Antihistamines - Twitter summary from #CSACI19 meeting

Dr. Mariam Hanna, MD @PedsAllergyDoc:

Bilastine for refractory CSU. Trial: Q2 wks, double dose unless complete response. Many improved with daily antihistamine and with doubling to 40mg. No significant improvement in use of Bilastine 40mg vs 80mg. May benefit from biologic? Minimal somnolence.

Cross over study looking at onset of action for Bilastine to evaluate the effects of fasting - 1/3 less absorption with food, by day 4 no change in onset of action or wheel/flare response... therefore if taking regularly, taking on an empty stomach not essential.

Dr. Wasserman on seasonal allergic rhinitis with Rupatadine - 10 vs 20mg didn’t improve control for mild sx, dosing with 20mg for those that are more severely impacted may benefit with higher dose, comparable reactions, 7% somnolence regardless of dose.

What about perennial allergic rhinitis and Rupatadine, improved TNSS but if ongoing symptoms, updose to ‘double’ and patients improve in about 2 weeks. **somnolence more frequent at higher doses.

Dr. Vanderleek - to approve a peds antihistamine - need a pharmacokinetic study and safety study to enter into a younger age group... Bilastine for 2-11 years?

Indication in Japan for use of Rupatadine with pruritis associated with eczema (again 20mg for those with ongoing sx at 10mg).

Impairment of 50mg of Benadryl is WORSE than 0.1% blood alcohol level.

Educate families to the dangers to first generation antihistamines!! Poisonings and overdoses frequently reported. Efficacy poor. Dr Sussman asks: who still drives a car from the 1940s?

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