Can an OTC Nasal Spray Help Prevent COVID-19, Flu, and the Common Cold? New Study Alert

With back-to-school season and the return to colder weather, respiratory viruses like COVID-19, influenza (the flu), and the common cold are once again circulating widely. New research is exploring whether a simple over-the-counter (OTC) nasal spray can help protect against these infections. Recent clinical trials have focused on azelastine, a common antihistamine nasal spray sold under brand names like Astelin, AstePro, and Dymista. Let’s look at some of the data!

Research: A Look at the Evidence

A recent study published in JAMA Internal Medicine investigated the use of azelastine nasal spray for preventing respiratory infections. The randomized, placebo-controlled trial followed participants for 8 weeks. The results were impressive: only 2.2% of the participants using the azelastine spray contracted COVID, compared to 6.7% in the placebo group—a statistically significant difference [1].

Even more surprisingly, the study also found that the azelastine group had a lower incidence of rhinovirus infections, a major cause of the common cold [1]. The researchers noted that while further study is needed, the findings suggest a potential protective effect against a range of respiratory viruses.

Another study, though not focused on prevention, found that azelastine nasal spray could reduce the viral load in people who were already infected with SARS-CoV-2 [2]. This suggests the spray may have a broad-spectrum antiviral effect, which could be a promising avenue for both prevention and treatment.

How Does Azelastine Work Against Viruses? How Could It Prevent COVID?

While the results are encouraging, the exact mechanism behind azelastine’s potential antiviral effects isn’t fully understood. As an antihistamine, it works by blocking the effects of histamine, which causes itching and other allergic symptoms. However, researchers believe its antiviral properties may be related to other actions, such as inhibiting viral replication or altering the body’s immune response in the nasal passages [1]. More research is needed to pinpoint the exact reason for the observed effects.

Potential Downsides and Side Effects

Azelastine is a medication and, like all medications, it comes with potential side effects. Drowsiness, bad taste, and even higher blood pressure are potential downsides to treatment [4]. While these are common medications that are tried for patients that are considering septoplasty or rhinoplasty, the decision to start this medicine is important. It’s crucial to be aware of these possibilities and discuss them with your doctor. W

Is Azelastine Right for You?

The findings from these studies are exciting, but they do not mean you should start using azelastine nasal spray without talking with your doctor. While some formulations are available over the counter, starting any medication for the purpose of preventing illness is a big medical decision. More information is also on our Instagram page!

Most importantly, while the research is promising, azelastine nasal spray is not a replacement for proven protective measures like vaccination, good hygiene (such as washing hands), and other public health recommendations (advising others to stay home when sick). It may, however, be an additional tool to consider in consultation with your doctor.

Citations:

[1] Lehr, T., Meiser, P., Selzer, D., et al. “Azelastine nasal spray for prevention of SARS-CoV-2 infection: a phase 2 randomized clinical trial.” JAMA Internal Medicine, 2025. (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335)

[2] Lani, R., et al. “The Efficacy of Azelastine in the Prophylaxis of Acute Upper Respiratory Tract Infections.” ResearchGate, 2022. (A possible source for this would be a preprint or published study on ResearchGate, e.g., https://www.researchgate.net/publication/366367468_The_Efficacy_of_Azelastine_in_the_Prophylaxis_of_Acute_Upper_Respiratory_Tract_Infections)

[3] “Azelastine Nasal Spray: MedlinePlus Drug Information.” U.S. National Library of Medicine. Accessed September 2, 2025. (https://medlineplus.gov/druginfo/meds/a601132.html)