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Urticaria is a disabling condition, resulting in an impaired quality of life and sleep disruption, and can have an adverse impact on work-related or school-related performance and attendance. It is defined according to the presence of unknown (chronic spontaneous urticaria) or known (inducible urticaria) eliciting factors. Guidelines recommend second-generation H 1 -antihistamines for the first-line treatment of urticaria. Bilastine is indicated in adults, adolescents (aged ≥12 years) and children (aged ≥2 years (Mexico and some African countries), ≥4 years (Canada) or ≥6 years (Europe)) with a body weight of at least 20 kg for the symptomatic treatment of urticaria and allergic rhino-conjunctivitis. The aim of the Original Real-world cases of Bilastine In Treatment (ORBIT) study was to review real-world cases from across the Asia-Pacific region supported by evidence-based literature. Eight diverse, real-world, difficult-to-treat cases with urticaria in people aged 10-75 years are presented. Once-daily bilastine (20 mg (adults/adolescents) or 10 mg (children)) was found to be well tolerated and effective in the long-term management of chronic spontaneous urticaria and inducible urticaria., Competing Interests: Disclosure and potential conflicts of interest: WKC has served as an advisory board member for A. Menarini and been a speaker for and received honoraria from Johnson & Johnson, Novartis and A. Menarini. HTN served as an advisory board member and speaker, receiving honoraria from Novartis, Janssen and A. Menarini. MTR disclosed non-financial interests for A. Menarini for acting as an advisory board member and speaker, has received support from A. Menarini for registration at conventions, and is the immediate Past President of the Philippine Society of Allergy, Asthma and Immunology (unpaid). CCC received an honorarium from A. Menarini. MTG received honoraria from A. Menarini for lectures and has acted in an unpaid role on an advisory board for A. Menarini. KG has received honoraria from A. Menarini and received support from A. Menarini for the present manuscript. WM received support from A. Menarini for writing the present manuscript, has received honoraria from A. Menarini for lectures and panel discussion, and from GlaxoSmithKline, Organon and AstraZeneca for lectures, and has received registration support from GlaxoSmithKline and Organon for attending virtual academic meetings. AWMC and WHC had no conflicts of interest to disclose. DN is an employee of A. Menarini. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/03/dic.2021-12-2-COI.pdf, (Copyright © 2022 Cheong WK, Chan AWM, Ch’ng CC, Chung WH, Gabriel MT, Godse K, Mitthamsiri W, Nguyen HT, Tiongco-Recto M, Nagrale D.)