Overview

• In a peer-reviewed trial in Germany, 2.2% of participants using azelastine tested positive for SARS-CoV-2 versus 6.7% with placebo over 56 days, with PCR confirmation reported.
• Participants used one puff per nostril three times daily and underwent twice-weekly testing, and those on azelastine showed delayed time to infection, fewer symptoms, and shorter periods of positivity.
• The study also observed fewer overall respiratory infections in the azelastine group, including a lower incidence of rhinovirus infections (1.8% vs. 6.3%).
• The spray was generally well tolerated, with two serious adverse events reported among azelastine users that investigators did not attribute to the treatment.
• Authors and independent experts cautioned that the mostly young, healthy cohort limits generalizability, stressed that the spray should not replace vaccination, and said broader trials are needed as mechanisms remain hypothetical.