Treating Nasal Allergy With Astelin and Patanase Spray

Comparing Nasal Antihistamine and Nasal Steroid Sprays

Man squirting nasal spray into his nose
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Nasal allergies (allergic rhinitis) may be more than a nuisance to people who are chronic sufferers. They can affect a person's ability to function and significantly decrease the quality of life. While oral medications can alleviate the many of these symptoms, they can often cause unwanted side effects ranging from drowsiness to weight gain.

As a result, many people to turn nasal sprays for allergy relief.

The drugs come in various formulations with differing mechanisms of action, including:

  • Topical antihistamines which block the effects of histamines, a chemical released by the body in response to allergy-causing substances (allergens)
  • Topical nasal steroids which reduce the inflammation caused by allergic and non-allergic rhinitis (vasomotor rhinitis)
  • Topical anticholinergics which works by drying the nasal passages
  • Topical mast cell stabilizers which can prevent immune cells (called mast cells) from releasing histamines into the bloodstream

Of these, a newer class of antihistamine offers a unique mechanism of action They include the nasal sprays Astelin (azelastine), Patanase (olopatadine).

Indications and Use

Patanase was approved for the treatment of allergic rhinitis in 2008, while Astelin received its FDA approval in 2001 for both allergic and non-allergic rhinitis. Both are available by prescription and approved for use in adults and children over of five.

The sprays should not be used in combination with any other drug containing an antihistamine, including multi-symptom cold and allergy relief medications.

How They Work

When immune cells (such as mast cells or basophils) come into contact with an allergen, they release histamines into the bloodstream.

These histamines bind to proteins throughout the body called H1 receptors and, by doing so, trigger the spectrum of symptoms we recognize as an allergy. Patanase and Astelin are classified as H1 antagonists and effectively block this attachment. Unlike older-generation antihistamines like Benadryl (diphenhydramine),

Patanase and Astelin do not cross the blood-brain barrier. Because of this, they don't have the same sedating effect as some of the older allergy medications. Moreover, as a nasal spray, Patanase and Astelin only affect the immediate nasal passages rather than being distributed throughout the body.

Advantages

Nasal antihistamine sprays offer several advantages over other formulations:.

  • Nasal antihistamines start working within 15 minutes, while nasal steroids may take hours or days to start working.
  • Nasal antihistamines have fewer side effects than nasal steroids, with no increased risk of glaucoma or cataracts.
  • Astelin offers dual action, blocking H1 attachment while preventing mast cells from releasing histamines.
  • Astelin offers anti-inflammatory effects that may relieve breathing problems.

Like nasal steroids, nasal antihistamines also appear effective in alleviating eye allergies.

So, while nasal antihistamines may not be as effective as steroids in treating chronic symptoms, studies suggest that the combination of the two may be more effective than using an individual drug.

Disadvantages

For all of their short-term benefits, there are some side effects associated with Patanase and Astelin use:

  • Astelin and Patanase can cause mild nasal irritation, soreness, and even nosebleeds. These are more often associated with overuse of the sprays but can sometimes happen within the recommended dosage.
  • Astelin and Patanase may leave a bitter taste in the mouth. This can sometimes be avoided by sniffing gently through your nose after each spray rather than breathing in deeply.
  • Astelin has been known to cause some dizziness or drowsiness in some.

While nasal antihistamines sprays are great at providing immediate relief of seasonal allergy symptoms, they aren't as effective as nasal steroids for persistent or chronic symptoms. They are also less effective at treating non-allergic rhinitis.

Sources:

Berger, W. and E. Meltzer. "Intranasal Spray Medications for Maintenance Therapy of Allergic Rhinitis." American Journal of Rhinology and Allergy. 2015. 29(4):273-82.

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