IP Indian Journal of Clinical and Experimental Dermatology 5 (2019) 261–263 Content available at: iponlinejournal.com IP Indian Journal of Clinical and Experimental Dermatology Journal homepage: www.innovativepublication.com Short Communication Bilastine in higher doses in chronic spontaneous urticaria Kiran Godse 1, *, Gauri Godse 1 1 Dept. of Skin, Shree Skin Centre Nerul, Navi Mumbai, Maharashtra, India ARTICLE INFO Article history: Received 31-05-2019 Accepted 04-09-2019 Available online 14-09-2019 Keywords: Bilastine Chronic spontaneous urticaria Efficacy ABSTRACT Objective: To evaluate efficacy and safety of bilastine in higher than usual doses in patients with chronic spontaneous urticaria (CSU). Material and Methods: Adult patients with CSU with pruritus and wheal score of more than two were investigated for complete blood count, urine examination, blood sugar level and thyroid-stimulating hormone level and treated with bilastine 20 mg (one tablet) before breakfast. In patients who did not show satisfactory response, dose was increased to 40 mg (two tablets) before breakfast at the end of one week and 80 mg (two divided doses) at the end of two weeks, if no response seen after the end of one week. Symptoms were evaluated using urticaria activity score (UAS) and sedation score. Results: A total of 30 patients (mean age 30.5 years; 56.67% females; baseline mean UAS 5.2) with mean duration of CSU of 18.9 months were enrolled. Fourteen (51.85%), 10(37.04%) and 2(7.41%) patients became symptom-free with 20,40, and 80 mg dose of bilastine respectively whereas 1(3.70%) patient not responding to 80 mg bilastine required cyclosporine. After 1 week of treatment, 3 patients were lost to follow up. Bilastine was well tolerated without any serious adverse events. Conclusion: Bilastine is effective and well tolerated in higher (up to 4 times) than normal doses in the management of chronic spontaneous urticaria. © 2019 Published by Innovative Publication. 1. Introduction Chronic spontaneous urticaria is a common dermatological condition. Although it is not a life threatening condition, patients suffering from this condition report significant impairment in the quality of life. 1 Several mediators are involved in the pathogenesis of allergic conditions. Out of these, histamine is an important mediator in pathophysiological course of allergic reactions including allergic rhinitis and urticaria. Because of the central role of histamine, antihistamines are considered as the mainstay of treatment in patients with chronic urticaria. Among the available antihistamines, first generation agents because of their potential to cross blood brain barrier are associated with adverse events related to central nervous system especially sedation. Second-generation H-1 antihistamines score over their first generation counterparts in this regards. Considering the advantages, current clinical guidelines * Corresponding author. E-mail address: kvg402@gmail.com (K. Godse). recommend second-generation H1- antihistamines as initial treatment of chronic urticaria. 2 Although many second generation antihistamines are available in the market, each has its own advantages and limitations. Bilastine is a new addition to the list of available agents with promising profile. Bilastine is a potent and specific H1-antihistamine with quick onset and long duration of action with good response in the treatment of chronic spontaneous urticaria (CSU). 3 Moreover, it has several clinical advantages because of its pharmacological profile which make it suitable for use in CSU. Bilastine is not associated with risk of cardiotoxicity. Similarly, it does not interact with cytochrome P450 resulting in very less risk of drug to drug interactions. Dosage modification is not required in patients with renal impairment. In a double blind clinical trial, bilastine 20 mg administered for 28 days has been shown to provide significant reduction in clinical features and improved patient quality of life in patients with chronic idiopathic https://doi.org/10.18231/j.ijced.2019.056 2581-4710/© 2019 Published by Innovative Publication. 261