Cold contact urticaria (CCU) features the itchy wheal and flare responses following the release of histamine and other pro-inflammatory mediators after exposure to cold. The treatment of choice remains nonsedating antihistamines, which can be increased up to fourfold if standard doses are ineffective. The present study assessed the effects of a standard 20 mg dose and up-dosing to 40 and 80 mg of bilastine in reducing the symptoms of CCU and inflammatory mediator release following cold challenge.

The study enrolled 20 patients with CCU and randomized them to a placebo-controlled 12-week study. They received a placebo, 20, 40 or 80 mg of bilastine daily each for 7 days with 14-day washout periods. The study looked for a change in critical temperature thresholds (CTT), pruritus, levels of histamine interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α collected by skin microdialysis, and safety and tolerability of bilastine.

The study observed:

• Bilastine 20 mg to be highly effective in reducing CTT.
• A significant increase in effectiveness after up-dosing bilastine to 80 mg.
• Ninety-five percent of patients responded to treatment, with 60% becoming symptom-free at this dose.
• Only 1 patient refractory to treatment.
• A significant decrease in the microdialysis levels of histamine, IL-6 and IL-8, 1 to 3 hours after the cold challenge following up-dosing with 80 mg bilastine.
• Well tolerance of bilastine treatment without evidence of increased sedation with dose escalation.

This study shows the effectiveness of bilastine in reducing the symptoms of patients with CCU. Increased efficacy of bilastine with fourfold up-dosing comes without sedation and supports the urticaria treatment guidelines.

Source: Krause K, Spohr A, Zuberbier T, et al. Up-dosing with bilastine results in improved effectiveness in cold contact urticaria. Allergy. 2013;68(7):921-8.