Azelastine Nasal Spray

How it works

It antagonises histamine H1 receptors and stabilises mast cells locally in the nasal lining, blunting sneezing, itch, rhinorrhoea and congestion, with a rapid onset of action.

Prescribing in practice

• A bitter or unpleasant taste is the most common and characteristic side effect and the main reason for poor adherence; correct technique reduces it.
• Acts locally with rapid onset and minimal systemic absorption, so systemic sedation is uncommon at recommended use.
• Mild nasal irritation, stinging or epistaxis can occur with topical nasal use.

Monitoring

No laboratory monitoring is needed; review symptom control, inhaler-style technique and local tolerability.

Counselling the patient

• Prime the spray before first use and direct it slightly away from the nasal septum.
• Keep your head tilted forward and avoid sniffing hard to lessen the bitter taste running down the throat.
• Use it regularly through the allergy season rather than only when symptomatic.

Evidence & guidelines

Intranasal antihistamines are recommended in allergic rhinitis guidance as effective options with rapid onset, often combined with an intranasal corticosteroid for more severe symptoms.