Allergic Rhinitis

1. PHIL-BIL-082022-1182-E
CLIMATE & LIFESTYLE:
SHAPERS OF THE ALLERGIC NOSE

2. SESSION OBJECTIVES
• Discuss how climate and lifestyle influence the development of
nasal allergy
• Examine the real-life evaluation and management of allergic rhinitis
• Review the role of Bilastine in the management of allergic rhinitis

3. https://climate.nasa.gov/vital-signs/global-temperature/

4. https://www.pagasa.dost.gov.ph/information/climate-change-in-the-philippines

5. https://climateknowledgeportal.worldbank.org/country/philippines
https://www.germanwatch.org/en/19777

6. Emissions in the Philippines are
Projected to Grow
Philippines: Country Climate & development Report 2022; The World Bank Group

7. https://www.climatelinks.org/countries/philippines

8. In recent years, Asia has experienced rapid economic growth and a
deteriorating environment and increase in allergic diseases to epidemic
proportions.
Air pollution levels in many Asian countries are substantially higher than
are those in developed countries. Moreover, industrial, traffic-related, and
household biomass combustion, indoor pollutants from chemicals and
tobacco are major sources of air pollutants, with increasing burden on
respiratory allergies.

9. Allergy Cascade is Influenced by the EXPOSOMES:
the total environmental exposures affecting all living
systems and their genomes
Renz H et al. J Allergy Clin Immunol 2017;140:24-40.
Three categories of exposures:
• General external environment
(climate, biodiversity, urban
environment, social and economic
factors)
• Specific external environment
(allergens, microbes, diet, tobacco,
pollutants, and toxic substances)
• Host-dependent internal
environment (metabolic factors,
inflammation, and oxidative stress)

10. Effect of
EXTERNAL
EXPOSOME
on Epithelial Barriers
Celebi Sozener Z, et.al. (2022) The External Exposome and Allergies: From the
Perspective of the Epithelial Barrier Hypothesis. Front. Allergy 3:887672. doi:
10.3389/falgy.2022.887672
Exposome:
total environmental
exposures affecting all
living organisms and their
genomes

11. Epithelial Barrier Damaging Agents
From the Environment
Sozener ZC et. al. Allergy, 2022.
disrupt intercellular connections and anchoring of epithelial cells

12. The environment is the great modifier of genome and
epigenome, and most of the adaptation to
environmental changes involves these cellular
components.
Multiple factors that could
affect : HDM growth,
allergen exposure, sensitization
and allergic symptoms.
The final outcomes depend on
the interaction between
genetic, environmentally
protective and risk factors.
Acevedo N. et. al. Allergy Asthma Immunol Res. 2019 Jul; 11(4): 450–469.

13. Effect of Outdoor Pollution and Climate
Change Over Allergenic Plant species
Eguiluz-Gracia I et.al. Allergy 2020.

14. Crosstalk Between Environmental Factors and
Immune Responses in Allergic Inflammation
Xing Y, Wong G. Environmental influences & allergic diseases in the AP region: What ill happen in next 30
years. AAIR 2022 Jan:14(1):21-39

15. SUGGESTIONS TO CREATE A
HEALTHY ENVIRONMENT
Naclerio et al. World Allergy Organization Journal (2020) 13:100106 http://doi.org/10.1016/j.waojou.2020.100106

16. SUGGESTIONS TO CREATE A
HEALTHY ENVIRONMENT
Naclerio et al. World Allergy Organization Journal (2020) 13:100106 http://doi.org/10.1016/j.waojou.2020.100106

17. SUGGESTIONS TO CREATE A
HEALTHY ENVIRONMENT
Naclerio et al. World Allergy Organization Journal (2020) 13:100106 http://doi.org/10.1016/j.waojou.2020.100106

18. SUGGESTIONS TO CREATE A
HEALTHY ENVIRONMENT
Naclerio et al. World Allergy Organization Journal (2020) 13:100106 http://doi.org/10.1016/j.waojou.2020.100106

19. RECOMMENDATIONS ON ALLERGIC
RHINITIS DIAGNOSIS IN ADULTS
(Grade A Recommendation, Level 1C Evidence)
• The diagnosis of AR is strongly considered in the presence of the
following symptoms: nasal itching, sneezing, rhinorrhea,
and/or nasal congestion or obstruction
• Triggered by allergen exposure
• Symptoms may be associated with conjunctival redness, itchy
and/or teary eyes.
ALLERGIC RHINITIS IN ADULTS, Clinical Practice Guidelines 2016;
Philippine Society of Otolaryngology-Head & Neck Surgery

20. RECOMMENDATIONS ON ALLERGIC
RHINITIS DIAGNOSIS IN ADULTS
Supportive clinical information that must be sought includes:
• Frequency and duration (intermittent or persistent) and severity of
symptoms
• Personal history of other manifestations of atopy
• Family history of atopy
• Identification of possible allergens in the environment: home, workplace,
school, etc.
• Absence of symptoms upon change of environment
• Result of previous allergy testing (e.g., skin test, serum specific IgE test,
nasal provocation test)
• The effects of previous allergen avoidance measures
ALLERGIC RHINITIS IN ADULTS, Clinical Practice Guidelines 2016;
Philippine Society of Otolaryngology-Head & Neck Surgery

21. Diagnosis of Allergic Rhinitis: Procedures
Performed Routinely Amongst Experts in
the Asia-Pacific Region (n=16)
Chantaphakul, Wang DY, Lobo RC, Navarro-Locsin G, Poblete D. et. al. Current perspectives on the management of allergic rhinitis in
selected Asia-Pacific countries: a meeting report. Drugs Context. 2022;11:2022-5-3. https://doi.org/10.7573/dic.2022-5-3

22. Bousquet J et al. Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines, Allergy (2008)

23. Church MK et al Allergy 2010 :65
Simons FER & Simons KJ J Allergy Clin Immunol 2011;128:1139-50.
First generation AH Second generation AH
Histamine blockade ✚ ✚
Anti-inflammatory effects At very high doses At therapeutic doses
Pharmacokinetics Not full determined Evidence-based
Sedation ✚✚✚ ✚⁄−
Impairment of cognitive functions ✚✚✚ None
Cardio-toxicity May prolong QTC No effect of QTC ( except terfenadine &
astemizole)
Drug-interactions ( cytochrome P450 ) ✚ Minimal
Duration of action 4-8 hours >24 hours
Tolerance ✚ None
Danger of toxicity with overdosage ✚ Minimal
1st vs. 2nd Generation Antihistamines

24. Preferred first-line treatment for an adolescent/adult
patient with moderate-to-severe allergic rhinitis
symptoms amongst experts in the Asia-Pacific region
(n=16)
Chantaphakul, Wang DY, Lobo RC, Navarro-Locsin G, Poblete D. et. al. Current perspectives on the management of
allergic rhinitis in selected Asia-Pacific countries: a meeting report. Drugs Context. 2022;11:2022-5-3.
https://doi.org/10.7573/dic.2022-5-3

25. Preferred non-sedating H1-antihistamine for allergic
rhinitis amongst experts in the Asia-Pacific region
(n=16)
Chantaphakul, Wang DY, Lobo RC, Navarro-Locsin G, Poblete D. et. al. Current perspectives on the management of
allergic rhinitis in selected Asia-Pacific countries: a meeting report. Drugs Context. 2022;11:2022-5-3.
https://doi.org/10.7573/dic.2022-5-3

26. BILASTINE: Immediate AR
Symptom Control
Hashiguchi K et. al. Allergol Int. 2017

27. Bachert C. et al.; Allergy, 2009.
BILASTINE: Effectively Improves Sleep
& Quality of Life

28. New Classification of Antihistamines Based
on Brain H1 Receptor Occupancy
Kawauchi H et al Int J Mol Sci 2019:20

29. -Vigilance and tracking test
(VisTrack)
24 healthy male volunteers
Reduced pressure to
75.2 kPa 30 min after
drug administration -Multi Attribute Task
Battery (MATS)
-Stanford Sleepiness
Scale (SSS)
Tests
Tested Placebo, Bilastine
20 mg, Hydroxyzine 50mg
basal 1 2 3 5 6
Time after treatment (h)
basal
Time after treatment (h)
1 2 3 5 6 basal 1 2 3 5 6
Time after treatment (h)
VisTrack MAT
S
SSS
Placebo Bilastine Hydroxyzine
Valk PJL, Simons R, Jetten AM, Valiente R, Labeaga L.. Aerosp Med Hum Perform. 2016; 87(7):622–627.
Bilastine in Simulated Cabin Altitude
Test (BISCAT)

30. BILASTINE: Safe for Long-Term Treatment
Okubo k et. al. Auris Nasus Larynx. 2017.

31. BILASTINE: No Psychomotor
Impairment During Driving
Demonte A et al. Eur Rev Med. Pharmacol Sci 2018.

32. Safety Studies on Bilastine
Sedation: no sedation at recommended dose (20 mg)
Alcohol interaction: no alcohol interaction at recommended dose
Lorazepam interaction: no interaction at recommended dose
Psychomotor assessment (driving) test: not different from placebo even
up to 2x the recommended dose (40 mg)
Bilastine offers an excellent CNS safety profile

33. BILASTINE: An Ideal Antihistamine

34. Treatment Algorithm for Selecting
Antihistamine for Allergic Rhinitis
Based on ARIA and EAACI/GA(2)LEN/EDF/WAO Guidelines
Recto MT, Gabriel MT, Kulthanan K et al. Selecting optimal second-generation
antihistamines for allergic rhinitis and urticaria in Asia Clin Mol Allergy. 2017; 15(1).

35. Kawauchi H. et. al. Int. J. Mol. Sci. (2019)
✔
✔
✔
✔
✔
✔
BILASTINE HAS THE HIGHEST NUMBER OF ARIA-RECOMMENDED
ANTIHISTAMINE PROPERTIES

36. ✔
✔
✔
✔
Clinically
Relevant Drug
Interaction
BILASTINE HAS THE HIGHEST NUMBER OF ARIA-RECOMMENDED
ANTIHISTAMINE PROPERTIES
Kawauchi H. et. al. Int. J. Mol. Sci. (2019)

37. SUMMARY
• Allergic rhinitis result from interactions between multiple genetic
and environmental factors
• The increase in AR prevalence may be explained by climate
changes and adoption of a pro-allergic lifestyle
• Bilastine is an ideal antihistamine which is truly non-sedating with
high H1-receptor selectivity. Its controls AR symptoms in 30 to 45
minutes and sustained beyond 24 hours in 1 dosing. It also offers
long-term efficacy and safety for 1 year even for special patient
population