Introduction

Allergic rhinitis (AR) affects up to 10-30% of adults and 40% of children worldwide, with India reporting a prevalence of 20%–30%. Triggered by allergen‑induced IgE‑mediated inflammation, AR causes nasal symptoms such as sneezing and blockage, along with systemic effects like headache, sleep issues, and eye irritation. It is classified into four types based on severity and duration. AR increases asthma risk and imposes significant economic burden. Standard treatments include intranasal corticosteroids, antihistamines, and leukotriene receptor antagonists. Bilastine and montelukast offer complementary benefits, and their combination may improve outcomes, though Indian clinical practice data remain limited.

Aim

To investigate the clinical practice pattern of the Indian physicians and understand the role of a combination of bilastine and montelukast in the management of allergic rhinitis (AR).

Method

Study Design

Treatment Strategy 

• This digital survey was conducted across 19 Indian states from May to October 2024, involving 445 healthcare professionals (HCPs) including ENT surgeons, consulting physicians, and chest physicians
• Using convenience sampling, only clinicians experienced in treating allergic rhinitis (AR) were included
• A validated 15‑item questionnaire assessed AR prevalence, symptoms, diagnostics, and perceptions of bilastine–montelukast combination therapy
• Participants provided digital consent and completed the survey independently
• Data were collected electronically and analyzed using descriptive statistics

Results

• About 43.12% of the HCPs were in the age group of 31-40 years and 38% had a clinical experience of more than 10-20 years
• Among the HCPs, 39.91% were ENT surgeons, 20.86% were chest physicians and 17.9% were consulting physicians   
• The prevalence of AR of 21-30% was reported by 40% 
• About 38% reported that concomitant asthma was prevalent in 10-20% of the AR patients
• Sneezing was the most reported bothersome AR symptom as seen in Figure 1.

Figure 1. Most often reported bothersome symptom of AR

• A skin prick test was recommended in patients with mild severe or persistent or recurrent AR by 56.4%, whereas 44.27% recommended the test before initiating the allergen immunotherapy
• Antihistamines were preferred by 45.39%, while 53.71% favored a combination of antihistamines and leukotriene receptor antagonists for moderate intermittent/persistent AR
• Approximately 87% of HCPs preferred the bilastine-montelukast combination for AR management
• The reason for preferring oral antihistamine in combination with montelukast by the HCPs is shown in Table 1.

Table 1. The preferred oral antihistamine and reason as reported by the HCPs 

• Bilastine was preferred in combination with montelukast by 81% mainly due to its nonsedative properties, cardiac safety, and compatibility with renal or hepatic impairments
• Around 61% supported its use for various AR patient profiles, including those with asthma, mild-to-moderate AR with any cardiac or renal dysfunction, moderate-to-severe AR not controlled with intranasal corticosteroids, mild-to-moderate intermittent AR, and persistent AR
• The ideal duration of this combination reported by 44% was 3–4 weeks
• About 88.87% were satisfied with the efficacy of bilastine-montelukast combination for managing AR, with 48.99% and 39.78% reporting satisfaction and high satisfaction respectively
• Overall, 92.36% expressed satisfaction with this combination’s safety, with 50.79% and 41.57% being satisfied and very satisfied with the treatment respectively
• Gastrointestinal disturbances were the most common adverse effect followed by fatigue and headache
• Neuropsychiatric events were also cited as an AE seen in patients by 6.74% of the HCPs

Conclusion

• Most physicians prefer the combination of bilastine and montelukast for managing allergic rhinitis due to their nonsedative properties, superior control of nasal congestion, cardiac safety, and compatibility for patients with renal or hepatic impairments
• The overall satisfaction of the physicians regarding the efficacy and safety of this treatment was high, highlighting it as a good option for managing AR

J Assoc Chest Physicians 2025;13:203-11.