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Direct Answer
Azelastine nasal spray (brand name Astelin or Astepro) is typically dosed as one or two sprays in each nostril twice daily for adults with allergic rhinitis. For best results, tilt your head slightly forward, aim the spray tip toward the outer wall of your nostril (away from the septum), and breathe in gently. Timing matters—using it consistently morning and evening works better than sporadic use. If azelastine alone is not controlling your symptoms, a board-certified allergist can evaluate whether adding sublingual immunotherapy (SLIT) could treat the root cause of your allergies.
Key Takeaways
- Azelastine is a nasal antihistamine spray — It works directly in the nose to block histamine and reduce sneezing, congestion, runny nose, and post-nasal drip within 15 minutes of use.
- Standard adult dose is 1–2 sprays per nostril, twice daily — The 0.1% formulation (Astelin) and 0.15% formulation (Astepro) have slightly different dosing. Follow your allergist's instructions.
- Technique matters as much as dose — Spraying toward the outer nasal wall (not the septum) improves absorption and reduces side effects like nosebleeds and bitter taste.
- Consistency beats timing — Using azelastine at the same times each day (morning and evening) provides the most reliable symptom control.
- It works faster than nasal steroids — Azelastine provides relief in 15–30 minutes, while nasal corticosteroids can take days to reach full effect. Many allergists recommend using both together.
- For long-term relief, consider SLIT — HeyPak® allergy drops treat the root cause of allergies so you may eventually need fewer medications, including azelastine.
What Is Azelastine and How Does It Work?
Azelastine hydrochloride is a second-generation antihistamine delivered as a nasal spray. Unlike oral antihistamines that travel through your entire body, azelastine works directly on the nasal lining where allergic reactions happen. This targeted approach means faster relief with fewer systemic side effects like drowsiness.
Azelastine blocks H1 histamine receptors in the nasal mucosa, which stops the chain reaction that causes sneezing, itching, runny nose, and congestion. It also has anti-inflammatory and mast cell stabilizing properties, meaning it does more than just block histamine—it helps prevent the release of other inflammatory chemicals as well.
The medication is available in two strengths. Azelastine 0.1% (Astelin) has been available by prescription for years. Azelastine 0.15% (Astepro) is a higher-concentration formulation that became available over the counter in 2022. Both are effective for allergic rhinitis and vasomotor rhinitis (non-allergic rhinitis).
Azelastine Dosing Guide
| Formulation | Age Group | Dose | Frequency |
|---|---|---|---|
| Azelastine 0.1% (Astelin) | Adults and children ≥12 years | 1–2 sprays per nostril | Twice daily |
| Azelastine 0.1% (Astelin) | Children 5–11 years | 1 spray per nostril | Twice daily |
| Azelastine 0.15% (Astepro) | Adults and children ≥12 years | 1–2 sprays per nostril | Twice daily |
| Azelastine 0.15% (Astepro) | Children 6–11 years | 1 spray per nostril | Twice daily |
| Azelastine/fluticasone combo (Dymista) | Adults and children ≥6 years | 1 spray per nostril | Twice daily |
Important: Always follow the specific instructions from your allergist. Your dose may differ based on the severity of your symptoms, your age, and whether you are using azelastine alone or in combination with other medications.
Step-by-Step: How to Use Azelastine Nasal Spray Correctly
Proper technique is just as important as the right dose. Many patients use nasal sprays incorrectly, which reduces effectiveness and increases the risk of side effects like nosebleeds or a bitter taste dripping into the throat.
Step 1: Prime the Pump (First Use or After Inactivity)
If you are using a new bottle or have not used it in 3 or more days, prime the spray by pumping it away from your face until a fine mist appears. This usually takes 4–6 pumps for a new bottle. Priming ensures you get a consistent dose with each spray.
Step 2: Clear Your Nose
Gently blow your nose before spraying. Removing excess mucus allows the medication to reach the nasal lining where it needs to work. Do not blow forcefully—a gentle clearing is enough.
Step 3: Position Your Head and the Spray
Tilt your head slightly forward (chin toward chest). This keeps the spray in your nasal passages instead of running down your throat (which causes the bitter taste many people complain about).
Insert the spray tip into one nostril. Aim the tip toward the outer wall of your nostril—toward your ear on that side—not toward the center of your nose (the septum). Directing the spray at the septum can cause irritation, dryness, and nosebleeds over time.
Step 4: Spray and Breathe
Press the pump firmly while breathing in gently through your nose. Do not sniff hard. A gentle, steady inhale draws the mist across the nasal lining for maximum absorption. Close your mouth during the inhale.
Step 5: Switch Nostrils and Repeat
Repeat for the other nostril using the same technique. If your dose is 2 sprays per nostril, complete both sprays on one side before switching.
Step 6: Avoid Blowing Your Nose Immediately After
Wait at least 10–15 minutes before blowing your nose. This gives the medication time to absorb. Also avoid sneezing, tilting your head back, or lying down immediately after spraying.
Timing: When to Use Azelastine for Best Results
Azelastine starts working within 15 to 30 minutes—much faster than nasal corticosteroids, which may take several days to reach peak effect. This makes azelastine useful for quick relief during acute flares.
For ongoing allergic rhinitis, the key is consistency. Using azelastine at the same times each day provides the most reliable symptom control. A common schedule is:
- Morning dose: Use after your morning routine (shower, brushing teeth) to cover daytime exposure to allergens.
- Evening dose: Use before bed to reduce nighttime congestion, post-nasal drip, and morning symptoms.
If you are using azelastine in combination with a nasal corticosteroid spray (like fluticasone), separate the two by at least 15–30 minutes. Use the corticosteroid first, then follow with azelastine. This allows each medication to absorb properly.
Common Side Effects and How to Manage Them
Most side effects of azelastine are mild and related to technique rather than the drug itself.
- Bitter taste: This is the most common complaint. It happens when the spray drips from the nasal passages into the throat. Fix: keep your head tilted forward during and immediately after spraying. Do not tilt your head back or sniff hard.
- Drowsiness: Azelastine can cause mild drowsiness in some patients, though less than oral antihistamines. If this affects you, take your evening dose closer to bedtime and discuss with your allergist.
- Nasal burning or stinging: Usually temporary and improves after a few days of regular use. If persistent, you may be spraying too close to the septum.
- Nosebleeds: Almost always caused by spraying directly at the nasal septum. Redirect the spray tip toward the outer wall of the nostril.
- Headache: Uncommon. If frequent, discuss with your allergist.
Azelastine vs. Other Nasal Allergy Treatments
| Factor | Azelastine (Nasal Antihistamine) | Nasal Corticosteroid (e.g., Fluticasone) | SLIT Allergy Drops (HeyPak®) |
|---|---|---|---|
| Speed of relief | 15–30 minutes | Hours to days for full effect | 3–6 months for noticeable improvement |
| How it works | Blocks histamine locally in the nose | Reduces nasal inflammation | Retrains immune system to tolerate allergens |
| Treats root cause? | No | No | Yes |
| Duration of benefit | While using (hours per dose) | While using daily | Years after completing 3–5 year course |
| Best for | Quick symptom relief, breakthrough symptoms | Daily maintenance control | Long-term allergy freedom |
| Weight gain risk | No | No | No |
| Can be used together? | Yes (combo with steroid available as Dymista) | Yes | Yes (can reduce need for sprays over time) |
Many allergists recommend using azelastine and a nasal corticosteroid together for moderate-to-severe allergic rhinitis. The combination product Dymista (azelastine + fluticasone) combines both in a single spray. For patients who want to reduce their long-term dependence on daily nasal sprays, sublingual immunotherapy with HeyPak® allergy drops treats the underlying cause. Over time, SLIT can decrease the severity of your allergic response so you need fewer rescue and maintenance medications.
Azelastine and Immunotherapy: A Complementary Approach
Azelastine and SLIT allergy drops are not competing treatments—they complement each other. Azelastine provides immediate symptom control while SLIT works in the background to retrain your immune system. Many patients use azelastine during the early months of SLIT treatment, then gradually reduce or stop the spray as their immune tolerance builds.
This is similar to the relationship between azelastine and allergy shots. Both immunotherapy approaches (shots and drops) take time to work. Having azelastine for breakthrough symptoms during that buildup phase keeps you comfortable while the long-term treatment takes effect.
When to See an Allergist
You should schedule a consultation with a board-certified allergist if:
- Azelastine alone is not controlling your allergic rhinitis symptoms
- You are using azelastine daily for more than a few months and want to explore treatments that address the root cause
- You are unsure whether your symptoms are from allergies, a structural issue, or non-allergic rhinitis
- You experience side effects from azelastine that you cannot resolve with technique adjustments
- You have asthma or chronic sinusitis in addition to allergic rhinitis
- You want a personalized treatment plan that may include SLIT allergy drops, nasal corticosteroids, and targeted allergen avoidance
At HeyAllergy, our board-certified allergists can identify your specific allergy triggers with blood testing, optimize your current medications, and build a comprehensive treatment plan—all through a convenient telemedicine visit. No waitlist. No referral needed.
What to Do Next
Using azelastine correctly is a great start, but it only manages symptoms. To treat the root cause of your allergies, book your online allergy consultation with a board-certified allergist—no waitlist, no referral needed. Ask about HeyPak® allergy drops for personalized immunotherapy that can reduce your need for daily sprays over time.
Frequently Asked Questions
How many times a day should I use azelastine?
The standard dosing for adults is twice daily—once in the morning and once in the evening. Each dose is typically 1 to 2 sprays per nostril depending on the formulation and your allergist's recommendation. Consistent twice-daily use provides better control than using it only when symptoms flare.
Why does azelastine leave a bitter taste in my mouth?
The bitter taste happens when the spray drips from your nasal passages into the back of your throat. To prevent this, tilt your head slightly forward when spraying (chin toward chest), breathe in gently (do not sniff hard), and avoid tilting your head back afterward. The 0.15% formulation (Astepro) was designed to reduce this taste issue.
Can I use azelastine and Flonase together?
Yes. Using a nasal antihistamine (azelastine) with a nasal corticosteroid (fluticasone/Flonase) is a well-established combination for moderate-to-severe allergic rhinitis. The combination product Dymista contains both in one spray. If using them separately, apply the corticosteroid first and wait 15–30 minutes before using azelastine.
Is azelastine safe for children?
Yes, with age-appropriate dosing. Azelastine 0.1% is approved for children 5 years and older. Azelastine 0.15% is approved for children 6 years and older. Always follow your allergist's dosing instructions for pediatric use. If your child has persistent nasal allergy symptoms, a board-certified allergist can determine the best treatment approach.
Can I use azelastine while on allergy drops (SLIT)?
Absolutely. HeyPak® allergy drops and azelastine work through different mechanisms and complement each other. Many patients use azelastine for immediate symptom control while SLIT gradually builds long-term immune tolerance. Over time, as SLIT takes effect, your need for azelastine may decrease.
How long can I use azelastine?
Azelastine is safe for long-term daily use. However, if you find yourself dependent on it for months or years, that is a sign your underlying allergies are not being addressed. A board-certified allergist can evaluate whether sublingual immunotherapy could reduce your dependence on daily medications.
Author, Review and Disclaimer
Author: Krikor Manoukian, MD, FAAAAI, FACAAI — Board-Certified Allergist/Immunologist
Bio: Dr. Manoukian is a board-certified allergist/immunologist with over 20 years of experience. He leads HeyAllergy's clinical team and specializes in telemedicine-enabled allergy care and personalized sublingual immunotherapy programs.
Medical Review: HeyAllergy Clinical Team (Board-Certified Allergists/Immunologists)
Disclaimer: This article is educational and not a substitute for personalized medical advice. Always consult your clinician about your medications and treatment options.
References
- Brozek JL, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines—2016 revision. Journal of Allergy and Clinical Immunology. 2017;140(4):950-958.
- Carr W, et al. A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis. Journal of Allergy and Clinical Immunology. 2012;129(5):1282-1289.
- AAAAI, Rhinitis Treatment Guidelines. AAAAI
- Astepro (azelastine HCl) Prescribing Information. FDA-approved labeling.
