Azelastine nasal spray (
Allergodil((R)), Lastin((R)),
Afluon((R)); Meda AB, Stockholm, Sweden) is a fast-acting, efficacious and well-tolerated H1-receptor antagonist for the treatment of
rhinitis. In addition it 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. Well-controlled studies in patients with
seasonal allergic rhinitis (SAR), perennial
rhinitis (PR) or
vasomotor rhinitis (VMR) confirm that
azelastine nasal spray has a rapid onset of action, and improves nasal symptoms associated with
rhinitis such as nasal congestion and post-nasal drip.
Azelastine nasal spray is effective at the lower dose of 1 spray as well at a dose of 2 sprays per nostril twice daily, but with an improved tolerability profile compared to the 2-spray per nostril twice daily regimen. Compared with intranasal
corticosteroids,
azelastine nasal spray has a faster onset of action and a better safety profile, showing at least comparable efficacy with
fluticasone propionate (
Flonase((R)); GSK, USA), and a superior efficacy to
mometasone furoate (
Nasonex((R)); Schering Plough, USA). In combination with
fluticasone propionate,
azelastine nasal spray exhibits greater efficacy than either agent used alone, and this combination may provide benefit for patients with difficult to treat
seasonal allergic rhinitis. In addition,
azelastine nasal spray can be used on an as-needed basis without compromising clinical efficacy. Compared with oral
antihistamines,
azelastine nasal spray also demonstrates superior efficacy and a more rapid onset of action, and is effective even in patients who did not respond to previous oral
antihistamine therapy. Unlike most oral
antihistamines,
azelastine nasal spray is effective in alleviating nasal congestion, a particularly bothersome symptom for
rhinitis sufferers.
Azelastine nasal spray is well tolerated in both adults and children with
allergic rhinitis. Bitter taste which seems to be associated with incorrect dosing technique is the most common side effect reported by patients, but this problem can be minimized by correct dosing technique.