Hallucinations associated with bilastine in a teenager: case report and disproportionality analysis in VigiBase®.

Bilastine is a second-generation H1-antihistamine considered to have minimal central nervous system penetration and low anticholinergic activity. Neuropsychiatric adverse drug reactions (ADRs), including hallucinations, are not expected with bilastine, although such reactions have been reported with other second-generation antihistamines (sgAH). We report the case of a 13-year-old girl who developed visual hallucinations and panic attacks shortly after starting treatment with bilastine, after having experienced a recurrent sensation of presence while taking desloratadine. The patient's symptoms resolved progressively after discontinuation of bilastine, with a Naranjo score of 6 indicating probable causality. VigiBase® analysis was also performed and identified a possible association between bilastine and hallucinations. This case, supported by pharmacovigilance data, although predominantly in older adults, suggests a potential pharmacovigilance signal with possible association between bilastine and hallucinations. Furthermore, similar neuropsychiatric ADRs have been reported with other second-generation antihistamines. Clinicians should be aware of this rare but potentially distressing ADR to ensure prompt recognition and discontinuation of treatment.