistamines, such as bilastine, have been demonstrated to decrease allergy symptoms effectively without causing night-time sleep disturbances and related adverse events. 
Method: A real-world case project was developed to help optimize patient care by recognizing the role bilastine can play for allergic conditions where antihistamine treatment is needed. The presented real-world patient cases conducted by the panel members are supported with evidence from the literature, where available. Any discussion concerning off-label use should be considered an expert opinion only.
Results: The real-world cases presented here used bilastine in conditions such as perennial and seasonal allergic rhinitis, chronic urti-caria, as well as urticarial vasculitis and pruritus associated with inflammatory skin conditions. The treated patients were between 9 and 76-years old providing information on a full spectrum of patients that require treatment with antihistamines.
Conclusions: The presented real-world cases using the second-generation antihistamine, bilastine,  demonstrated favorable outcomes for the treated patients. While effectively relieving symptoms, the antihistamine was reported to be safe and well-tolerated.

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

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INTRODUCTION

Allergic conditions, such as seasonal allergic rhinitis (SAR), perennial allergic rhinitis (PAR), and urticaria (both acute and chronic) are frequently treated with antihistamines (AHs).1,2 Most first-generation AHs have a long history and were introduced decades before clinical pharmacology studies, and randomized controlled trials were required by regulatory agencies.2 Consequently, first-generation AHs that were previously approved for use are assumed to be safe and effective.2 However, physicians have become aware these first-generation AHs cause impairment and potentially interfere with restful sleep, cause hangovers or “morning after” effects, impair learning and memory, and reduce work efficiency.3 Additionally, various second-generation AHs have been developed that decrease allergy symptoms effectively, while potentially increasing quality of life and reducing night-time sleep disturbances.4 One of these new second-generation AHs approved for the treatment of various allergic conditions such as SAR and chronic spontaneous urticaria (CSU) is bilastine (Blexten, Aralez Pharmaceuticals Canada Inc.).5-7 Bilastine is available by prescription; it is not derived from nor is it a metabolite of another AH, has a rapid one-hour onset of action and provides sustained efficacy.5-9 This AH does not penetrate the brain, is scarcely metabolized and does not interact with cytochrome P450.6,7 For the treatment of allergic conditions in adults and adolescents over 12 years of age, a daily oral dose of bilastine 20 mg is recommended.7