Astelin: how it works to relieve allergy symptoms

In some cases, over-the-counter medications or natural treatments can nip allergy symptoms in the bud. Other times, allergy sufferers might need something stronger to combat the signature sneezing, runny nose, congestion, and more that can accompany allergies. One option is Astelin, a prescription antihistamine nasal spray. Read on to learn more about this effective allergy treatment.  

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Astelin is used to treat allergic rhinitis, which is caused by airborne allergens, like pollen, dust mites, molds, and pet dander, which irritate the nasal cavity. It helps improve nasal symptoms like sneezing, itchy or runny nose, and nasal congestion (Akhouri, 2021).

Astelin (active ingredient azelastine hydrochloride) is different from the other allergy nasal sprays because it is an antihistamine nasal spray. It is FDA-approved to treat the following conditions (FDA, 2014): 

• Seasonal allergic rhinitis (hay fever) in adults and children over five years of age

• Vasomotor rhinitis (nonallergic rhinitis) in adults and children over 12 years of age

Astepro is a different medication that contains azelastine HCl and is FDA-approved to treat seasonal allergies. The two medications are similar: Both contain 0.1% formulations of azelastine HCl, and both have dosing requirements of one or two sprays per nostril twice daily. The major difference between Astelin and Astepro is that Astepro was recently FDA-approved to be used without a prescription. It is the first antihistamine nasal spray to be available over-the-counter (FDA, 2021).

Astelin nasal spray is an antihistamine medication, which puts it in the same category as other allergy drugs like levocetirizine (brand name Xyzal), cetirizine (brand name Zyrtec), diphenhydramine (brand name Benadryl), and loratadine (brand name Claritin). 

Astelin is distinct from other antihistamines because it's a nasal spray, delivering the medication in a fine mist directly to the nasal cavity. Astelin works like other types of antihistamines: When your body is sensitive to a specific allergen, your body's immune system releases a chemical called histamine. 

Histamine is what causes you to experience the symptoms of an allergic reaction, like a runny or stuffy nose, sneezing, postnasal drip, itchy eyes, watery eyes, and more. Antihistamines actually block histamine receptors to battle these symptoms, so histamine can't do what it normally would (Farzam, 2021).

Astelin (generic name azelastine HCl) comes in 137 mcg/spray (30 mL), 0.1% (30 mL), and  0.15% (30 mL) dosage forms. 

The typical dose is one or two sprays in each nostril twice daily, but you should follow your provider's instructions for use.

Before you use Astelin for the first time, be sure to prime the nasal spray pump. Hold the bottle upright, with the applicator tip inside your nostril. Point the tip towards the corner of your eye, breath in, and press the pump to release the spray while inhaling. 

Like all medications, azelastine nasal sprays have potential adverse effects. Because of the natural flavor of azelastine HCl, Astelin may cause a bitter taste in the mouth. It can also cause drowsiness, which is typical of many antihistamines. Other possible side effects of Astelin include headaches, cold symptoms, cough, pharyngitis, muscle aches, nasal burning, nosebleeds, eye irritation, and dry mouth (FDA, 2014). 

This does not include all possible adverse effects; talk to your healthcare professional for more drug information. 

Avoid combining Astelin with central nervous system (CNS) depressants that affect your mental alertness, like alcohol, as this can worsen drowsiness (FDA, 2014). 

It's important to always talk with your healthcare provider or allergist about the potential risks and benefits of all the medications you take. Your healthcare provider can also give you medical advice concerning any potential drug interactions involving any OTC and/or prescription drugs you use.

Since Astelin can cause drowsiness or sedation, be careful operating heavy or dangerous machinery or driving until you know how you will feel on Astelin (FDA, 2014). 

Experts still aren't sure whether the ingredient, azelastine HCl, can be harmful to a pregnant woman or unborn baby, so let your healthcare provider know if you are pregnant or plan to become pregnant. Astelin is considered Pregnancy Category C, which means we don’t have enough information on its safety during pregnancy. Using Astelin while breastfeeding may cause your breast milk to have a bitter taste. If you plan to breastfeed while using Astelin, consult with your healthcare professional (FDA, 2014).

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Current version

July 12, 2021

Written by

Michael Martin

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.