Expert opinion on the role of bilastine and bilastine-montelukast combination in the management of allergic rhinitis: An Indian perspective

In India, the burden of allergic rhinitis (AR) is enormous, comprising 55% of all patients with allergies. Intranasal corticosteroids are the recommended first-line therapy for patients with moderate-to-severe AR, particularly when nasal congestion is the predominant symptom. However, second-generation antihistamines are the first line of treatment in mild AR and effectively improve symptoms, such as sneezing, itching, and rhinorrhoea. Bilastine is a second-generation H1-antihistamine indicated for the symptomatic treatment of allergic rhinoconjunctivitis in adults and adolescents over 12 years of age. Though it is an effective individual molecule for the management of AR, studies have shown that synergistic combination therapy of bilastine-montelukast has a dual action on early- and late-phase allergic reactions in AR patients with concomitant asthma. An advisory board meeting was conducted (on a virtual platform) to gain insights from Indian experts on the following: (i) burden of AR and AR with concomitant asthma in Indian settings; (ii) current unmet needs; and (iii) role and positioning of bilastine and bilastine plus montelukast combination in the management of AR and AR with concomitant asthma in adults and adolescents over 12 years of age. The experts shared their opinions based on the available scientific evidence and/or clinical expertise or experience. In this article, we have summarized the highlights of the expert panel discussion and available evidence for each of these topics.