From the Guidelines
For most people with allergic rhinitis, Flonase (fluticasone) is generally recommended as the first-line treatment over Azelastine. This is based on the most recent and highest quality study, which found that intranasal corticosteroids, such as fluticasone, are the most effective medication class for controlling symptoms of allergic rhinitis 1.
Key Differences Between Azelastine and Flonase
- Flonase is a corticosteroid nasal spray that reduces inflammation in the nasal passages, addressing the underlying cause of allergy symptoms, whereas Azelastine is an antihistamine nasal spray that works faster but may cause drowsiness in some people.
- Flonase is effective for multiple symptoms including congestion, sneezing, and itching, and is available over-the-counter for long-term use if needed.
- Azelastine is typically prescribed if Flonase alone is not sufficient, and can be used in combination with Flonase for added benefit, as shown in studies that compared the efficacy of combination therapy with an intranasal antihistamine and an intranasal corticosteroid compared with monotherapy with either agent for initial treatment of nasal symptoms in persons aged 12 years or older with seasonal allergic rhinitis 1.
Treatment Recommendations
- Start with Flonase nasal spray, using 1-2 sprays in each nostril once daily, and use consistently for at least 1-2 weeks to see full benefit.
- If symptoms persist after 2 weeks of consistent Flonase use, consider adding Azelastine or consult a healthcare provider about combining treatments.
- Both medications are generally safe and effective, but Flonase's broader action and convenience make it the preferred initial choice for most allergy sufferers.
From the Research
Comparison of Azelastine and Flonase (Fluticasone)
- Azelastine is a fast-acting, efficacious, and well-tolerated H1-receptor antagonist for the treatment of rhinitis, with mast-cell stabilizing and anti-inflammatory properties 2.
- Flonase (Fluticasone) is an intranasal corticosteroid, which has a slower onset of action compared to azelastine nasal spray 2.
- Azelastine nasal spray has a faster onset of action and a better safety profile compared to fluticasone propionate (Flonase) 2.
- In combination with fluticasone propionate, azelastine nasal spray exhibits greater efficacy than either agent used alone, and this combination may provide benefit for patients with difficult to treat seasonal allergic rhinitis 2.
Efficacy of Azelastine
- Azelastine nasal spray is effective at a dose of 1 spray per nostril twice daily, with improved tolerability compared to 2 sprays per nostril twice daily 3.
- Azelastine nasal spray at a dose of 0.15% or 0.10% significantly improved nasal symptoms associated with seasonal allergic rhinitis, with an onset of action within 30 minutes 4.
- Azelastine nasal spray was well tolerated in both adults and children with allergic rhinitis, with bitter taste being the most common side effect reported by patients 2, 4, 3.
Comparison with Other Treatments
- Azelastine nasal spray was more effective than oral cetirizine in improving total nasal symptom score and quality of life in patients with seasonal allergic rhinitis 5.
- Azelastine nasal spray was effective in improving rhinitis symptoms in patients who remained symptomatic after treatment with fexofenadine 6.