Rhinolast

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Rhinolast on Prescriptsy

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Rhinolast is a nasal spray containing azelastine hydrochloride 0.1% (137 micrograms per actuation).

It is a topical antihistamine used to treat the symptoms of allergic rhinitis (both seasonal and perennial) and vasomotor (non-allergic) rhinitis.

Unlike oral antihistamines, Rhinolast works directly on the nasal mucosa, providing rapid onset of symptom relief within 15 minutes.

It is effective against sneezing, itching, rhinorrhoea (runny nose), and nasal congestion.

Rhinolast is a prescription-only medicine (POM) in the United Kingdom, manufactured by Meda (now part of Viatris).

Allergic rhinitis is one of the most common chronic conditions in the UK, affecting an estimated 10 to 30 million people.

Seasonal allergic rhinitis (hay fever) is triggered by outdoor allergens, predominantly grass pollen (May to July), tree pollen (February to May), and weed pollen (June to September).

Perennial allergic rhinitis is triggered by year-round indoor allergens such as house dust mites, pet dander, and mould spores.

Vasomotor rhinitis, which accounts for a significant proportion of chronic rhinitis cases, presents with similar nasal symptoms but without an identifiable allergic cause.

This page provides a comprehensive clinical guide to Rhinolast, covering how it works, dosage instructions, side effects, safety warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about Rhinolast

Before reading further, please note these essential safety points.

• Rhinolast is for nasal use only. Do not spray it into the eyes.
• A bitter taste in the mouth after application is the most common side effect and is harmless. Tilting the head forward during use can reduce this.
• Although uncommon, drowsiness may occur. If affected, avoid driving or operating machinery.
• If nasal symptoms do not improve after 2 weeks of regular use, consult your prescriber for reassessment.
• Persistent unilateral nasal symptoms, blood-stained discharge, or loss of smell should be investigated regardless of a known allergy diagnosis.

Understanding allergic rhinitis

Allergic rhinitis is an IgE-mediated inflammatory condition of the nasal mucosa.

When a sensitised individual inhales an allergen (such as pollen or house dust mite protein), the allergen binds to IgE antibodies on the surface of mast cells in the nasal mucosa.

This cross-linking of IgE triggers mast cell degranulation, releasing preformed mediators (histamine, tryptase) and newly synthesised mediators (leukotrienes, prostaglandins, cytokines).

Histamine is the primary mediator of the early-phase allergic response, acting on H1 receptors to cause vasodilation, increased vascular permeability, mucus secretion, and sensory nerve stimulation.

This produces the characteristic symptoms of sneezing, itching, watery rhinorrhoea, and nasal congestion within minutes of allergen exposure.

A late-phase response occurs 4 to 8 hours later, driven by the recruitment of inflammatory cells (eosinophils, basophils, T lymphocytes) to the nasal mucosa.

This leads to persistent nasal obstruction and continued mucus production. Chronic allergic inflammation can cause nasal mucosal remodelling, nasal polyp formation, and impaired mucociliary clearance.

The impact of allergic rhinitis on quality of life is substantial: it disrupts sleep, impairs concentration and school or work performance, and frequently coexists with asthma, conjunctivitis, and sinusitis.

Understanding vasomotor rhinitis

Vasomotor rhinitis (also termed non-allergic, non-infectious rhinitis or idiopathic rhinitis) presents with nasal obstruction, rhinorrhoea, and postnasal drip in the absence of an identifiable allergic trigger.

Skin prick testing and specific IgE tests are negative.

The pathophysiology is not fully understood but is thought to involve autonomic nervous system dysregulation, with hyperreactive parasympathetic nerves in the nasal mucosa responding excessively to environmental stimuli.

Common triggers include temperature changes, strong odours (perfume, cleaning products, cooking fumes), humidity, tobacco smoke, alcohol, spicy foods, and emotional stress.

Vasomotor rhinitis accounts for an estimated 25% to 50% of chronic rhinitis cases and can be challenging to manage because standard antihistamines and allergen avoidance strategies are less effective.

Rhinolast is one of the few treatments specifically licensed for vasomotor rhinitis in the UK.

How Rhinolast works

Azelastine hydrochloride has a dual mechanism of action that distinguishes it from simple H1 receptor antagonists.

Its primary mechanism is competitive and selective blockade of H1 receptors on nasal mucosal cells, sensory nerve endings, and vascular endothelium.

By occupying H1 receptors, azelastine prevents histamine from initiating the allergic cascade, reducing sneezing, itching, rhinorrhoea, and congestion.

The topical route of administration ensures high local drug concentrations on the nasal mucosa with minimal systemic absorption, contributing to rapid onset of action (within 15 minutes) and a low incidence of systemic side effects.

Azelastine also exerts anti-inflammatory effects that extend beyond simple histamine receptor blockade.

It inhibits the generation of leukotrienes (LTB4, LTC4) by blocking lipoxygenase activity, reduces the release of pro-inflammatory cytokines (IL-1beta, IL-6, TNF-alpha) from nasal epithelial cells and mast cells, decreases intracellular adhesion molecule-1 (ICAM-1) expression (reducing inflammatory cell recruitment), and stabilises mast cell membranes to reduce further mediator release.

These anti-inflammatory properties help explain its efficacy in vasomotor rhinitis, where histamine is not the primary mediator, and in reducing the late-phase allergic response in allergic rhinitis.

Clinical evidence for Rhinolast

The efficacy of intranasal azelastine in allergic rhinitis has been demonstrated in multiple randomised controlled trials.

A meta-analysis of studies comparing intranasal azelastine with placebo showed significant improvements in total nasal symptom scores (TNSS), including sneezing, rhinorrhoea, nasal congestion, and nasal itching.

Intranasal azelastine was also shown to be at least as effective as oral second-generation antihistamines (cetirizine, loratadine) for nasal symptoms, with the added advantage of faster onset of action.

In vasomotor rhinitis, randomised controlled trials have shown that intranasal azelastine significantly reduces rhinorrhoea, sneezing, and postnasal drip compared with placebo.

The MP-AzeFlu programme (azelastine combined with fluticasone in a single device, marketed as Dymista) has shown that the combination is more effective than either component alone for moderate to severe allergic rhinitis, providing a rationale for combining Rhinolast with an intranasal corticosteroid when single-agent therapy is insufficient.

NICE CKS on allergic rhinitis recommends intranasal antihistamines as an alternative to oral antihistamines, particularly for patients who prefer topical treatment or who experience inadequate relief from oral antihistamines alone.

Rhinolast compared with other rhinitis treatments

The main treatment options for allergic rhinitis in the UK include oral second-generation antihistamines (cetirizine, loratadine, fexofenadine), intranasal corticosteroids (beclometasone, fluticasone, mometasone), intranasal antihistamines (azelastine), and combination intranasal azelastine/fluticasone (Dymista).

Oral antihistamines are convenient but may not adequately control nasal congestion.

Intranasal corticosteroids are the most effective single agent for overall symptom control, particularly nasal congestion, but take 1 to 2 weeks to reach full effect.

Rhinolast offers the advantage of rapid onset (15 minutes) and efficacy in both allergic and vasomotor rhinitis, making it a useful option when quick symptom relief is needed or when intranasal corticosteroids alone are insufficient.

For patients with moderate to severe allergic rhinitis not controlled by either an intranasal antihistamine or intranasal corticosteroid alone, the combination product Dymista (azelastine plus fluticasone) provides both rapid onset and potent anti-inflammatory effects in a single spray.

Alternatively, Rhinolast and a separate intranasal corticosteroid can be used together, applied at least 5 to 10 minutes apart.

Dosage and administration

For allergic rhinitis in adults and children aged 6 and over, use one spray per nostril twice daily.

For vasomotor rhinitis in adults and adolescents aged 12 and over, use one spray per nostril twice daily; the dose may be increased to two sprays per nostril twice daily if needed.

Prime the pump before first use. Blow your nose gently before application, tilt your head slightly forward, and aim the nozzle away from the nasal septum.

Breathe in gently while spraying.

Side effects of Rhinolast

Common side effects

Bitter taste is the most frequently reported effect, occurring in 10% to 20% of users.

It results from a small amount of spray draining into the throat and is harmless.

Nasal irritation (stinging, burning, or dryness) may occur, particularly during the first few days. These effects are usually mild and transient.

Uncommon side effects

Headache, drowsiness, and nosebleed (epistaxis) are uncommon. Drowsiness is unlikely with topical use but should be considered, particularly at higher doses. Nausea is rare and may be related to swallowing the bitter-tasting solution.

When to seek medical advice

Contact your GP or call NHS 111 if you experience persistent nosebleeds, worsening nasal symptoms despite regular use, unilateral nasal obstruction, or blood-stained nasal discharge.

These may indicate a condition other than rhinitis.

If you experience signs of a severe allergic reaction (swelling of the face, lips, or throat; difficulty breathing), call 999 immediately.

Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Rhinolast is contraindicated in patients with known hypersensitivity to azelastine or any excipient in the formulation.

Special populations

Pregnancy: use Rhinolast during pregnancy only on the advice of your prescriber. Breastfeeding: caution is advised. Children under 6 (allergic rhinitis) or under 12 (vasomotor rhinitis): not recommended.

Driving and machinery

Although drowsiness is uncommon, if you feel drowsy after using Rhinolast, do not drive or operate machinery until the effect has resolved.

Managing allergic rhinitis: broader guidance

Allergen avoidance is the first step in managing allergic rhinitis, though evidence for house dust mite avoidance measures is limited.

During the pollen season, practical measures include monitoring pollen forecasts (Met Office or Allergy UK), keeping windows closed during high-pollen periods, showering and changing clothes after being outdoors, wearing wraparound sunglasses, and drying clothes indoors.

For perennial rhinitis, regular vacuuming, using anti-allergen bedding covers, minimising soft furnishings, and managing pet exposure may help reduce symptom burden.

Saline nasal irrigation (using a sterile saline solution or commercially available nasal douche) can help clear allergens and mucus from the nasal passages and is recommended as an adjunct to pharmacological treatment.

How to get Rhinolast in the UK

Rhinolast is available on NHS prescription from your GP or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC).

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

Prepayment certificates are available for patients who need multiple prescription items. Generic intranasal azelastine may also be available.

Sources

• Rhinolast, Summary of Product Characteristics (EMC)
• Azelastine hydrochloride, British National Formulary (BNF)
• Allergic rhinitis, NICE CKS
• Allergic rhinitis, NHS
• Allergy UK
• MHRA Yellow Card Scheme