Azelastine and fluticasone nasal spray is a prescription medication formulated to manage symptoms of allergic rhinitis in adults and children six years of age and older. This treatment uniquely combines two distinct classes of medicine into a single device, offering a multi-faceted approach to allergy relief. The two active components are azelastine hydrochloride, which is an antihistamine, and fluticasone propionate, a corticosteroid. This combination is designed to alleviate the uncomfortable nasal symptoms caused by environmental allergens through both immediate and long-term action.
The Dual Mechanism of Action
The effectiveness of this combination spray stems from the complementary actions of its two components, each targeting a different part of the allergic response. Azelastine hydrochloride acts rapidly as a selective H1-receptor antagonist, quickly blocking the effects of histamine. Histamine is a chemical messenger released by the immune system that causes immediate allergy symptoms like sneezing, itching, and a runny nose. By blocking H1 receptors, azelastine provides relief from these acute symptoms, often within minutes of administration, and also exhibits secondary anti-inflammatory properties by inhibiting other inflammatory mediators.
Fluticasone propionate, a synthetic glucocorticoid, targets the underlying inflammatory process that causes chronic symptoms. This corticosteroid binds to specific glucocorticoid receptors within the nasal lining, suppressing the activity of multiple inflammatory cells, including mast cells, eosinophils, and lymphocytes. Fluticasone reduces swelling and congestion in the nasal passages by blocking the release of inflammatory substances such as prostaglandins, cytokines, and leukotrienes.
Because this component works to resolve inflammation at a cellular level, its full therapeutic benefit is not immediate and may take several days of consistent use to achieve maximum effect. Combining these two agents results in a superior clinical outcome compared to using either monotherapy alone. The azelastine component delivers fast relief, while the fluticasone component provides sustained control over nasal congestion and chronic inflammation. This dual-action approach treats both the immediate and delayed phases of the allergic response.
Approved Conditions for Treatment
The primary purpose of this combination nasal spray is the management of allergic rhinitis, commonly known as hay fever. This condition involves the inflammation of the nasal passages caused by an overreaction of the immune system to typically harmless substances. The formulation is officially approved for treating both seasonal and perennial forms.
Seasonal allergic rhinitis refers to symptoms that occur during specific times of the year, typically triggered by outdoor allergens like pollen from trees, grasses, and weeds. In contrast, perennial allergic rhinitis causes symptoms year-round because the triggers are constant, such as dust mites, mold spores, or pet dander found indoors. The dual mechanism of the medication is effective against the symptoms of both types of allergies, regardless of the specific trigger.
Correct Usage and Administration Technique
Proper administration is necessary to ensure the medication reaches the nasal lining for maximum effectiveness. Before the very first use, or if the bottle has not been used for 14 days or more, the device must be primed. Priming involves gently shaking the bottle and releasing sprays into the air—usually six initially—until a fine mist is visible. Before each dose, gently shake the bottle and clear the nasal passages by lightly blowing the nose.
To spray, tilt the head slightly forward and insert the nozzle tip just inside one nostril. Angle the tip away from the nasal septum (the wall that divides the nostrils) to prevent irritation and potential nosebleeds. The nozzle should be aimed slightly toward the ear or the side of the nose. While spraying, gently inhale through the nose to draw the mist toward the back of the nasal cavity without sniffing too hard.
The recommended dosage is typically one spray into each nostril twice a day, and this schedule should be followed consistently. Since fluticasone requires time to build its anti-inflammatory effects, regular, daily use is necessary, even when symptoms seem minimal. After use, wipe the nozzle clean with a dry tissue before replacing the cap, and do not blow the nose for at least 15 minutes to allow the medication to absorb.
Key Warnings and Potential Adverse Reactions
Users should be aware of potential side effects, although the combination spray is generally well-tolerated. A frequently reported side effect is a bitter or unpleasant taste, associated with the azelastine component. Other local reactions include nasal irritation, dryness, and nosebleeds (epistaxis).
The azelastine component can sometimes lead to drowsiness, so patients should exercise caution when driving or operating machinery until they understand how the medication affects them. In rare instances, particularly with long-term use, fluticasone can cause local side effects such as sores inside the nose or a whistling sound from nasal septal perforation. More serious warnings relate to the potential for systemic absorption, which can rarely lead to adrenal gland suppression or eye problems like glaucoma or cataracts.
Patients with pre-existing eye conditions, such as glaucoma or cataracts, should discuss these concerns with their healthcare provider before starting treatment. It is also important to notify a doctor if a wound or sore inside the nose does not heal, as corticosteroids can impair the natural healing process.