Azelastine — a convenient, easy-to-use over-the-counter nasal spray — has been proven in clinical trials to bring fast relief from seasonal allergens. Most enthralling is its possible role as a Covid-19 prophylactic. The researchers at Saarland University Hospital in Germany did an innovative trial. One study found that azelastine was able to substantially lower the rate of Covid infections relative to a placebo.
The study included 450 non-Hispanic Black and White adult participants, average age early 30s. For one trial, researchers administered azelastine to one group, while a control group received a placebo. Participants in the azelastine group had a Covid infection rate of just 2.2%. By comparison, the infection rate in the placebo group was 6.7%. Azelastine shows potential for treatment and prevention against respiratory infections. This even includes related to infections by the SARS-CoV-2 virus which causes COVID-19.
We already knew that azelastine has excellent antiviral effects. It has direct antiviral properties and effectively counters respiratory infections like flu and respiratory syncytial virus (RSV). Prof. Robert Bals, a professor of internal medicine and pneumology at Saarland University, directs the experiments and is the study’s senior author. He suggests azelastine would make for a very useful OTC prophylactic against Covid, most especially during periods of high community transmission or in confined places such as big events and travel.
During the almost two-month trial period, all participants were tested bi-weekly with rapid Covid testing. The people taking azelastine need to spray a puff of the nasal spray in each nostril. They have to do it three times a day. Azelastine did look pretty good on this trial, suggesting strong potential treatment for Covid. Perhaps most surprisingly, it showed a reduction in other symptomatic respiratory infections, as detailed in a paper recently published in JAMA Internal Medicine.
“The mask may be more awkward and annoying but might be easier to comply with than remembering a thrice-daily nasal spray day after day.” – Dr. William Messer
Experts are warning that while these results are undeniably promising, azelastine should not be seen as a silver bullet to prevent Covid. Dr. Peter Chin-Hong, a professor in the UCSF Department of Medicine’s Division of Infectious Diseases, said azelastine could have exciting prospects. For now, he underscored, it’s too soon to start advising it as the go-to technique for halting virus spread. He emphasized the importance of masking and vaccination, especially among older adults.
“For those 65 and older, I would still continue to recommend vaccines as my number one defense against Covid.” – Dr. Peter Chin-Hong
Dr. Bals made clear that azelastine is to supplement — not replace — current preventive measures, such as vaccinations. To further solidify these findings, he advocated for bigger analyses to further corroborate these results. Not until then did he recommend using azelastine as a regular preventive weapon against Covid.
Azelastine has a preventive effect through binding directly to the virus in the nasal mucosa and preventing its entry [ 2 ]. It has shown to inhibit another key enzyme that is required for viral replication. This move could help lead to the virus being unable to form an infection in the upper respiratory tract.
