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Can a common nasal spray help protect against COVID-19?

COVID-19 most often enters the body through the nose and throat, where the virus first settles and begins to multiply

Unlike the tablets people often take for allergies, azelastine comes as a nasal spray that works directly in the nose. (Source: Pixabay)

For many people, a nasal spray is a go-to remedy when seasonal allergies strike. One such spray, azelastine, is widely available over the counter and has been used for years to relieve symptoms like runny nose, sneezing, and itchy or watery eyes. Interestingly, experts are now looking at how this everyday medicine could also play a role in reducing the risk of COVID-19.

This follows a new clinical trial, published in JAMA Internal Medicine, which suggests this antihistamine may also help prevent COVID-19. It found the incidence to be significantly lower with application of azelastine nasal spray compared with a placebo treatment. The randomized, placebo-controlled clinical trial included 450 healthy adults, who were enrolled at Saarland University Hospital in Germany. They were randomly assigned to receive either azelastine nasal spray or a placebo three times a day for 56 days. COVID-19 occurred in 6.7 percent of the placebo group and 2.2 percent of the azelastine group. The researchers also found significant reductions in the overall number of PCR-confirmed symptomatic infections (21 in the azelastine group compared with 49 in the placebo group).

What is Azelastine?

Azelastine belongs to a group of medicines known as antihistamines. Unlike the tablets people often take for allergies, azelastine comes as a nasal spray that works directly in the nose. When allergens such as dust, pollen, or pet dander trigger an immune response, the body releases histamine, a chemical that causes swelling, congestion and irritation. Azelastine blocks this reaction, soothing the lining of the nose and making breathing easier. Because of its local action, azelastine is fast-acting. Many people start to feel relief within minutes of using it.

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Over the years, it has become a trusted solution for people who struggle with allergic rhinitis, hay fever or persistent nasal congestion. While early findings are promising, there is still a need for larger-scale studies to fully understand its potential benefits beyond allergy management.

How does it connect to COVID-19?

COVID-19 most often enters the body through the nose and throat, where the virus first settles and begins to multiply. This makes the nasal passages a key entry point. A nasal spray like azelastine, which works directly in the nose, could help reduce the virus’s chances of taking hold. By calming inflammation and creating a less favorable environment for the virus, azelastine may help lower the risk of infection in people who use it.

This potential benefit has sparked attention because azelastine is already widely available, affordable, and easy to use. Unlike new medicines that require years of testing and approvals, this spray is something people are already familiar with for allergy care.

Why it’s promising but not a substitute

Even though azelastine may offer an extra layer of protection, health experts stress that it should not be viewed as a replacement for COVID-19 vaccines. Vaccination remains the most powerful tool for preventing severe illness, hospitalization, and death. A nasal spray, while helpful, cannot provide the same level of whole-body immunity that vaccines do.

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Instead, azelastine could be seen as a simple add-on measure—something that supports the body’s defences alongside vaccines, masks, and good hygiene. It may be particularly useful in crowded places such as schools, offices, or public transport, where reducing exposure risk is important.

(Dr Modi is senior consultant, Respiratory and Critical Care, Indraprastha Apollo Hospitals, New Delhi)