Intranasal antihistamines as first-line treatment of allergic rhinitis

Azelastine nasal spray, 0.1%, and olopatadine nasal spray, 0.6%, have rapid onsets of action, are well tolerated, and have clinical efficacy for treating allergic rhinitis that is equal or superior to oral second-generation antihistamines.

Both have a significant effect on nasal congestion. Azelastine is also approved for nonallergic rhinitis.

Medications for Allergic Rhinitis (click to enlarge the image).

Older data suggest that intranasal steroids have greater efficacy than nasal antihistamines but more recent comparisons in mild to moderate allergic rhinitis have shown equal or noninferior efficacy.

In addition, the combination of a nasal antihistamine and intranasal steroid may provide additive benefits in more severe rhinitis. Premixed antihistamine-steroid combinations may offer additional benefits in the treatment of mixed (AR/non-AR) rhinitis.

Azelastine. Image source: Wikipedia, public domain.

Olopatadine. Image source: Wikipedia, public domain.

This literature review supports current recommendations for nasal antihistamines as first-line therapy for allergic rhinitis.

Azelastine-Fluticasone nose spray (Dymista) is effective for allergic rhinitis and is awaiting FDA approval ( and


Azelastine and olopatadine in the treatment of allergic rhinitis. Kaliner MA. Ann Allergy Asthma Immunol. 2009 Nov;103(5):373-80.
Combination nose spray azelastine plus fluticasone works better than individual components in allergic rhinitis. JACI, 2012.
Allergic Rhinitis: A Short Review
Mind Maps: Allergic Rhinitis
Mnemonics: Allergic Rhinitis
Image source: Wikipedia, a Creative Commons license.
A 2014 study showed that Dymista (FP and AZE) was twice as effective as AZE or FP for allergic rhinitis, 7 out of 10 patients became symptom-free after 1 month of therapy

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