Sept. 4, 2025 – A common over-the-counter nasal spray grabbed headlines and social media buzz this week as a simple, surprising way to reduce your chances of getting COVID-19.
But is the hype getting ahead of the science?
Experts say the research behind the headlines is promising but early. The key may be that the spray, used to treat seasonal allergies, helps keep the nose lining calm.
The study that prompted all the attention – published Tuesday in JAMA Internal Medicine –showed that healthy adults under 65 who used the spray (called azelastine) three times daily for eight weeks had a 67% reduced risk of testing positive for COVID, compared to people who used a placebo spray.
They also had a reduced risk of being diagnosed with rhinovirus (the common cold).
This latest study builds on nearly a dozen others pointing to azelastine's multi-factor potential to prevent COVID.
"There is relatively little risk to try it," said Cindy Liu, MD, PhD, MPH, an associate professor at the Milken Institute School of Public Health at George Washington University. The drug is inexpensive – $10 to $30 for a 30-day supply – and already shown to be safe by the FDA in people ages 6 and up.
"However, azelastine should not take the place of good hygiene practices and COVID-19 vaccines," said Liu, who was not involved in the study. "This is only a small study, and we will need much more data to know how well it works and who can benefit."
Why an Allergy Nasal Spray Might Prevent COVID
Azelastine is FDA-approved for rhinitis – inflamed nasal passages that usually come with a runny or stuffy nose.
Anyone with rhinitis who takes azelastine might be "less susceptible to super infections, like COVID or other viruses, because it does have multiple mechanistic effects," said allergist Jonathan A. Bernstein, MD, an expert on azelastine and a professor at the University of Cincinnati College of Medicine. (He was not involved in the study.)
Research suggests that azelastine may calm a type of protein in the nose that sometimes triggers nasal hyperreactivity, said Bernstein, who has studied the protein, called TRPV1. When the protein is overactive, it can trigger inflammation and damage the nasal lining, making it easier for viruses to slip through. By preventing the protein from becoming overactive, azelastine helps keep the lining intact and less inflamed, making it harder for viruses to penetrate and infect underlying cells, Bernstein said.
Its prevention mechanism would likely hold up even as the virus continues to mutate into new variants – "a big challenge for vaccines," which must be updated annually as new variants emerge, said Liu, an expert in how the nasal microbiome influences immune response in the nasal cavity.
"Since azelastine most likely works differently from COVID-19 vaccines, this means that an individual could gain additional protection," she said.
Why Scientists Are Focused on the Nose
Scientists have long been interested in preventing COVID via the nose. That's because another type of protein, called ACE2 receptors, are "abundant in the nasal cavity," Liu said. These proteins provide the pathway that SARS-CoV-2 – the virus that causes COVID – is thought to invade to gain access to the respiratory tract.
Intramuscular vaccines provide what's called "non-sterilizing" immunity – meaning they reduce severe illness (including hospitalization or death) but aren't as good at stopping infection and transmission. By targeting the moist membrane of the nose – called the nasal mucosa – scientists believe they may be able to develop "sterilizing immunity" protection methods, by preventing the virus from entering the body.
If You Want to Try the Spray …
Talk to your doctor first, Liu said. And don't rely on the spray alone to protect you against COVID, especially if you are 65 or older, have a weakened immune system, or have a medical condition that puts you at a higher risk of a severe infection.
"Since this is an early pilot-scale study in a small population (mostly young women), COVID-19 vaccines have a much better track record for protecting against COVID-19 infection," Liu said. "If you are already vaccinated or if you cannot access COVID-19 vaccine, and would like additional protection, this could be an option."
Robert Bals, MD, PhD, the author of this latest study, suggested azelastine may be particularly helpful for travelers, during COVID surges, and for people at heightened risk.
He said the early results warrant further study and show that the drug could help protect against other respiratory pathogens.
