From the Guidelines
Nasal sprays for allergies are most effectively treated with a combination of an intranasal corticosteroid and an intranasal antihistamine, as recommended for moderate to severe seasonal allergic rhinitis in persons aged 12 years or older.
Key Points to Consider
- The most effective medication class for controlling symptoms of allergic rhinitis is intranasal corticosteroids, which can be used as initial treatment without a previous trial of antihistamines and/or oral decongestants 1.
- Intranasal antihistamines, such as azelastine (Astelin), can be used as an alternative for first-line treatment of allergic and nonallergic rhinitis, and may be considered for initial treatment without a previous trial of antihistamines and/or oral decongestants 1.
- The combination of an intranasal corticosteroid and an intranasal antihistamine may provide additive benefits for treating moderate to severe seasonal allergic rhinitis in persons aged 12 years or older 1.
Treatment Recommendations
- Start with a steroid nasal spray such as fluticasone (Flonase), mometasone (Nasonex), or triamcinolone (Nasacort), which are available over-the-counter.
- Use 1-2 sprays in each nostril once daily, ideally at the same time each day.
- For faster relief, consider adding an antihistamine nasal spray like azelastine (Astelin), which requires a prescription.
- Saline nasal sprays can also help flush allergens and thin mucus.
Administration Instructions
- When using any nasal spray, tilt your head slightly forward, aim toward the outer wall of the nostril, and avoid sniffing forcefully after spraying.
- Steroid nasal sprays work by reducing inflammation in nasal passages, while antihistamines block histamine receptors that trigger allergy symptoms.
- For best results, start using these sprays before allergy season begins and continue throughout the season.
From the FDA Drug Label
Astelin® Nasal Spray is indicated for the treatment of the symptoms of seasonal allergic rhinitis such as rhinorrhea, sneezing, and nasal pruritus in adults and children 5 years and older, and for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older.
Azelastine nasal spray is used to treat symptoms of allergic rhinitis, including:
- Rhinorrhea
- Sneezing
- Nasal pruritus It is indicated for use in adults and children 5 years and older for seasonal allergic rhinitis, and in adults and children 12 years and older for vasomotor rhinitis 2.
From the Research
Nasal Sprays for Allergies
- Nasal sprays are a common treatment for allergic rhinitis, with various options available, including azelastine and fluticasone propionate 3, 4.
- Azelastine nasal spray has been shown to be effective in reducing nasal symptoms associated with rhinitis, such as nasal congestion and post-nasal drip, with a rapid onset of action and a good safety profile 3.
- Fluticasone propionate nasal spray is also effective in treating allergic rhinitis, with its efficacy resulting from direct topical effects rather than systemic absorption 4.
- Intranasal corticosteroids, including fluticasone propionate, are considered safe and effective first-line therapy for allergic rhinitis, relieving symptoms such as nasal congestion, itching, rhinorrhea, and sneezing 5.
Comparison of Azelastine and Fluticasone Nasal Sprays
- A study comparing the effects of azelastine and fluticasone nasal sprays in patients with allergic rhinitis found that both had comparable efficacy in symptom control, with azelastine having fewer side effects 6.
- Another review compared once-daily intranasal corticosteroids, including fluticasone propionate, and found that they are similar in terms of efficacy and safety, but may differ in patient preference, cost, and safety during pregnancy 7.
Key Findings
- Azelastine nasal spray is effective and well-tolerated, with a rapid onset of action and a good safety profile 3.
- Fluticasone propionate nasal spray is effective in treating allergic rhinitis, with its efficacy resulting from direct topical effects rather than systemic absorption 4.
- Intranasal corticosteroids, including fluticasone propionate, are considered safe and effective first-line therapy for allergic rhinitis 5.
- Azelastine and fluticasone nasal sprays have comparable efficacy in symptom control, with azelastine having fewer side effects 6.