Abstract:
This case study highlights the successful management of Chronic Spontaneous Urticaria (CSU) using Bilastine, a potent, non-sedating second-generation H1-antihistamine with a superior safety and tolerability profile. A 43-year-old female executive with a three-month history of recurrent generalized hives, pruritus, and intermittent angioedema—unresponsive to fexofenadine, levocetirizine, and hydroxyzine—presented with a baseline UAS7 score of 24, indicating poorly controlled CSU. Initiation of Bilastine 40 mg once daily resulted in consistent clinical improvement, with UAS7 scores declining to 13 in month 1, 9 in month 2, and 2 in month 3, followed by a sustained remission (UAS7 = 0) for the subsequent three months. The drug was gradually tapered to 20 mg, and therapy was discontinued after six months without relapse. Importantly, the patient reported no sedation, cognitive impairment, or performance limitations, underscoring Bilastine’s unique CNS-sparing profile. This clinical outcome aligns with guideline recommendations supporting up-dosing of second-generation antihistamines in refractory CSU and reinforces Bilastine’s role as an ideal first-line and long-term therapy, given its high H1-receptor selectivity, absence of anticholinergic or cardiotoxic effects, no hepatic metabolism, and excellent safety even at higher doses. This case exemplifies the efficacy and tolerability of Bilastine in achieving rapid control and sustained remission in moderate-to-severe CSU.
The complete case details, including monthly UAS7 progress and clinical commentary, are available in the attached PDF.
