Allegra vs. Astelin

See how Allegra and Astelin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Allegra is a pill taken once or twice daily, while Astelin is a nasal spray used in each nostril twice daily.

  • Allegra also treats chronic hives, a use Astelin does not have, while Astelin also treats vasomotor rhinitis, a use Allegra does not have.

  • Astelin can cause drowsiness and a bitter taste, while Allegra is non-sedating and does not require a spray.

Allegra vs. Astelin Drug Summary

Allegra

Allegra (fexofenadine) is a second-generation H1 antihistamine used to relieve seasonal allergic rhinitis symptoms and chronic idiopathic urticaria. It comes as a tablet, orally disintegrating tablet, or liquid, taken once or twice daily depending on the dose.

Astelin

Astelin (azelastine) is an H1-antihistamine nasal spray used for seasonal allergic rhinitis and vasomotor rhinitis. It's sprayed into each nostril once or twice daily depending on the dose and symptoms.

Allegra vs. Astelin Side Effects

Allegra

Most common
Headache (≥2%)
Back pain (≥2%)
Dizziness (≥2%)
Stomach discomfort (≥2%)

Astelin

Most common
Headache (≥2%)
Bitter taste (≥2%)
Somnolence (≥2%)
Nasal burning (≥2%)

Allegra vs. Astelin Dosage

Allegra

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 30 mg twice daily At the start
Maximum dose 60 mg once daily If needed
Dose changes 3 increases As tolerated

Astelin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 spray/nostril twice daily At the start
Maximum dose 2 sprays/nostril twice daily If needed
Dose changes 1 increase As tolerated

Allegra vs. Astelin Indications

Allegra

Allegra relieves seasonal allergic rhinitis symptoms like sneezing, runny nose, and itchy eyes, and also treats chronic idiopathic urticaria (hives). It is approved for children as young as 6 years and adults, with dosing based on age and kidney function.

  • Seasonal allergic rhinitis symptom relief

  • Chronic idiopathic urticaria (hives) treatment

  • Approved for ages 6 and older

  • Available as tablet, ODT, or liquid

Astelin

Astelin treats seasonal allergic rhinitis in patients 5 and older and vasomotor (nonallergic) rhinitis in those 12 and older. It is sprayed directly into the nose, targeting local nasal symptoms rather than hives or full-body allergic reactions.

  • Seasonal allergic rhinitis in ages 5 and up

  • Vasomotor (nonallergic) rhinitis in ages 12+

  • Not approved for allergic rhinitis under age 5

  • Nasal spray targets local nasal symptoms

Allegra vs. Astelin Pros and Cons

Allegra

Allegra is a non-sedating oral antihistamine taken as a tablet, orally disintegrating tablet, or liquid to relieve seasonal allergic rhinitis and chronic hives. It works throughout the body rather than targeting the nose directly, so it does not treat vasomotor rhinitis.

Pros

  • Non-sedating, no drowsiness warning

  • Oral tablet, ODT, or liquid, no spray needed

  • Also treats chronic idiopathic urticaria (hives)

  • Roughly $6 to $20 per month, less than Astelin

Cons

  • Not approved for vasomotor (nonallergic) rhinitis

  • ODT form contains phenylalanine, avoid with PKU

  • Does not directly target nasal congestion

  • Twice-daily dosing unless using 180 mg once-daily

Astelin

Astelin is an intranasal antihistamine spray used for seasonal allergic rhinitis and, unlike Allegra, for vasomotor (nonallergic) rhinitis. It delivers medication directly to nasal tissue but carries a sedation risk and a bitter taste some patients notice.

Pros

  • Also approved for vasomotor (nonallergic) rhinitis

  • Delivers medicine directly to nasal tissue

  • Approved down to age 5 for allergic rhinitis

  • No boxed warning despite sedation risk

Cons

  • Can cause drowsiness, avoid driving until known

  • Bitter taste reported by many users

  • Must avoid alcohol due to additive sedation

  • Roughly $21.60 to $70.38 per month, more than Allegra

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