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Patient’s Collection Form

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Doctor Name *

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Doctor Name *

@endif

ID No.*

Initial diagnosis of urticaria is based on*

A. Clinical examination

B. IgE levels

C. Blood tests

D. Serum skin tests

What is the most common age group affected by chronic urticaria*

A. < 15 years

B. 15-30 years

C. 30-50 years

D. 50 years and above

For how many weeks standard dose of anti-histamine is prescribed as initial therapy in the management of urticaria?*

A. 4-6 weeks

B. 6-12 weeks

C. 12-18 weeks

D. More than 18 weeks

In patients who does not respond to standard dose of anti-histamines, what is your next step?*

A. Double dose of anti-histamines

B. Anti-histamines plus cyclosporine

C. Anti-histamines plus omalizumab

D. Omalizumab plus cyclosporine

According to you, what are the main advantages of bilastine?*

A. Non- sedative property

B. Efficacy similar to levo-cetirizine

C. No drug- drug interaction

D. All of the above

Overall based on real life experience, how patient of bilastine does?*

A. Very much improved

B. Improved

C. Unchanged

D. Minimally Worse

E. Worse

How is the tolerability of bilastine?*

A. Very well tolerated

B. Well tolerated

C. Not well tolerated

D. Serious side effects are reported frequently

What are the main side effects of bilastine?*