Ultimate Urticaria Solution
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These findings suggest that bilastine may be a more attractive treatment in allergic conditions compared to other, less selective, antihistamines. In general, bilastine exhibited similar efficacy to cetirizine in terms of antihistaminic activity, although there were differences in some in vivo assays. Bilastine was at least as effective as cetirizine and more effective than fexofenadine in reducing these different allergic responses Fig. In this study, bilastine displayed no carcinogenic potential in rats or mice. Bilastine was considered to display no carcinogenic potential as the type and incidence of lesions diagnosed during the course of the study are commonly diagnosed in animals of the strains and ages used In vivo studies have investigated the pharmacokinetic properties of bilastine in various species, primarily dogs and rodents.
Bioavailability measurements have varied between species and gender. For example, while bilastine exhibited no differences in plasma levels between the sexes in rats and dogs, there were significant differences between male and female mice The liver and lungs have virtually no intrinsic ability to metabolise bilastine Radioactivity was widely distributed to tissues, with higher values found in the gastrointestinal tract, liver and kidneys, correlating with patterns of elimination. There was no accumulation of radioactivity in the brain or other peripheral tissues New antihistamines should be developed with minimal ability to enter the brain.
This suggests that bilastine will have minimal impact on the central nervous system CNS. The fact that bilastine undergoes minimal hepatic clearance, and is eliminated in the faeces and urine as unchanged drug, supports a reduced possibility of interactions with other drugs. A widely used model to determine these parameters is the wheal and flare reaction following histamine skin prick testing.
A recent phase I study in healthy male volunteers evaluated the effect of five different bilastine single doses 2. Studies in human volunteers demonstrated that bilastine is rapidly absorbed after oral treatment, reaching maximal plasma concentrations 1—1. Measurement of metabolites in the plasma, urine and faeces indicated that bilastine is not metabolised in humans and is almost exclusively eliminated as unchanged drug No metabolites were produced as a result of cellular activity, indicating an absence of intestinal metabolism Additional in vitro studies in human microsomes and hepatocytes showed that bilastine is neither an inducer nor an inhibitor of CYP isoenzymes Simulated pharmacokinetic models have also assessed parameters such as age, gender, body weight, height, pulse rate, and albumin, bilirubin and creatinine plasma concentrations, but none of these variables had a significant effect on the pharmacokinetic profile of bilastine The pharmacokinetic parameters of erythromycin and ketoconazole were unaltered in the presence of bilastine.
These data demonstrate that grapefruit juice reduces the systemic exposure of bilastine This observation should be taken into account when considering the administration of bilastine. This is an experimental setting in which subjects are exposed to specific allergens for prolonged periods, under controlled and reproducible conditions. Like cetirizine and fexofenadine, bilastine was safe and well tolerated in this short term study.
Bilastine had a better tolerability profile than cetirizine in terms of CNS effects, particularly with regards to a lower incidence of somnolence. Post hoc analysis showed this was indicative of a considerable placebo effect in one region of the study.
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A simulated model of pharmacokinetic parameters based on data from adults was recently developed Similar tolerability was also reported for bilastine and placebo in clinical trials in patients with allergic rhinoconjunctivitis 11 , Of this population, 18 subjects 3. However, these AEs were not considered by the investigator to be due to study medication Balancing the beneficial peripheral H 1 inhibitory effects with unwanted CNS effects involves determining at what dose the drug is clinically effective, whilst minimising adverse effects.
The data also suggest that there is dissociation between the peripheral and central antihistamine effects of bilastine. A number of studies have assessed the CNS effects of bilastine in combination with others drugs known to cause sedation. However, given the seriousness of the effects, the development of any new antihistamine now involves vigorous testing of cardiotoxicity, including assessment of the QTc interval. IC 50 values of 6. Bilastine did not produce any significant effects on QTc interval at either dosage. Furthermore, bilastine has been associated with improved QoL in allergic rhinoconjunctivitis and urticaria patients.
Indeed, in clinical trials it was no different from placebo in terms of tolerability and this makes this novel antihistamine a potentially exciting treatment for allergic diseases. The removal of astemizole and terfenadine from the marketplace has raised the awareness and some concerns regarding antihistamines and cardiotoxicity Larger, long term trials are required to fully elucidate this potential and to help determine its overall place in the treatment of diseases for which an antihistamine is advocated such as allergic rhinoconjunctivitis and urticaria.
Volume 65 , Issue s If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Allergy Volume 65, Issue s Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Allergic rhinoconjunctivitis and urticaria are increasing in prevalence in many developed countries.
Mild allergic rhinoconjunctivitis No impairment of sleep, daily activities, sport or leisure, work or school and no disruptive symptoms. Moderate to severe allergic rhinitis Presence of one of the following events: abnormal sleep, impairment of daily activities, sport or leisure; impaired work or school; or disruptive symptoms. Figure 1 Open in figure viewer PowerPoint.
Type IV allergic reaction: contact dermatitis induced by oxazolone Measurement of ear swelling Male CD1 mice Oral, topical No effect of bilastine, cetirizine or fexofenadine. Figure 2 Open in figure viewer PowerPoint. Preclinical: pharmacokinetic studies In vivo studies have investigated the pharmacokinetic properties of bilastine in various species, primarily dogs and rodents. Phase II study. Bilastine reduced allergic symptoms with a rapid onset and a long duration of action. Bilastine was similar in activity to cetirizine and maintained the effect for longer than fexofenadine.
Well tolerated, similar safety profile to placebo. To compare the efficacy of bilastine with cetirizine and placebo in the symptomatic treatment of SAR. Phase III study. Bilastine and cetirizine were equally effective.
Similar safety profile to placebo. Better tolerated than cetirizine. To compare the safety and efficacy of bilastine to desloratadine in SAR patients Bilastine and desloratadine were equally effective. To compare the efficacy of bilastine to cetirizine in perennial allergic rhinoconjunctivitis PAR patients However these effects were not different from placebo.
Open label extension study. To assess the efficacy of bilastine administered at different doses in patients with chronic idiopathic urticaria To assess the clinical efficacy and safety of bilastine in patients with chronic idiopathic urticaria. Bilastine and levocetirizine were equally effective. Pharmacodynamic interaction study.
Alcohol: 0. Both responders exhibited a clear steroid-sparing effect, rendered more remarkable by incomplete response at baseline to moderate-dose prednisone that evolved into complete clinical remission soon after starting sirolimus. Drug-free remission, in many ways the holy grail of urticaria management, has been observed in some CU patients taking calcineurin inhibitors. Variability of disease over time is a problem in the investigation of the efficacy of interventions in CU and UV. However, the abrupt cessation of all symptoms in the expected time frame ie, response time comparable to cyclosporine 10 and, in one responder, a dose-response effect support some role for sirolimus in achieving remission.
No serious adverse effects were observed with the moderate doses and short durations typical of urticaria applications. Leg swelling was observed in 2 patients and of sufficient severity that one chose to avoid future use despite excellent clinical results.
Major adverse effects include headache, alimentary complaints, extremity edema, rash, tremor, arthralgias, fatigue, weight gain, dyslipoproteinaemia probably to a lesser degree than would be expected with a regimen of cyclosporine , cytopenias, and immune suppression-related neoplasia or infections. Sirolimus is a substrate of cytochrome P 3A4, which may give rise to important drug interactions. As with other alternative agents, 11 - 13 urticaria, angioedema, and drug rash have been reported as adverse effects, mainly in renal transplant recipients.
Weight, fluid status, and evidence of infectious complications were also assessed. The ultimate role of sirolimus in the management of refractory CU and UV remains to be determined. Assuming that sirolimus shares comparable efficacy with calcineurin inhibitors, to have this additional option to offer frustrated patients and clinicians would be a welcome prospect. Compared with the calcineurin inhibitors, different intracellular binding targets are responsible for the distinct mechanism of action and side effects of sirolimus, although both have overlapping indications and immunologic properties.
Whereas calcineurin inhibitors block production of interleukin-2, sirolimus inhibits the response to interleukin-2, thus inhibiting activation of B- and T-lymphocytes. As in other applications, differences in adverse effects and efficacy may thus become apparent between sirolimus and parallel medications, which will lead to better design of therapeutic regimens.
Future investigation of sirolimus should be considered for CU and UV patients, especially randomized controlled trials and even comparative studies with calcineurin inhibitors. Clinicians, residents, and fellows are invited to submit cases of challenges in management and therapeutics to this section. Cases should follow the established pattern. Manuscripts should be prepared double-spaced with right margins nonjustified. Clinical photographs, photomicrographs, and illustrations must be sharply focused and submitted as separate JPG files with each file numbered with the figure number.
Preliminary inquiries regarding submissions for this feature may be submitted to George J. Hruza, MD ghruza aol. Author Contributions: Dr Morgan had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Arch Dermatol. All Rights Reserved.
Acute and Chronic Urticaria: Evaluation and Treatment
Citations 5. View Metrics. The Cutting Edge. Report of cases. Case 1. View Large Download. Case 2.
Doxycycline helps one-third of chronic cold urticaria patients
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