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

Abstract

BackgroundAllergic 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.MethodsSpecialists from allergology, dermatology, and otorhinolaryngology were surveyed on practical considerations and key decision points when treating patients with allergic rhinitis and/or urticaria.ResultsClinicians 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.ConclusionsCompliance 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12948-017-0074-3) contains supplementary material, which is available to authorized users.

Insights on Allergic Rhinitis Management from a Northern Cyprus Perspective and Evaluation of the Impact of Pharmacist-Led Educational Intervention on Patients’ Outcomes

“…In another study done in Asia, Recto et al (2017) revealed a high awareness of the ARIA guidelines among allergists, dermatologists and ENT specialists. Eighty percent of ENT specialists generally follow ARIA guidelines for AR treatment [ 27 ]. Prepageranet al’s survey done in Malaysia showed high satisfaction with the recommendations from the current ARIA guidelines; between 58% and 89% of ENT specialists, pharmacists, and GPs [ 28 ].…”

Immunotherapy and probiotic treatment for allergic rhinitis in children

“…9 It is described in a review by Hardy et al in 2013 that probiotic has the ability as immunomodulatory on the cells, molecules and immune response in the gut mucosae. 7 Subcutaneous injection immunotherapy has been demonstrated to be efficacacious in the management of allergic rhinitis and asthma, even in multi-allergen situations. This therapy has been effective in the prevention of new sensitizations and progression of rhinitis to asthma.…”

“…6 The standard therapy for allergic rhinitis is second generation antihistamines, but additional therapy may be needed in persistent or severe cases. 7 Probiotic treatment has a unique, disease-modifying effect, as it manipulates the normal flora ecosystem in the gastrointestinal tract, induces the stability of Th1 and Th2 immune responses, and stimulates T-regulators to inhibit excessive Th1 and Th2 reactivity. 8 Probiotic supplementation was shown to be beneficial for decreasing nasal eosinophil percentages in children with allergic rhinitis.…”

<p>Using Patient Profiles To Guide The Choice Of Antihistamines In The Primary Care Setting In Malaysia: Expert Consensus And Recommendations</p>

“…Awareness of and adherence to guidelines is high among specialists, but notably lower in primary care, in Asia and elsewhere 1,5,11. Non-adherence to guidelines is reported particularly in general practitioners, many of whom still prescribe first-generation antihistamines 13. Notably, a higher proportion of pharmacists (42%) than general practitioners (11%) in Malaysia were dissatisfied with the ARIA guidelines 5.…”

“…Despite active development and regular updates to international guidelines for allergy, regional/national surveys of healthcare professionals show a clear gap between guidelines and real-world practice, particularly at primary care level 11,13. This motivates efforts to devise pragmatic guidelines to meet the challenges of primary care and real-life practice.…”