Treatment of Allergic Rhinitis and Urticaria: a Review of the Newest Antihistamine Drug Bilastine
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Journal name: Therapeutics and Clinical Risk Management Article Designation: Review Year: 2016 Volume: 12 Therapeutics and Clinical Risk Management Dovepress Running head verso: Wang et al Running head recto: Bilastine in allergic rhinitis and urticaria open access to scientific and medical research DOI: http://dx.doi.org/10.2147/TCRM.S105189 Open Access Full Text Article REVIEW Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine Xue Yan Wang1 Abstract: Allergic rhinitis and urticaria are common allergic diseases that may have a major Margaret Lim-Jurado2 negative impact on patients’ quality of life. Bilastine, a novel new-generation antihistamine 3 that is highly selective for the H histamine receptor, has a rapid onset and prolonged duration Narayanan Prepageran 1 Pongsakorn Tantilipikorn4 of action. This agent does not interact with the cytochrome P450 system and does not undergo De Yun Wang5 significant metabolism in humans, suggesting that it has very low potential for drug–drug interactions, and does not require dose adjustment in renal impairment. As bilastine is not 1Department of Allergy, Beijing metabolized and is excreted largely unchanged, hepatic impairment is not expected to increase Shijitan Hospital, Capital Medical University, Beijing, People’s Republic systemic exposure above the drug’s safety margin. Bilastine has demonstrated similar efficacy to of China; 2St Luke’s Medical Center, cetirizine and desloratadine in patients with seasonal allergic rhinitis and, in a Vienna Chamber Quezon City, Manila, Philippines; 3Department of Otorhinolaryngology, study, a potentially longer duration of action than fexofenadine in patients with asymptomatic Head & Neck Surgery, University seasonal allergic rhinitis. It has also shown significant efficacy (similar to that of cetirizine) and Malaya Faculty of Medicine, Kuala safety in the long-term treatment of perennial allergic rhinitis. Bilastine showed similar efficacy Lumpur, Malaysia; 4Rhinology and Allergy Division, Department of to levocetirizine in patients with chronic spontaneous urticaria and can be safely used at doses Otorhinolaryngology, Faculty of of up to fourfold higher than standard dosage (80 mg once daily). The fourfold higher than Medicine Siriraj Hospital, Mahidol standard dose is specified as an acceptable second-line treatment option for urticaria in interna- University, Bangkok, Thailand; 5Department of Otolaryngology, Yong tional guidelines. Bilastine is generally well tolerated, both at standard and at supratherapeutic Loo Lin School of Medicine, National doses, appears to have less sedative potential than other second-generation antihistamines, and University of Singapore, Singapore has no cardiotoxicity. Based on its pharmacokinetic properties, efficacy, and tolerability profile, bilastine will be valuable in the management of allergic rhinitis and urticaria. Keywords: bilastine, second-generation antihistamines, allergic rhinitis, urticaria Introduction The frequency and impact of allergic diseases are often underestimated.1 A key facilitator of the allergic response is immunoglobulin E (IgE) that is present on the surface of mast cells and basophils.2 Interaction of the allergen with IgE and its recep- tor complex leads to activation of these cells and release of the substances, including histamine, that cause allergic symptoms.2 Because of the central role of histamine in allergic responses, many allergic conditions are treated with antihistamines, including allergic rhinitis and urticaria.3,4 Antihistamines have been in clinical use for .70 years, and the pharmacological 5 Correspondence: De Yun Wang characteristics of these agents have been evolving over that time. Department of Otolaryngology, Yong The objective of this article is to review the current burden of allergic rhinitis and Loo Lin School of Medicine, National urticaria in Asia Pacific, to briefly describe the evolution of antihistamine pharma- University of Singapore, 1E Kent Ridge Road, Singapore 119228 cology, and to systematically review the pharmacological characteristics and clinical Tel +65 6772 5373 results of bilastine, a new antihistamine that is highly selective for the H histamine Fax +65 6775 3820 1 Email [email protected] receptor. submit your manuscript | www.dovepress.com Therapeutics and Clinical Risk Management 2016:12 585–597 585 Dovepress © 2016 Wang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you http://dx.doi.org/10.2147/TCRM.S105189 hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Wang et al Dovepress Research methodology cities with high levels of environmental pollution.14 The For the systematic review of bilastine data, a PubMed search Allergies in Asia Pacific survey reported an adult preva- was undertaken of all publications including “bilastine” in lence of 9% across the region, with 63% of patients having the title and/or abstract. No date limits were applied. All seasonal or intermittent allergies.11 However, the prevalence preclinical and clinical trials were assessed for inclusion in of allergic rhinitis subtypes does differ between countries the review. Attention was preferentially given to randomized in Asia Pacific. In several Southeast Asian surveys, ~70% controlled trials, with appropriate controls for variation and of patients with allergic rhinitis had persistent disease bias (eg, placebo group, blinding). and ~30% had intermittent symptoms,15,16 whereas in the People’s Republic of China, ~25% of patients with allergic Burden of allergic diseases in Asia rhinitis had the persistent form and 75% had intermittent Pacific disease.17 Allergic rhinitis Allergic rhinitis is a symptomatic condition of the nose Urticaria caused by allergen exposure and IgE-mediated inflammation.6 Another common disease is urticaria. Patients with urticaria Allergic rhinitis is defined as intermittent or persistent, typically develop wheals (hives), angioedema, or both.4,18 and its severity is classed as mild or moderate-to-severe.6 Usually, about half of all patients with urticaria have Historically, symptoms of the condition were categorized as associated angioedema.19 If the condition has a duration occupational, seasonal, or perennial, but this classification is of ,6 weeks, it is acute. If it persists for .6 weeks, or now unsatisfactory because these categories are not neces- recurs, it is chronic. Symptoms of the disorder may endure sarily mutually exclusive.7 In 2001, the document “Allergic for several months or years.20 The most frequent causes rhinitis and its impact on asthma” (ARIA) recommended of acute urticaria, which may affect up to 15%–25% of replacing the terms “seasonal” and “perennial” rhinitis by all individuals at some stage in their lives, are viral infec- intermittent allergic rhinitis and persistent allergic rhinitis, tions (especially affecting the upper respiratory tract), food respectively.8 Subsequently, “intermittent” and “persistent” allergies, and drug adverse reactions.18 Physical effects, are not precisely synonymous with seasonal and perennial systemic disease, or long-term infection may also lead to allergic rhinitis. urticaria/angioedema.20,21 In patients with chronic urticaria, Allergic rhinitis is frequently encountered in primary the condition is often idiopathic (ie, has no discernible cause care. Patients report that allergic rhinitis has a marked in ~55%–80% of cases); this is known as chronic sponta- detrimental effect on their sleep, social life, quality of life, neous urticaria.19,22 The counterpart is chronic inducible and attendance and functioning at school and work.6,9–11 urticaria, which is caused by physical stimuli such as cold, Another issue is that allergic rhinitis commonly coexists heat, sun, or pressure.4 with other forms or allergic disease. Considerable clinical Unfortunately, there are limited data on the burden of and epidemiological evidence also exists of an association urticaria in Asia Pacific. Internationally, chronic spon- between asthma and allergic rhinitis.12 It has been estimated taneous urticaria is estimated to have a point prevalence that up to 75% of patients with asthma have rhinitis9,10 and of ~0.5%–1.0%.1,23,24 The peak age of occurrence is usually that approximately one-third of patients with allergic rhinitis between 20 years and 40 years, and typical disease duration have asthma.10 Comorbid links between allergic rhinitis and is 1–5 years, although this can be greater in many cases. sinusitis, conjunctivitis, otitis media, and nasal polyposis As with allergic rhinitis, chronic urticaria is a devastating have been documented, although the extent of such links disorder that can have a major negative influence on a remains unclear.12 The economic burden of allergic rhinitis patient’s quality of life, including vitality, sleep, mobility, is frequently underrated, and indirect costs of the disorder and social life.23,25–27 Because of emotional distress, patients are extensive.6,13 with chronic spontaneous urticaria