Dymista

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Dymista on Prescriptsy

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Dymista is a prescription-only nasal spray that combines two active ingredients, azelastine hydrochloride (an antihistamine) and fluticasone propionate (a corticosteroid), in a single device.

It is licensed in the United Kingdom for the treatment of moderate to severe allergic rhinitis when monotherapy with either an intranasal antihistamine or an intranasal corticosteroid alone is not sufficient to control symptoms.

Dymista is approved for use in adults and adolescents aged 12 years and over.

Allergic rhinitis is one of the most common chronic conditions in the UK, affecting an estimated 10 to 30% of the adult population and up to 40% of children.

Seasonal allergic rhinitis (hay fever) is triggered by pollen from grasses, trees, and weeds, while perennial allergic rhinitis is caused by year-round allergens such as house dust mites, pet dander, and mould spores.

Symptoms include nasal congestion, sneezing, itching of the nose and palate, watery rhinorrhoea (runny nose), and postnasal drip.

Many patients also experience associated ocular symptoms including itchy, watery, or red eyes (allergic conjunctivitis).

These symptoms can significantly impair quality of life, disrupting sleep, concentration, work productivity, and daily activities.

This page provides a comprehensive clinical overview of Dymista, including how it works, who it is suitable for, how to use it correctly, expected results, side effects, important warnings, and how to obtain it in the UK.

Important safety information about Dymista

Before reading further, note the following essential safety points. Dymista is a prescription-only medicine (POM) and should be used as directed by your prescriber.

• Dymista is for allergic rhinitis only. It does not treat common colds, sinusitis, or nasal polyps.
• Do not exceed the recommended dose of one spray per nostril twice daily.
• Long-term use of nasal corticosteroids at higher than recommended doses may rarely cause systemic effects. Use the lowest effective dose for the shortest duration necessary.
• Dymista may cause a bitter taste after application; this is harmless and transient.
• If you experience persistent nosebleeds, nasal pain, or visual disturbances, stop using Dymista and contact your GP.

Understanding allergic rhinitis

Allergic rhinitis occurs when the immune system overreacts to inhaled allergens.

On initial exposure, the immune system produces allergen-specific immunoglobulin E (IgE) antibodies, which bind to mast cells in the nasal mucosa.

On subsequent exposure, the allergen cross-links IgE on these mast cells, triggering degranulation and the immediate release of histamine, leukotrienes, prostaglandins, and other inflammatory mediators.

Histamine acts on H1 receptors in the nasal mucosa to cause itching, sneezing, and watery rhinorrhoea within minutes (the early-phase response).

Over the following 4 to 8 hours, a late-phase inflammatory response develops, driven by recruitment of eosinophils, basophils, and T lymphocytes to the nasal tissue.

This late-phase response causes mucosal swelling, persistent congestion, and tissue remodelling.

Nasal congestion is often the most bothersome symptom and the one least well controlled by antihistamines alone, which primarily target the early-phase response.

Effective treatment of moderate to severe allergic rhinitis therefore requires addressing both phases of the allergic response.

This is the rationale for Dymista's combination formulation, which delivers rapid antihistamine action against the early phase alongside sustained corticosteroid suppression of the late-phase inflammatory cascade.

How Dymista works: dual mechanism of action

Dymista's two active ingredients act on different aspects of the allergic inflammatory pathway, providing complementary and synergistic effects.

Azelastine hydrochloride (antihistamine component)

Azelastine is a second-generation antihistamine applied topically to the nasal mucosa. It competitively blocks H1 histamine receptors, rapidly relieving sneezing, itching, and rhinorrhoea.

Unlike first-generation antihistamines (such as chlorphenamine), azelastine has minimal CNS penetration when used intranasally, resulting in a low incidence of drowsiness.

Azelastine also exhibits additional anti-inflammatory properties beyond simple H1 blockade: it stabilises mast cell membranes, inhibits the release of leukotrienes and cytokines, and reduces eosinophil recruitment.

Onset of action occurs within approximately 15 minutes of administration.

Fluticasone propionate (corticosteroid component)

Fluticasone propionate is a potent synthetic corticosteroid with high topical anti-inflammatory potency and low systemic bioavailability (less than 2% after intranasal administration).

It suppresses the production of a broad range of inflammatory mediators including cytokines, chemokines, and adhesion molecules. This reduces mucosal oedema, vascular permeability, mucus secretion, and tissue eosinophilia.

Fluticasone propionate is particularly effective at relieving nasal congestion, the symptom that antihistamines alone often fail to control adequately.

Maximum anti-inflammatory effect builds over several days of regular use.

Synergistic effect

Clinical studies have demonstrated that the combination of azelastine and fluticasone in a single spray provides statistically and clinically significant greater symptom relief than either component alone.

In the pivotal MP29-02 studies, Dymista achieved approximately twice the improvement in total nasal symptom score (TNSS) compared with fluticasone propionate monotherapy and approximately three times the improvement compared with azelastine monotherapy.

The combination also achieved faster onset of clinically meaningful symptom relief, with patients reporting improvement on the first day of treatment.

Clinical evidence and UK prescribing guidance

Dymista was licensed in the UK following demonstration of superior efficacy to its individual components in large, randomised, double-blind clinical trials involving over 4,000 patients with moderate to severe seasonal allergic rhinitis.

The MP29-02 trial programme showed that Dymista provided faster onset of action, greater overall symptom control, and improved quality of life compared with fluticasone propionate or azelastine spray used alone.

NICE Clinical Knowledge Summaries on allergic rhinitis recommend a stepwise approach to treatment. Mild intermittent symptoms may be managed with oral or intranasal antihistamines or an intranasal corticosteroid.

For moderate to severe symptoms, or symptoms inadequately controlled by monotherapy, combination therapy is recommended.

Dymista offers the convenience of delivering both agents in a single device with a single dosing regimen.

The British Society for Allergy and Clinical Immunology (BSACI) guidelines similarly support the use of combination intranasal therapy for patients with moderate to severe allergic rhinitis.

The ARIA (Allergic Rhinitis and its Impact on Asthma) international guidelines classify allergic rhinitis by severity and duration and recommend stepping up treatment based on symptom control, endorsing intranasal corticosteroid-antihistamine combination sprays as an effective option for patients who are not adequately controlled on monotherapy.

Who should use Dymista

Dymista is appropriate for adults and adolescents aged 12 and over with moderate to severe allergic rhinitis whose symptoms are not adequately controlled by a single antihistamine or corticosteroid nasal spray.

It is suitable for both seasonal allergic rhinitis (hay fever) and perennial allergic rhinitis.

You may benefit from Dymista if you have tried an intranasal corticosteroid spray (such as fluticasone, mometasone, or beclometasone) and still experience troublesome congestion, sneezing, or itching; or if you have used an antihistamine nasal spray or oral antihistamine and still have significant nasal blockage and inflammation.

Dymista is also a convenient option for patients who would otherwise need to use two separate nasal sprays.

How to use Dymista correctly

Correct technique is essential for maximum benefit and minimum side effects from any nasal spray.

Before first use, prime the pump by pressing it firmly 6 times until a fine, even mist appears.

If the spray has not been used for more than 7 days, re-prime with one actuation. Shake the bottle gently before each use.

Blow your nose gently to clear the nasal passages.

Hold the bottle upright with your thumb under the base and your index and middle fingers on either side of the nozzle.

Tilt your head slightly forward (do not tip it back).

Insert the nozzle into one nostril, angling it slightly towards the outer wall of the nose (away from the central septum). Close the opposite nostril with a finger.

Press the pump once while breathing in gently and steadily through the nose.

Do not sniff forcefully, as this pulls the medication past the nasal cavity and into the throat (causing the bitter taste). Repeat the process in the other nostril.

Wipe the nozzle with a clean tissue after use and replace the cap.

Administer one spray per nostril twice daily (morning and evening). Do not exceed this dose. Consistency is important; try to use the spray at roughly the same times each day for optimal symptom control.

Side effects of Dymista

Common side effects

The most frequently reported side effect is dysgeusia (an unpleasant, bitter taste), occurring in approximately 5 to 7% of users.

This is caused by the azelastine component and happens when the spray trickles down the back of the nose into the throat.

It is harmless and usually resolves within a few minutes. Tilting the head forward during administration and avoiding hard sniffing can reduce its occurrence.

Epistaxis (nosebleed) is reported by about 3 to 5% of users and is related to the local effect of the corticosteroid on nasal blood vessels.

Nosebleeds are usually mild and self-limiting.

Uncommon and rare side effects

Uncommon effects include headache, nasal dryness, nasal discomfort or burning sensation after spraying, sneezing immediately after application, throat irritation, and nausea. Drowsiness has been reported rarely with intranasal azelastine; it is much less common than with oral antihistamines.

Rare side effects associated with prolonged intranasal corticosteroid use include nasal septal perforation (extremely uncommon), glaucoma, raised intraocular pressure, and posterior subcapsular cataracts.

These are very unlikely at the recommended dose but merit awareness in patients requiring long-term use.

Systemic corticosteroid effects such as adrenal suppression are not expected at the intranasal dose delivered by Dymista, but total corticosteroid exposure should be considered if the patient is also using inhaled or topical corticosteroids for other conditions.

When to seek medical advice

Contact your GP or NHS 111 if you experience persistent or recurrent nosebleeds, pain inside the nose, nasal crusting, visual disturbances (blurred vision, eye pain), or symptoms of infection (green or yellow nasal discharge with fever).

Report any suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Infections

Do not start Dymista if you have an untreated nasal infection (bacterial, fungal, or viral). The corticosteroid component may mask symptoms of infection or impair local immune defences.

If a nasal infection develops during treatment, you may need to temporarily stop using the spray and seek treatment for the infection first.

Nasal surgery or injury

If you have recently had nasal surgery or sustained nasal trauma, allow the tissue to heal fully before starting Dymista. Using a corticosteroid spray before healing is complete may delay recovery.

Eye effects

Long-term use of corticosteroids, including intranasal preparations, has been associated rarely with glaucoma and cataracts.

If you have a personal or family history of glaucoma or cataracts, inform your prescriber. Routine eye examinations may be recommended for patients on prolonged corticosteroid therapy.

Growth in adolescents

Although growth retardation is extremely unlikely at standard intranasal corticosteroid doses, it remains a theoretical concern. Prescribers should monitor growth in adolescents aged 12 to 17 who require long-term Dymista treatment and use the lowest effective dose.

Pregnancy and breastfeeding

Dymista should be used during pregnancy only if the expected benefit to the mother outweighs any potential risk to the foetus.

The safety of azelastine and fluticasone combination during pregnancy has not been established in human studies.

The individual components have limited safety data in pregnancy; fluticasone propionate has very low systemic absorption after intranasal use.

Discuss the risks and benefits with your GP or midwife. If you are breastfeeding, consult your doctor before using Dymista.

Driving and operating machinery

Dymista may rarely cause drowsiness. If you feel drowsy after using it, do not drive or operate machinery. Avoid alcohol and other sedating medicines if you are affected.

Dymista compared with other allergy treatments

Over-the-counter options for allergic rhinitis include oral antihistamines (cetirizine, loratadine, fexofenadine), intranasal antihistamines (azelastine alone), and intranasal corticosteroids (beclometasone, fluticasone). These are appropriate for mild to moderate symptoms.

For moderate to severe symptoms that do not respond to single-agent therapy, Dymista provides the advantage of dual action in a single device, with evidence showing superior efficacy to either component alone.

It is also more convenient than using two separate nasal sprays with different dosing schedules.

Immunotherapy (desensitisation) is a specialist option for patients with severe allergic rhinitis that does not respond to pharmacotherapy.

It involves controlled exposure to the allergen over months to years and is available via subcutaneous injection or sublingual tablets. Referral to an allergy specialist is required.

How to get Dymista in the UK

Dymista is a prescription-only medicine. Your GP can prescribe it following assessment of your allergic rhinitis symptoms and treatment history. It is available on the NHS.

The standard prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Authorised online prescribers registered with the GPhC may also prescribe Dymista following a structured consultation.

Living with allergic rhinitis: practical advice

Alongside pharmacological treatment, allergen avoidance and environmental measures can help reduce symptom burden.

For seasonal allergic rhinitis, check pollen counts daily (available on the Met Office website and weather apps), keep windows closed during high pollen periods, shower and change clothes after spending time outdoors, dry laundry indoors, and consider wearing wraparound sunglasses.

For perennial allergic rhinitis, use allergen-proof mattress and pillow covers, wash bedding at 60 degrees Celsius weekly, reduce soft furnishings that harbour dust mites, and keep pets out of bedrooms.

Nasal saline irrigation (using a commercially available saline spray or neti pot) can help clear allergens and mucus from the nasal passages before applying Dymista.

When to seek further medical advice

Contact your GP or NHS 111 if your symptoms are not controlled despite using Dymista as directed, if you develop signs of infection, or if you experience persistent nosebleeds or other concerning symptoms.

If you develop wheeze, chest tightness, or breathing difficulty in addition to nasal symptoms, seek prompt medical review as this may indicate coexisting asthma requiring separate treatment.

Report any adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Dymista 137/50 micrograms/actuation Nasal Spray, Summary of Product Characteristics (EMC)
• Azelastine with fluticasone propionate, British National Formulary (BNF)
• NICE CKS: Allergic rhinitis
• Allergic rhinitis, NHS
• BSACI Guidelines: Rhinitis
• MHRA Yellow Card Scheme