Summary: Second-generation antihistamines are the most important group of pharmaceuticals used for treatment of allergic diseases. They are characterized by selective antagonism against histamine H1 receptors, high effectiveness and a high safety profile in relation to first-generation antihistamines. Even in the group of second-generation antihistamines, the main substances' pharmacokinetic and pharmacodynamic properties can differ from one another. Bilastine is a highly effective H1-antihistamine even when used up to a fourfold dose, which is recommend by the EAACI/GA2LEN/EDF/WAO guidelines for the management of difficult-to-treat urticaria. Bilastin is classified among non-brain-penetrating antihistamines, thus it does not affect psychomotor ability and does not cause sedation and sleepiness. These properties are also very important for the pediatric population, in which the safety and effectiveness of a dose of 10 mg bilastin per day has been proven.