What is the use of azelastine (Astelin) nasal spray?

From the Guidelines

Azelastine nasal spray is an effective treatment for seasonal and perennial allergic rhinitis, with a recommended dosage of 1-2 sprays in each nostril twice daily for adults and 1 spray per nostril twice daily for children 5-11 years old. The medication works by blocking histamine receptors in the nasal passages, reducing inflammation and symptoms like sneezing, itching, and runny nose 1. It typically begins working within 30 minutes and provides relief for up to 12 hours. Common side effects include bitter taste, drowsiness, headache, and nasal irritation 1. Azelastine can be used long-term without rebound congestion, making it suitable for ongoing allergy management.

Key Points:

• Azelastine nasal spray is effective for treating nasal symptoms of seasonal and perennial allergic rhinitis 1
• The standard adult dosage is 1-2 sprays in each nostril twice daily, while children 5-11 years old usually receive 1 spray per nostril twice daily 1
• Common side effects include bitter taste, drowsiness, headache, and nasal irritation 1
• Azelastine works by blocking histamine receptors in the nasal passages, reducing inflammation and symptoms like sneezing, itching, and runny nose 1
• It can be used long-term without rebound congestion, making it suitable for ongoing allergy management 1

Administration:

• Prime the pump before first use by pressing 4 times, and if unused for 3 days, reprime with 2 sprays 1
• Clear your nasal passages first, tilt your head slightly forward, insert the tip into your nostril away from the septum, and spray while breathing in gently through your nose 1

Comparison to Other Treatments:

• Azelastine is less effective than intranasal corticosteroids but can be used as an alternative for first-line treatment of allergic and nonallergic rhinitis 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 1
• Azelastine can be used in conjunction with other medications, such as leukotriene receptor antagonists, for patients with concurrent diagnoses of mild persistent asthma 1

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 indicated for:

• Treatment of seasonal allergic rhinitis symptoms in adults and children 5 years and older
• Treatment of vasomotor rhinitis symptoms in adults and children 12 years and older 2

From the Research

Azelastine Nasal Spray Efficacy

• Azelastine nasal spray is a fast-acting, efficacious, and well-tolerated H1-receptor antagonist for the treatment of rhinitis, with a rapid onset of action and improved nasal symptoms associated with rhinitis, such as nasal congestion and post-nasal drip 3.
• The spray has been shown to be effective at a dose of 1 spray per nostril twice daily, with an improved tolerability profile compared to the 2-spray per nostril twice daily regimen 4.
• Azelastine nasal spray exhibits superior efficacy to oral antihistamines, such as desloratadine and cetirizine, and comparable efficacy to the potent intranasal corticosteroid fluticasone propionate 5.

Azelastine Nasal Spray Safety

• The most common side effect reported by patients is bitter taste, which can be minimized by correct dosing technique 3, 4.
• Azelastine nasal spray has an excellent safety profile, with a low incidence of somnolence and other adverse events 5, 4.
• The spray is well tolerated in both adults and children with allergic rhinitis, with no significant differences in safety profile between the 1-spray and 2-spray per nostril twice daily regimens 3, 4.

Azelastine Nasal Spray Mechanism of Action

• Azelastine nasal spray acts as a histamine H1-receptor antagonist, inhibiting the production or release of many chemical mediators of the allergic response, such as leukotrienes, free radicals, and cytokines 6.
• The spray also has mast-cell stabilizing and anti-inflammatory properties, reducing the concentration of leukotrienes, kinins, and platelet activating factor in vitro and in vivo, as well as inflammatory cell migration in rhinitis patients 3.

Azelastine Nasal Spray Dosage and Administration

• The recommended dose of azelastine nasal spray is 1-2 sprays per nostril twice daily, with the option for as-needed use without compromising clinical efficacy 3, 5.
• The spray can be used in combination with other agents, such as fluticasone propionate, to enhance clinical benefit in patients with difficult-to-treat seasonal allergic rhinitis 3, 5.