Dymista Nasal Spray has been added to the Formulary for initiation in either primary or secondary care for the relief of symptoms of moderate to severe seasonal and perennial allergic rhinitis if monotherapy with either intranasal antihistamine or glucocorticoid is not considered sufficient. This should not be used in children under 12 years of age. Dymista contains 137 micrograms azelastine hydrochloride (releasing 125 micrograms of azelastine) and 50 micrograms fluticasone propionate. Dymista should not be used as a first line therapy and should only be considered when an oral antihistamine combined with a Formulary steroid nasal spray has seen a partial, but inadequate response. Oral antihistamines include cetirizine, loratadine, acrivastine and fexofenadine. Nasal sprays include beclometasone dipropionate 50mcg, mometasone furoate 50mcg and fluticasone furoate 27.5mcg.