Abstract
Bilastine is a non-sedating second generation H1 oral antihistamine (OAH) for treating allergic rhinitis (AR) patients. The effect of bilastine has not previously been evaluated in a meta-analysis. The aim of this review was to determine the efficacy and safety of bilastine in treating AR. An electronic literature search was performed using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Science Direct and Google Scholar up to March 2021. Randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy were included. The included studies must have diagnosis of AR established by clinicians and the outcomes must have a minimum of 2 weeks of follow-up period. The primary outcomes assessed were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QOL) and adverse events. The risk of bias and quality of evidence for all studies were appraised. The meta-analysis was done using Review Manager 5.3 software based on the random-effects model. The search identified 135 records after removal of duplicates. Following screening and review of the records, fifteen full-text articles were assessed for eligibility. Five trials involving 3,329 patients met the inclusion criteria. Bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QOL but has comparable efficacy with other OAHs in TSS, NSS, NNS, rhinitis discomfort score and QOL. There was no difference in adverse effects when bilastine was compared against placebo and other OAHs except for somnolence. Bilastine has fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality. Bilastine is effective and safe in treating the overall symptoms of AR with comparable efficacy and safety with other OAHs except somnolence. Whilst bilastine has similar efficacy to cetirizine, somnolence is notably less in bilastine.
Highlights
Rhinitis is described as an inflammation of the nasal epithelium causing rhinorrhoea, nasal blockage, itching and sneezing
Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines classified allergic rhinitis (AR) as seasonal or perennial based on the duration of symptoms and graded its severity as mild, moderate to severe according to its impact on the quality of life (Bousquet et al, 2008)
The included studies must have diagnosis of allergic rhinitis established by clinicians and the outcomes must have a minimum of 2 weeks of follow-up period
Summary
Rhinitis is described as an inflammation of the nasal epithelium causing rhinorrhoea, nasal blockage, itching and sneezing. The commonest form of rhinitis is allergic rhinitis (AR) with the occurrence of the rhinitis symptoms and allergic sensitization following exposure to allergens (Burbach et al, 2009; Braido et al, 2014). The IgE type-specific antibodies are secreted postexposure to an allergen which link to the receptors on the surface of mast cells and basophils. This interaction causes exocytosis of histamine and different inflammatory mediators such as cytokines and platelet-activating factor. H1, H2, H3 and H4 are the four main histamine receptor subtypes, but the allergic response is mainly mediated by the H1 receptor subtype (Zazzali et al, 2012)
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