{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:26:19Z","timestamp":1787775979287,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bilastine 20 mg daily is a second-generation antihistamine (sgAH) approved for chronic spontaneous urticaria (CSU). Up-dosing to 40 or 80 mg daily is recommended in uncontrolled patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim and Objectives:<\/jats:title>\n                    <jats:p>Evaluating the effectiveness, safety, and tolerability of bilastine at 20, 40, and 80 mg daily in CSU patients uncontrolled with licensed doses of other sgAHs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>In this institution-based, open-label, longitudinal trial, CSU patients were evaluated for demography, angioedema, and symptomatic dermographism. Urticaria disease severity was assessed by urticaria activity score (UAS7) score on days 0, 14, 28, and 42. All patients received bilastine 20 mg daily for two weeks. Non-responders (UAS7 &gt; 0) were up-dosed to 40 or 80 mg. Laboratory tests were conducted at baseline and on day 42.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-five CSU patients (mean age 34.5 years, median duration six months) were included. Bilastine 20 mg reduced mean UAS7 score from 25.7 to 6 at day 14 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), with 16 achieving complete resolution (UAS7 = 0). Among non-responders, up-dosing to 40 mg further reduced UAS7 to 1.9 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), with 15 more patients achieving UAS7 = 0. Only four required 80 mg, showing minimal additional benefit. (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.1). Overall, 94% achieved complete control. Somnolence (22%) and headache (50%) occurred at higher doses, but with good tolerability. A higher baseline UAS7 score increased the odds for up-dosing (OR 1.2,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>Our study is limited by its small sample size, single-center design, and absence of a control group. Additionally, lack of information on prior antihistamine use or compliance may have confounded the assessment of refractoriness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Up-dosing of bilastine is effective, safe, and tolerable in CSU patients uncontrolled with licensed doses of other sgAHs. Almost 90% patients responded to 20\u201340 mg, while 80 mg did not show a significant additional benefit. A higher baseline UAS7 score may indicate the need for up-dosing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/idoj.idoj_7_25","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:00:18Z","timestamp":1772215218000},"page":"220-224","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness, Safety, and Tolerability of Bilastine Up-Dosing in Chronic Spontaneous Urticaria Uncontrolled with Licensed Doses of Other Second-Generation Antihistamines\u2014An Institution-Based, Open-Label, Single-Group Longitudinal Trial"],"prefix":"10.4103","volume":"17","author":[{"given":"Sankha S.","family":"Chakraborty","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Barasat Government Medical College, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9589-083X","authenticated-orcid":false,"given":"Indrashis","family":"Podder","sequence":"additional","affiliation":[{"name":"Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Bankura Samilani Medical College, Bankura, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2553-6453","authenticated-orcid":false,"given":"Arunima","family":"Dhabal","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Jagannath Gupta Institute of Medical Sciences, Kolkata, West Bengal, 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Efficacy of second-line treatments in chronic urticaria refractory to standard dose antihistamines","volume":"15","author":"Kim","year":"2023","journal-title":"Allergy Asthma Immunol Res"},{"key":"R12-20260303","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/cdr.cdr_25_21","article-title":"Comparative clinical assessment of updosing of bilastine and combination of levocetirizine and hydroxyzine in chronic spontaneous urticaria","volume":"6","author":"Shah","year":"2022","journal-title":"Clin Dermatol Rev"},{"key":"R13-20260303","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1016\/j.jaip.2024.05.027","article-title":"Cumulative dose effects of H1 antihistamine use on the risk of dementia in patients with allergic rhinitis","volume":"12","author":"Su","year":"2024","journal-title":"J Allergy Clin Immunol Pract"},{"key":"R14-20260303","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1111\/all.13494","article-title":"Updosing of bilastine is effective in moderate to severe chronic spontaneous urticaria: A real-life study","volume":"73","author":"Weller","year":"2018","journal-title":"Allergy"},{"key":"R15-20260303","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/pai.13325","article-title":"Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria","volume":"32","author":"Sarti","year":"2021","journal-title":"Pediatr Allergy Immunol"},{"key":"R16-20260303","doi-asserted-by":"crossref","first-page":"674","DOI":"10.4103\/ijd.ijd_89_23","article-title":"Real-world indian experience of switchover to bilastine 40 mg\/day in CSU patient refractory to other antihistamines at double dose","volume":"68","author":"De","year":"2023","journal-title":"Indian J Dermatol"},{"key":"R17-20260303","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/all.12171","article-title":"Up-dosing with bilastine results in improved effectiveness in cold contact urticaria","volume":"68","author":"Krause","year":"2013","journal-title":"Allergy"},{"key":"R18-20260303","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1111\/bjd.14768","article-title":"Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria: A systematic review and meta-analysis","volume":"175","author":"Guill\u00e9n-Aguinaga","year":"2016","journal-title":"Br J Dermatol"},{"key":"R19-20260303","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.jaci.2009.11.047","article-title":"The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria","volume":"125","author":"Staevska","year":"2010","journal-title":"J Allergy Clin Immunol"},{"key":"R20-20260303","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1684\/ejd.2024.4600","article-title":"Biomarkers to predict therapeutic response in chronic spontaneous urticaria:A review","volume":"34","author":"Gimenez-Arnau","year":"2024","journal-title":"Eur J Dermatol"}],"container-title":["Indian Dermatology Online Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/idoj.idoj_7_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:47:15Z","timestamp":1787773635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/idoj.idoj_7_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/idoj.idoj_7_25","relation":{},"ISSN":["2229-5178","2249-5673"],"issn-type":[{"value":"2229-5178","type":"print"},{"value":"2249-5673","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"assertion":[{"value":"2025-01-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}