Astelin and Patanase Nasal Sprays for Allergic Rhinitis

Antihistamine Nasal Sprays - Advantages and Disadvantages

man squirting nasal spray into his nose
Learn about Astelin and Patanase nasal sprays for allergic rhinitis.

What are Astelin (azelastine) and Patanase (olopatadine) nasal sprays and how do they work? What are their advantages and disadvantages, and how do they compare to other rhinitis treatments?

Nasal Allergy Symptoms (Allergic and Non-Allergic Rhinitis) and Nasal Sprays

Nasal allergies or allergic rhinitis, may seem like just a nuisance to those not living with the symptoms, but can significantly interfere with your comfort and activities.

At the same time, oral medication can sometimes have side effects ranging from fatigue to weight gain. Symptoms of non-allergic rhinitis (vasomotor rhinitis) are also annoying, but treating underlying allergies is not helpful in this case.

To avoid the need for oral medications, many people use nasal sprays. There are curently four types of prescription nasal sprays:

  • Topical anti-histamines - The medications Astelin and Patanase are considered topical antihistamines used to treat most nasal symptoms.
  • Topic steroids - Topical nasal steroids reduce the inflammation caused by allergic and non-allergic rhinitis and can decrease sneezing, itchy nose, runny nose (postnasal drip) and congestion. In studies they appear to be more effective than both nasal and oral antihistamines and work very well for eye allergies. Topical sprays include Nasacort (triamcinolone), Veramyst (fluticasone), Omnaris (ciclesonide), Rhinocort (budesonide), Nasonex (memtusone), Nasarel (flunisolide), and Flonase (fluticasone).
  • Topical anti-cholinergics - This category, which includes Atrovent nasal (ipatropium) works to dry up nasal secretions.
  • Topical mast cell stabilizers - Nasalcrom (cromolyn) is a topical mast cell stablilizers. Mast cells are cells in our immune system which release chemicals that cause allergy symptoms. This medication needs to be used before someone is exposed to an allergen and is used to prevent nasal symptoms.

    Antihistamine Nasal Sprays - Astelin and Patanase - Indications and Use

    There are currently two nasal antihistamine sprays available.

    Patanase is approved for the treatment of allergic rhinitis. This medication was approved in 2008.

    Astelin is approved for the treatment of allergic rhinitis but is also approved for the treatment of non-allergic rhinitis (vasomotor rhinitis.) This medication has been around much longer than Patanase.

    How Do Antihistamine Nasal Sprays Work?

    When immune cells such as mast cells or basophils come into contact with an allergen, they release histamines. Histamines bind to histamine receptors which results in the symptoms of allergies such as a runny nose. Antihistamines work by binding to the histamine receptors, stopping the pathway leading to symptoms.

    The older antihistamines such as Benadryl (diphenhydramine) were quite sedating, whereas newer oral antihistamines such Claritin (loratidine) cause much less drowsiness.

    Topical antihistamines nasal sprays act in a way similar to oral antihistamines, but in contrast, the medication is delivered to only the area affected by allergies (the nasal passageways) rather than being delivered throughout the body via the bloodstream.

    Advantages of Antihistamine Nasal Sprays

    Nasal antihistamine sprays do not appear to be as effective as nasal steroids for the treatment of allergies, although they do have some advantages.

    First, these medications start working within 30 minutes, while nasal steroids take hours to days to start working. Second, nasal antihistamines cause fewer side effects relative to the side effects of nasal steroids, with no increased risk of glaucoma or cataracts. Lastly, nasal antihistamines work in various ways—they have antihistamine effects and prevent mast cells from releasing chemicals that cause allergy symptoms. Astelin also has various anti-inflammatory effects. Some people also prefer the "smell" of these sprays over the flowery smells of most nasal steroids.

    Like nasal steroids, nasal antihistamines also seem to treat eye allergies. So, while nasal antihistamines may not be quite as good at treating allergy symptoms as nasal steroids, the combination of nasal antihistamines and nasal steroids has been shown to be more effective than either medication alone.

    Disadvantages of Antihistamine Nasal Sprays

    Topical antihistamines such as Astelin and Patanase can sometimes cause mild nasal irritation.

    When medications are used topically, a small amount of the medication is absorbed into the bloodstream. Since these medications are anti-histamines related to Benadryl this could cause some tiredness, and mild fatigue has been reported by some people.

    Antihistamines nasal sprays are also less effective for treating allergic rhinitis and non-allergic rhinitis than steroid nasal sprays.

    Bottom Line on Nasal Anti-Histamines and Allergic Rhinitis

    While nasal antihistamines are less effective than some other treatments for allergic rhinitis (and non-allergic rhinitis) they have relatively few side effects. For those with mild symptoms these could be a good choice. For those with more severe symptoms, the combination of antihistamine nasal sprays plus steroid nasal sprays may work better than either treatment used alone.

    There are many factors to take into account in treating allergy symptoms including not only medications, but avoidance of the causes. Check out this information on dealing with allergic rhinitis in your own life.

    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.

    Hampel, F., Ratner, P., Van Bavel, J. et al. Double-Blind, Placebo-Controlled Study of Azelastine and Fluticasone in a Single Nasal Spray Delivery Device. Annals of Allergy, Asthma and Immunology. 2010. 105(2):168-73.

    Wartna, J., Bohnen, A., Elshout, G. at al. Symptomatic Treatment of Pollen-Related Allergic Rhinoconjunctivitis in Children: Randomized Controlled Trial. Allergy. 2016 Oct 3. (Epub ahead of print).

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