What is an example of an antihistamine nasal spray?

From the Guidelines

Azelastine is the most effective antihistamine nasal spray for treating allergic rhinitis symptoms, with a recommended dose of 1-2 sprays in each nostril twice daily, as supported by the most recent study from 2017 1.

Key Points to Consider

• Azelastine is available as a prescription medication under brand names like Astelin and Astepro.
• It works by blocking histamine receptors in the nasal passages, reducing sneezing, itching, and runny nose.
• Unlike oral antihistamines, nasal sprays work directly at the site of inflammation, providing faster relief with fewer systemic side effects.
• Some patients may experience a bitter taste, mild nasal irritation, or drowsiness.
• For maximum effectiveness, use consistently as prescribed, even when symptoms improve, and clean the nozzle regularly to prevent clogging.
• If symptoms persist beyond 2-3 weeks of regular use, consult your healthcare provider as you may need additional treatment.

Administration and Side Effects

• Gently blow your nose before use, shake the bottle, tilt your head slightly forward, and spray while breathing in gently through your nose.
• Common side effects include bitter taste, epistaxis, somnolence, and headache, as reported in studies 1.
• The combination of an intranasal corticosteroid and an intranasal antihistamine, such as azelastine, may be recommended for initial treatment of moderate to severe seasonal allergic rhinitis in persons aged 12 years or older, as suggested by the 2017 Joint Task Force on Practice Parameters 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. Azelastine hydrochloride exhibits histamine H1 -receptor antagonist activity in isolated tissues, animal models, and humans. Each spray delivers a 0.137 mL mean volume containing 137 mcg of azelastine hydrochloride (equivalent to 125 mcg of azelastine base). The antihistamine nasal spray example is azelastine hydrochloride, which is administered intranasally and exhibits histamine H1-receptor antagonist activity. The spray delivers 137 mcg of azelastine hydrochloride per spray 2.

From the Research

Antihistamine Nasal Spray Example

• Azelastine nasal spray is a topical second-generation antihistamine used to treat symptoms of seasonal allergic rhinitis, seasonal allergic rhinitis with nonallergic triggers, and nonallergic vasomotor rhinitis 3.
• It has been shown to be effective in controlling rhinitis symptoms, including nasal congestion, regardless of rhinitis diagnosis 3, 4.
• Azelastine nasal spray has a rapid onset of action and is well tolerated, with a discontinuation rate due to adverse events of 2.3% 3.
• It has been compared to other treatments, such as fluticasone nasal spray, and has been found to have comparable efficacy in symptom control in patients with allergic rhinitis 5.
• Azelastine nasal spray may be considered a safer replacement to fluticasone for long-term use in patients with allergic rhinitis due to its lesser side effects 5.
• It is also approved for nonallergic rhinitis and has been shown to have a clinically significant effect on nasal congestion 6.

Mechanism of Action

• Azelastine is a potent H(1)-antihistamine that has effects on cytokines, adhesion molecules, and inflammatory cells 4, 7.
• It has been shown to downregulate intercellular adhesion molecule-1 expression and reduce inflammatory cell migration in patients with rhinitis 7.
• Azelastine nasal spray has a rapid onset of action, which is likely due to its topical activity 7.

Clinical Efficacy

• Azelastine nasal spray has been shown to improve nasal symptoms of rhinitis, including congestion and postnasal drip, in patients with seasonal allergic rhinitis and nonallergic vasomotor rhinitis 3, 7.
• It has been found to be effective in patients who have not responded adequately to oral antihistamines 4, 7.
• Azelastine nasal spray in combination with fluticasone nasal spray has been shown to provide significantly greater relief than either agent alone in patients with seasonal allergic rhinitis 7.