Does Azelastine Help with Runny Nose?
Yes, azelastine nasal spray is highly effective for treating runny nose (rhinorrhea) in allergic rhinitis, with rapid onset of action within 15 minutes and proven superiority over placebo in reducing nasal symptoms including rhinorrhea. 1, 2
Efficacy for Runny Nose
Azelastine significantly improves runny nose symptoms as demonstrated in multiple controlled trials:
In pivotal FDA trials, azelastine nasal spray significantly reduced the Major Symptom Complex (which includes runny nose/sniffles) compared to placebo, with improvements of 1.35 to 2.03 points greater than placebo (p<0.05) 3
The drug works rapidly, with clinically significant onset of action reported at 15 minutes, making it one of the fastest-acting intranasal medications available 1, 2
Azelastine improved all individual rhinitis symptoms including runny nose in controlled trials, with statistically significant benefits maintained over 2-8 weeks of treatment 4, 5
Dosing Recommendations
For patients ≥12 years with seasonal or perennial allergic rhinitis:
- Azelastine 0.1% (Astelin): 1-2 sprays per nostril twice daily 2
- Azelastine 0.15% (Astepro): 1-2 sprays per nostril twice daily 2
The 1-spray per nostril twice daily regimen is preferred for most patients because it provides equivalent efficacy with significantly improved tolerability—bitter taste occurs in only 8.3% (vs 19.7% with 2 sprays) and somnolence in only 0.4% (vs 11.5% with 2 sprays) 6
Combination Therapy for Severe Symptoms
For patients with moderate-to-severe seasonal allergic rhinitis who remain symptomatic on monotherapy:
Combining azelastine with fluticasone propionate nasal spray provides greater symptom reduction than either agent alone, with 40% relative improvement over monotherapy 1
In clinical trials, combination therapy reduced Total Nasal Symptom Scores by 5.31-5.7 points compared to 3.25-4.54 for azelastine alone and 3.84-5.1 for fluticasone alone 1
This combination is particularly beneficial for patients who failed previous oral antihistamine therapy 1
Important Safety Considerations
Counsel patients about these common adverse effects:
Bitter taste is the most common side effect (8.3-19.7% depending on dose), but can be minimized with correct dosing technique—patients should keep their head tilted forward during administration 7, 6
Somnolence occurs in 0.4-11.5% of patients (dose-dependent), which is generally mild and comparable to placebo in recent studies using the 1-spray regimen 1, 2, 6
Patients should be cautioned about potential drowsiness when initiating therapy, particularly if operating machinery or driving 1, 2
Clinical Advantages Over Other Treatments
Azelastine offers distinct benefits compared to alternatives:
Faster onset than oral antihistamines: Works within 15 minutes vs hours for oral agents 1, 2
Effective for nasal congestion: Unlike most oral antihistamines, azelastine relieves congestion in addition to runny nose, sneezing, and itching 7, 8
Works in oral antihistamine failures: Patients with seasonal allergic rhinitis who remained symptomatic on fexofenadine showed significant improvement when switched to azelastine 1
Can be used as-needed: Maintains efficacy with intermittent dosing for patients with episodic symptoms 7