All data generated or analyzed during the current study are included in this published article and its supplementary information files. 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.
Clinicians 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 Non-sedating antihistamine available in singapore lack of sedative effects. Compliance 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
Non-sedating antihistamine available in singapore for different patient profiles and varying symptoms of allergic rhinitis and urticaria.
The online version of this article doi: Allergic diseases comprise a variety of conditions including allergic rhinitis, allergic asthma, atopic dermatitis, contact allergies, and food allergies. Urticaria can also occur either as an allergic or nonallergic response. Statistics on the prevalence of allergic diseases in APAC are scarce; however, Allergies in Asia—Pacific Survey demonstrated that the prevalence of allergic rhinitis ranged from 2.
Due to rapid economic development and urbanization in Asia, the prevalence of allergic diseases in this region is expected "Non-sedating antihistamine available in singapore" rise over the next two decades [ 4 ]. In the European Union, an allergic person was estimated to have symptoms for an average of 51 working days per annum, hence affecting work performance and leading to absenteeism [ 7 ].
The duration of symptoms is expected to be higher in APAC due to the presence of perennial allergens. A patient with persistent allergic rhinitis could be suffering throughout the year where symptoms could be mild to severe, thereby impairing daily activities. Patients with chronic urticaria also reported reductions in the Satisfaction Profile score for the amount and quality of their sleep, physical wellbeing, resistance to stress, and mood [ 9 ].
H1 antihistamines interfere with histamine action and downregulate allergic inflammation [ 10 ]. Before prescribing pharmacotherapy, factors for consideration include efficacy, safety, cost-effectiveness, patient preference, goals of treatment, anticipated adherence to treatment, disease severity and control, and presence of concurrent conditions [ 5 ].
However, it was observed in a World Allergy Organization German study that only In this study, The above suggests that there remains an unmet need with regard to bringing the optimal treatment options to patients for the management of allergic rhinitis and urticaria in APAC. Many patients experience sedation from the usage of first-generation antihistamines [ 16 ].
In addition, the lack of persistent relief of symptoms, and the need for better therapies with fewer side effects, call for improvements or updates to the current treatment guidelines [ 17 ]. The objective of this article is to discuss current guidelines in the context of APAC considerations, i.
This would be done in view of the most common patient profiles found within APAC, bearing in mind the challenges and limitations when implementing existing guidelines in the region.
Ways to ensure that patients receive the best possible standard of care are also discussed. Specifically, this manuscript will provide guidance on the selection of the optimal antihistamines for the appropriate patients based on clinical evidence and existing treatment algorithms used by clinicians, to provide a convenient tool for specialists and GPs.
The findings from the survey were then used to generate an optimal treatment algorithm for common patient profiles encountered in their clinical practice. However, they indicated that there may be instances of noncompliance where other clinicians in the region lack awareness of dosage adjustments, or have individual preferences for the use of antihistamine combinations. The lack of "Non-sedating antihistamine available in singapore" local guidelines and the fear of prescribing or using steroids were cited as potential contributors to nonadherence to guidelines.
All ENT allergy specialists surveyed commonly see persistent or intermittent allergies among their patients. Non-sedating antihistamine available in singapore of these patients present with accompanying sinusitis, nasal polyps, asthma, food allergies, and eczema.
Considerations, unmet needs and challenges in implementing treatment guidelines for allergic rhinitis and urticaria. Data presented in this table reflect results from completed surveys and consensual agreement from authors. Survey results indicate that an inaccessibility to allergy testing due to the lack of allergy specialists and diagnostic tests in many South-East Asian countries, especially in rural areas, led to inadequate diagnosis of allergic diseases.
Furthermore, suitable allergen extracts for allergy testing in APAC, such as local grasses or pollen, are lacking and they may differ from those of the Western world. Other unmet needs include the lack of access to immunotherapy and rhinologic examinations for comorbidities such as nasal endoscopy for the detection of nasal polyps and rhinosinusitisand the lack of diagnosis of patients with mixed rhinitis and local allergic rhinitis.
The need for a long-acting and non-sedative antihistamine, better immunotherapy vaccines, and other biologics e. There are several aspects to diagnosis, and therefore treatment decision-making, for patients with allergic rhinitis, including the skin prick test recommended by the ARIA guidelines [ 5 ]. Responses from the survey show, however, that the latter may not be consistently applied across clinical practices—some clinicians may only perform it if patients do not respond to specific treatment possibly due to the dearth of allergy specialists in the region.
The presence of clinical symptoms seasonal or due to environmental triggers and accompanying symptoms nasal blockage, rhinorrhea, sinusitis, and nasal polyps also serve as key diagnostic considerations for allergic rhinitis. Patient profiles such as age, symptoms and severity intermittent or persistentpresence of hepatic or renal impairment, concomitant disease, pregnancy, and familial history of atopic diseases, Non-sedating antihistamine available in singapore as allergic rhinitis or asthma, influence treatment decisions.
The pattern of symptom occurrence is also another consideration—some patients report an inadequate control of bothersome symptoms, while others experience symptoms of allergic rhinitis that occur in the morning and gradually improve by midday. The presence of symptoms often leads to poorer quality of sleep.
Treatment is also determined by previous experience with antihistamines and drug allergies including those to aspirin and nonsteroidal anti-inflammatory drugs. The survey also highlighted the role of patients in treatment decision-making where they may demand therapies that restore their quality of life, enabling them to perform their daily activities.
Patient preference and lifestyle could also impact compliance; those with an active lifestyle may prefer non-sedative once-daily pills with a rapid onset of action, while a minority prefer slightly sedating antihistamines at night. Non-sedating antihistamine available in singapore results underscored several limitations to the treatment of allergic rhinitis, including financial constraints and misdiagnosis by non-medical professionals—parents of young patients often mistake their upper respiratory tract infections for allergic rhinitis.
Other limitations are the shortage of qualified allergologists and of long-term clinical studies investigating allergic rhinitis as a life-long condition.
Sixty per cent of dermatologists and allergologists described acute urticaria as being the ones most commonly reported amongst their patients. Results show that the choice of treatment is dependent on the onset of the drug preferably with extremely fast onsetdrug potency preferably highand dosing regimen preferably once-daily use. Non-sedating antihistamine available in singapore addition, other factors that influence treatment decision include patient age, response to treatment, disease severity, and affordability.
Furthermore, caution should be employed when prescribing antihistamines to patients with renal or hepatic impairment, and elderly patients should not take sedating antihistamines. Financial constrains often pose a challenge, especially in poor Asian countries where patients are unable to afford a regular dose or increased dose of a drug. Furthermore, institutional practices limiting drug prescriptions to specific agents also pose a challenge to the implementation of these guidelines.
In addition, the survey reiterated that patient adherence has an impact on the management of urticaria. The high expense of some antihistamines and drugs such as omalizumab, specialist reluctance to change management styles, and doctor or patient preference for sedating antihistamines owing to a lack of knowledge on the sedative effects of first-generation antihistamines, limit the usefulness and practical of current treatment guidelines.
Many considerations come into play when selecting the optimal antihistamine for patients. Ninety per cent of clinicians surveyed cited drug efficacy and safety as the most important consideration. Other considerations include concomitant disease, cost, pregnancy and breastfeeding, presence of renal or hepatic problems, cardiac disease and side effects, and consumption of other medications. Numbers in the cells indicate the number of responses received from clinicians for each of these criteria.
This survey highlighted that patient lifestyle also influences the selection of antihistamine; sixty per cent of clinicians stated a need to prescribe non-sedating antihistamines for patients who need to stay alert and require excellent psychomotor responses, and those who are active in sports or outdoor activities. Patients generally prefer to take antihistamines once daily, and those with difficulty adhering to treatment could be prescribed longer-acting, non-sedating drugs such as bilastine and fexofenadine [ 1618 ].
A good balance between drug efficacy and safety, with no cardiac or central nervous system adverse "Non-sedating antihistamine available in singapore" or drug interactions, should be Non-sedating antihistamine available in singapore in selecting the optimal antihistamine.
In this study, the consensus among the surveyed clinicians was that bilastine was the first-choice antihistamine for both allergic rhinitis and urticaria, followed by fexofenadine. Patients must also be clearly willing and able to pay for the antihistamines prescribed. Otherwise, cheaper alternatives need to be offered to these patients. The most versatile antihistamines for adults and the elderly, as shown in Fig. As second-generation antihistamines are non-sedative, they are all suitable for patients who lead an active lifestyle Fig.
Consensus among the clinicians indicated a preference in prescribing bilastine or fexofenadine to patients who may have had prior experience with other second-generation antihistamines. Further, the survey revealed that bilastine was the preferred antihistamine of choice for all the patient groups discussed here, i. Algorithms for selecting second-generation antihistamines for allergic rhinitis and urticaria based on patient profiles.
The choice of drugs has been listed in alphabetical order, not by preference. Clinicians surveyed were also asked to indicate their preferences and collective experiences for the treatment of allergic rhinitis and urticaria using the various second-generation antihistamines. Clinicians also indicated that due to their earlier approval and availability, the most frequently prescribed drugs for allergic rhinitis and urticaria are cetirizine and levocetirizine.
However, with Non-sedating antihistamine available in singapore greater availability of more novel second-generation antihistamines such as bilastine, along with comparable efficacy and greater safety, prescription patterns have started to change, particularly for patients described in Fig. They also indicated that desloratadine works well, especially for patients with chronic urticaria.
Hong Kong, the Philippines, Singapore, and Thailand; bilastine is not yet available in Vietnam, and rupatadine is not available in Malaysia and was only recently introduced in the Philippines and Thailand. Clinical profile differences and second-generation antihistamine usage based on collective experiences of clinicians surveyed.
In some APAC countries, only certain formulations of cetirizine are approved for allergic rhinoconjunctivitis. Additionally, nasal endoscopy may be performed to eliminate the possibility of nasal polyps, sinusitis or deviated nasal septum. If treatment is not effective with a second-generation antihistamine alone, it is often combined with a nasal steroid spray.
Seventy per cent of clinicians highlighted that the benefits of second-generation antihistamines were their non-sedating properties, once-daily dosing and quick onset of action compared with nasal sprays.
In addition, many of these newer antihistamines led to fewer anticholinergic effects and drug-to-drug interactions, longer duration of action and anti-inflammatory properties when dosage was increased.
Of note were the beneficial properties and characteristics of the second-generation antihistamines bilastine and fexofenadine, as specified by all clinicians: Additionally, dose adjustments are not required for patient with hepatic or renal impairment and no severe drug-to-drug interactions have been reported.
Non-sedating antihistamine available in singapore reason for there being such a large disparity between these estimates remains to be determined. Some GPs also choose to treat patients with first-generation antihistamines. An international multicenter study demonstrated that It should also be noted that this study details the opinions of experts in the APAC region and does not account for assumptions related to the efficacy or safety of specific antihistamines over the others.
However, results from this study and published literature highlight many challenges that lie ahead for the implementation of existing treatment guidelines, and increasing clinician and patient awareness of the existence of these guidelines could improve the existing clinical practices. However, the factors highlighted in this study limit the use of some second-generation antihistamines due to fears of drug-to-drug interactions.
In renal- or hepatic-impaired patients, dosages of these antihistamines may occasionally have to be adjusted. Nevertheless, the availability of newer second-generation antihistamines has generated interest in recent years in evaluating these newer compounds for their efficacy and safety, to assess if they meet the optimal profile for the management of allergic rhinitis and urticaria [ 1821 — 23 ].
The finding that bilastine, with its positive properties and characteristics, was the first-choice antihistamine amongst the Non-sedating antihistamine available in singapore clinicians, despite the need to take it on an empty stomach noted as a minor inconvenience for patientsagrees with a recent review by Wang et al.
A comprehensive review with references for the analysis of commonly prescribed members of an important class of drugs, non-sedating antihistamines. Lack of long-acting, non-sedative drugs (limited availability) . Philippines, Singapore, and Thailand; bilastine is not yet available in Vietnam. Antihistamines are available in tablets or liquids. Follow the may cause some people to feel drowsy, while other antihistamines do not have this effect at all.