Topical antihistamine (H1) Pregnancy: Probably safe topically — minimal systemic absorption. Loratadine or cetirizine preferred if oral antihistamine needed.

Azelastine

Brand names: Rhinolast (nasal spray), Optilast (eye drops), Dymista (with fluticasone propionate)

Adult dose

Dose: Allergic rhinitis (nasal spray 0.1%): 1 spray each nostril BD. Allergic conjunctivitis (eye drops 0.05%): 1 drop into each eye BD; up to QDS if needed.

Route: Nasal / Ophthalmic

Frequency: Twice daily (up to QDS for eyes)

Tilt head slightly forward and breathe out gently when administering nasal spray — reduces taste backflow.

Paediatric dose

Route: Nasal / Ophthalmic

Frequency: BD

Nasal: ≥5 yrs 1 spray each nostril BD. Eye drops: ≥4 yrs 1 drop each eye BD–QDS.

Clinical pearls

Very rapid onset (~15 min) for allergic rhinitis or conjunctivitis — useful for breakthrough symptoms or as monotherapy for mild–moderate disease.
Combination Dymista (azelastine + fluticasone propionate) is more effective than either monotherapy for moderate–severe persistent allergic rhinitis (MP4002 trial) — NICE / BSACI recommend as second-line.
Bitter taste is the leading cause of discontinuation — proper administration technique (head forward, gentle inhalation) significantly reduces this.
Eye drops: instruct patient to wait 10 min before reinserting contact lenses; preservative-free single-use units available for chronic use.
Effective in non-allergic / vasomotor rhinitis as well — unlike oral antihistamines.

Contraindications

Hypersensitivity to azelastine
Children under 4 years (eye drops) or under 5 years (nasal spray)

Side effects

Bitter taste (very common — counsel patient about head-forward technique)
Nasal irritation, epistaxis (mild)
Mild somnolence (less than oral antihistamines but possible)
Transient burning / stinging (eye drops)
Rhinitis, dry mouth

Interactions

Alcohol / CNS depressants: minimal at topical doses but counsel
Other topical antihistamines: avoid combination

Monitoring

Symptom response at 2–4 weeks

Reference: BNFc; BNF 90; SmPC Rhinolast / Optilast / Dymista; BSACI Rhinitis Guideline 2017; MP4002 trial Berger et al. AAAI 2016. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways