From the Guidelines
Intranasal antihistamines, including azelastine (Astelin, Astepro) and olopatadine (Patanase), are effective treatments for allergic rhinitis, providing rapid relief from symptoms such as sneezing, itching, runny nose, and nasal congestion. These medications work by blocking histamine receptors in the nasal passages, and are generally well-tolerated, though some patients may experience bitter taste, headache, or mild sedation 1.
Key Characteristics of Intranasal Antihistamines
- Azelastine (Astelin, Astepro) is available in 0.1% and 0.15% solutions, with dosing ranging from 1-2 sprays per nostril twice daily, depending on age and formulation 1.
- Olopatadine (Patanase) is available as a 0.6% solution, with dosing of 2 sprays per nostril twice daily for adults and children aged 12 and older, and 1 spray per nostril twice daily for children aged 6-11 1.
- Azelastine plus fluticasone (Dymista) is a combination product, with dosing of 1 spray per nostril twice daily for adults and children aged 12 and older 1.
Efficacy and Safety
- Intranasal antihistamines have been shown to be effective in reducing symptoms of allergic rhinitis, with a rapid onset of action, often within 15-30 minutes 1.
- They are generally less effective than intranasal corticosteroids, but may be preferred for their faster onset of action and fewer systemic side effects 1.
- Common side effects include bitter taste, headache, and mild sedation, with somnolence rates ranging from 0.9-11.5% 1.
Clinical Use
- Intranasal antihistamines can be used alone or in combination with intranasal corticosteroids for enhanced symptom control, and are appropriate for adults and children (age restrictions vary by product) 1.
- They are particularly useful for patients who need quick symptom relief or have inadequate response to other allergy treatments, and can be used as first- or second-line therapy 1.
From the FDA Drug Label
Astelin® (azelastine hydrochloride) Nasal Spray, 137 micrograms (mcg), is an antihistamine formulated as a metered-spray solution for intranasal administration. The list of intranasal antihistamines includes:
- Azelastine 2 Note that this list may not be exhaustive, as the provided information only mentions azelastine.
From the Research
Internasal Antihistamines
- Azelastine nasal spray: a fast-acting, efficacious and well-tolerated H1-receptor antagonist for the treatment of rhinitis, with a rapid onset of action and flexibility of both dose and dosage 3, 4, 5, 6, 7
- Olopatadine nasal spray: has rapid onset of action, is well tolerated, and has clinical efficacy for treating allergic rhinitis that is equal or superior to oral second-generation antihistamines 6
Key Characteristics of Azelastine Nasal Spray
- Rapid onset of action (15 min) 4
- Flexible dosing (one or two sprays/nostril twice daily) 4
- Effective in alleviating nasal congestion, a symptom that distinguishes it from oral antihistamines 3, 5, 6
- Well tolerated in both adults and children with allergic rhinitis 3, 5
- Can be used on an as-needed basis without compromising clinical efficacy 3