Does a Common OTC Nasal Spray for Allergies Lower the Risk of COVID-19?
A Simple Nasal Spray Being Tested for More Than Allergies
Scientists have recently become interested in a common nasal spray used for allergies because early lab studies showed that it might also help stop viruses, including the virus that causes COVID-19, from entering the body.
A new clinical trial published in JAMA Internal Medicine tested whether Azelastine nasal spray could help prevent COVID-19 infections in everyday adults.
Why Researchers Wanted to Study This Nasal Spray
Even though vaccines help protect against severe illness, people can still catch COVID-19. Researchers wanted to know if adding a nasal spray could give extra protection, especially during times when many respiratory viruses are spreading.
Azelastine was chosen because it has been available and used for years, is easy to access, and early studies showed it might have antiviral effects inside the nose which is the main place where viruses enter.
What Did the Research Discover?
The study was a phase 2 randomized, double-blind, placebo-controlled trial, which means people did not know whether they were getting the real spray or a fake one.
The trial took place at Saarland University Hospital in Germany from March 2023 to July 2024.
Who was studied:
- 450 healthy adults ages 18 to 65
- Average age was 33 years
- Most were vaccinated and otherwise healthy
How the study worked:
- Participants used either azelastine 0.1% nasal spray or a placebo spray
- They used the spray three times a day for 56 days
- They took COVID-19 tests twice a week
- PCR tests confirmed positive results
Key results:
- Only 2.2% of people using azelastine got PCR-confirmed COVID-19
- 6.7% of the placebo group got COVID-19
→ This means azelastine users had a 69% lower risk of infection - People using azelastine also had:
- Fewer symptomatic cases (1.8% vs. 6.3%)
- Longer time before infection (31 days vs. 19 days)
- Shorter illness, testing positive for fewer days (3.4 vs. 5.1)
- Fewer symptomatic cases (1.8% vs. 6.3%)
- The spray also reduced common cold infections caused by rhinovirus
- Side effects were mild and included bitter taste, nosebleeds, and tiredness
- Only two people stopped using the spray due to side effects
Overall, the results suggest that azelastine may help lower the risk of COVID-19 and shorten illness if someone gets infected.
How Can I Apply This Information?
This study shows that azelastine nasal spray might help reduce the chance of getting COVID-19 or other respiratory infections. It is important to remember that this is research, not a treatment guideline or official recommendation.
The nasal spray is already used and available OTC for allergies, but its use for COVID-19 prevention is still being studied. Larger clinical trials are needed before doctors can confidently recommend it for this purpose.
If you are looking for extra protection during travel, large gatherings, or times when viruses spread more easily, you can talk to your doctor about whether using azelastine nasal spray is right for you. It should always be used in addition to, not instead of, vaccination and other preventive measures.
This research offers an interesting look at how a simple, widely available medication may play a role in lowering infection risk in the future.
Source:
Lehr T, Meiser P, Selzer D, et al. Azelastine nasal spray for prevention of SARS-CoV-2 infections: a phase 2 randomized clinical trial. JAMA Intern Med. 2025;185(11):1309-1317. doi:10.1001/jamainternmed.2025.4283. Accessed by: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335
