A widely available anti-allergy azelastine nasal spray could reshape parts of the respiratory care market, after a clinical study showed the treatment reduced coronavirus infections by two-thirds. The findings, published in JAMA Internal Medicine, are likely to spark new commercial interest in a product already familiar to allergy sufferers.

Trial Demonstrates Significant Results

The randomized, double-blind clinical trial involved 450 healthy participants, divided into two groups over a 56-day period. The treatment group used azelastine nasal spray three times a day, while the control group received a placebo spray on the same schedule.

During the study, only 2.2% of the azelastine group tested positive for SARS-CoV-2, compared with 6.7% of the placebo group. Beyond COVID-19, participants using azelastine also reported fewer respiratory coronavirus infections overall, including a significantly lower rate of rhinovirus, one of the most common causes of colds.

These results build on earlier laboratory research suggesting that azelastine has antiviral properties. This is the first real-world clinical evidence that the spray may offer preventive benefits against viral respiratory coronavirus infections .

Potential Market Impact

Azelastine nasal spray has been sold for decades as an over-the-counter remedy for hay fever, but this new evidence positions it for broader use. If subsequent trials confirm these findings, the product could serve as an accessible and affordable preventive tool during peak infection seasons, in travel settings, or among high-risk populations.

For pharmaceutical companies, the implications are significant. Unlike entirely new drugs, azelastine has an established safety profile and manufacturing infrastructure. This could shorten the timeline for broader market applications and reduce the barriers to regulatory approval for expanded indications.

In addition, the global nasal spray market has been steadily growing due to rising demand for allergy and cold treatments. A proven prophylactic use against viral coronavirus infections could further accelerate growth and drive new investment in research and distribution.

Next Steps for Research and Industry

While the study’s results are promising, experts emphasize the need for larger, multicenter trials to validate the findings and assess performance against a wider range of respiratory pathogens. The current trial was sponsored by Saarbrücken-based pharmaceutical company URSAPHARM Arzneimittel GmbH, which also manufactured the investigational spray.

If follow-up studies confirm azelastine’s preventive capabilities, healthcare providers could integrate nasal sprays into broader infection-control strategies, complementing vaccines and antivirals. For businesses in the pharmaceutical and healthcare industries, this represents an opportunity to expand portfolios with a low-cost, consumer-friendly product that could reduce the burden of respiratory diseases worldwide.

Industry analysts note that such developments could also impact travel, hospitality, and workplace health strategies, as companies look for cost-effective measures to minimize disruptions from seasonal illnesses.

Looking Ahead

The study underscores how existing medications can find new life in emerging markets through repurposing. Azelastine’s potential role in respiratory infection prevention highlights the importance of continued research partnerships between academic institutions and industry sponsors.

For now, the business opportunity lies in exploring expanded clinical use, scaling up production capacity, and preparing for regulatory review. If the results hold, azelastine nasal spray could transition from a niche allergy treatment to a mainstream preventive tool, influencing both the pharmaceutical market and consumer behavior in the years ahead.