Azelastine Nasal Spray is Safe to Use During the COVID-19 Pandemic
Intranasal azelastine is safe to use for allergic rhinitis during the COVID-19 pandemic and may potentially offer additional benefits against SARS-CoV-2 viral replication.
Safety Profile of Azelastine During COVID-19
Azelastine is a second-generation antihistamine available as a nasal spray that is indicated for the treatment of both allergic and vasomotor rhinitis 1. During the COVID-19 pandemic, there has been no evidence suggesting that intranasal antihistamines like azelastine should be discontinued or avoided. In fact:
The American College of Rheumatology's 2020 COVID-19 guidance specifically states that medications like antihistamines may be continued if necessary to control underlying disease, even in patients with asymptomatic or symptomatic COVID-19 infection 2.
Intranasal antihistamines like azelastine are not considered aerosol-generating procedures, and therefore do not increase the risk of viral transmission during administration 2.
Potential Benefits of Azelastine Against SARS-CoV-2
Interestingly, recent research has identified potential antiviral properties of azelastine against SARS-CoV-2:
A 2022 study demonstrated that azelastine inhibits infection by major variants of SARS-CoV-2 in cell cultures and reconstituted human nasal tissue with an EC50 of 2.2-6.5 μM 3.
The same study showed that a five-fold dilution of commercially available azelastine nasal spray (containing 0.02% azelastine) was highly potent in inhibiting viral propagation in reconstituted human nasal tissue 3.
This research suggests azelastine may potentially serve as a topical prevention or treatment against nasal colonization by SARS-CoV-2, though this is not yet part of official treatment guidelines.
Clinical Efficacy for Allergic Rhinitis
Azelastine remains an effective treatment for allergic rhinitis during the pandemic:
Intranasal antihistamines like azelastine are effective for seasonal and perennial allergic rhinitis, with a rapid onset of action (within 15 minutes) 2, 4.
Azelastine is particularly effective for symptoms such as sneezing, rhinorrhea, and nasal pruritus 5.
Unlike many oral antihistamines, azelastine nasal spray has been shown to reduce nasal congestion in some studies 5.
Administration and Dosing During the Pandemic
Standard dosing of azelastine nasal spray is 1-2 sprays per nostril twice daily 1.
Continuous use is most effective for seasonal and perennial allergic rhinitis, but on-demand use is also appropriate due to its rapid onset of action 2, 6.
For patients with severe symptoms, azelastine can be used as adjunctive therapy to oral antihistamines 7.
Potential Side Effects and Precautions
Common side effects of azelastine nasal spray include:
- Bitter taste (19.4% of patients)
- Headache (7.9%)
- Somnolence (3.2%)
- Local nasal irritation 1
These side effects are not known to increase COVID-19 risk or severity.
Conclusion
Patients with allergic rhinitis can safely continue using azelastine nasal spray during the COVID-19 pandemic. There is no evidence that intranasal antihistamines increase the risk of COVID-19 infection or worsen outcomes. In fact, emerging research suggests azelastine may have beneficial effects against SARS-CoV-2, though this requires further clinical validation before becoming part of treatment recommendations.
For optimal symptom control during the pandemic, patients should follow the standard dosing recommendations and can use azelastine either continuously or as needed based on symptom severity.