Selecting optimal second-generation antihistamines for allergic rhinitis and urticaria in Asia

Abstract

Background: Allergic diseases are on the rise in many parts of the world, including the Asia-Pacific (APAC) region. Second-generation antihistamines are the first-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 profiles. 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 second-generation 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, financial 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 efficacy, impact on psychomotor abilities, and sedation. Country-specific considerations include drug availability and cost-effectiveness. Survey results reveal bilastine as a preferred choice due to its high efficacy and safety, suitability for special patient populations, and the lack of sedative effects.

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 beneficial. Updates to the existing international guidelines are suggested in APAC to reflect appropriate management for different patient profiles and varying symptoms of allergic rhinitis and urticaria.

Keywords: Allergic rhinitis; Antihistamines; Bilastine; Treatment algorithm; Urticaria.

Fig. 1

Algorithms for selecting second-generation antihistamines for allergic rhinitis and urticaria based on patient profiles. The choice of drugs has been listed in alphabetical order, not by preference. *Based on ARIA and EAACI/GA(2)LEN/EDF/WAO guidelines for allergic rhinitis and urticaria [6, 19]. ^†Preferred antihistamine in patients with cardiac problems or those who are likely to consume alcohol. ^‡Caution should be observed when prescribing antihistamines for elderly patients. ^§Availability in Asia–Pacific countries is limited. ^∥Pregnancy Category B (should be used in pregnancy if clearly needed)