Managing Allergies During Pregnancy
Rhinitis during pregnancy can be due to allergic rhinitis, sinusitis, or non-allergic rhinitis. If the woman has had allergic rhinitis prior to pregnancy, this could worsen, stay the same, or even improve. This change in symptoms may be dependent upon many factors, including the presence of seasonal allergens and increase in pregnancy hormones.
Non-allergic rhinitis in pregnancy may also be due to an increase in pregnancy hormones, leading to nasal congestion, runny nose and post nasal drip. This is called “rhinitis of pregnancy”. The symptoms may mimic allergies, but since they are non-allergic in nature, do not respond to anti-histamines.
The pregnant woman with rhinitis may be concerned about the safety of medications during pregnancy, and therefore avoid taking medications.
If avoidance of allergic triggers is not possible or successful, medications may be needed to control symptoms.
Diagnosis of Allergic Rhinitis During Pregnancy
Allergy testing includes skin testing or blood tests, called a RAST. In general, allergy skin testing is not done during pregnancy, given the small chance of anaphylaxis which may occur. Anaphylaxis during pregnancy, if severe, could result in a decrease in blood and oxygen to the uterus, possibly harming the fetus. Therefore, allergy testing is usually deferred during pregnancy, although a RAST would be a safe alternative if the results are needed during pregnancy.
Safety of Allergy Medications During Pregnancy
According to the Food and Drug Administration (FDA), no drugs are considered completely safe in pregnancy. This is because no pregnant woman would want to sign up for a medication safety study while she is pregnant. Therefore, the FDA has assigned risk categories to medications based on use in pregnancy.
Pregnancy category “A” medications are medications in which there are good studies in pregnant women showing the safety of the medication to the baby in the first trimester. There are very few medications in this category, and no asthma medications.
Category “B” medications show good safety studies in pregnant animals but there are no human studies available.
Pregnancy category “C” medications may result in adverse effects on the fetus when studied in pregnant animals, but the benefits of these drugs may out weight the potential risks in humans.
Category “D” medications show clear risk to the fetus, but there may be instances in which the benefits outweigh the risks in humans. And finally, category “X” medications show clear evidence of birth defects in animals and/or human studies and should not be used in pregnancy.
Before any medication is taken during pregnancy, the doctor and patient must have a risk/benefit discussion. This means that the benefits of the medication should be weighed against the risks – and the medication should only be taken if the benefits outweigh the risks.
Treatment of Rhinitis During Pregnancy
Nasal saline. Rhinitis of pregnancy tends not to respond to anti-histamines or nasal sprays. This condition seems to respond temporarily to nasal saline (salt water), which is safe to use during pregnancy (it is not actually a drug). Nasal saline is available over the counter, is inexpensive, and can be used as often as needed. Generally 3 to 6 sprays are placed in each nostril, leaving the saline in the nose for up to 30 seconds, and then blowing the nose.
Anti-histamines. Older anti-histamines, such as chlorpheniramine and tripelennamine, are the preferred agents to treat allergic rhinitis during pregnancy, and are both category B medications. Newer anti-histamines such as over-the-counter loratadine (Claritin/Alavert and generic forms) and prescription cetirizine (Zyrtec) are also pregnancy category B medications.
Decongestants. Pseudoephedrine (Sudafed, many generic forms) is the preferred oral decongestant to treat allergic and non-allergic rhinitis during pregnancy, although should be avoided during the entire first trimester, as it has been associated with infant gastroschisis. This medication is pregnancy category C.
Medicated nasal sprays. Cromolyn nasal spray (NasalCrom, generics) is helpful in treating allergic rhinitis if it is used before exposure to an allergen and prior to the onset of symptoms. This medication is pregnancy category B and is available over the counter. If this medication is not helpful, one nasal steroid, budesonide (Rhinocort Aqua), recently received a pregnancy category B rating (all others are category C), and therefore would be the nasal steroid of choice during pregnancy.
Immunotherapy. Allergy shots can be continued during pregnancy, but it is not recommended to start this treatment while pregnant. Typically the dose of the allergy shots is not increased, and many allergists will cut the dose of the allergy shot by 50 percent during pregnancy. Some allergists feel that allergy shots should be stopped during pregnancy, given the risk of anaphylaxis and possible danger to the fetus as a result. Other than anaphylaxis, there is no data showing that the allergy shots themselves are actually harmful to the fetus.
Allergic Reaction Medical Treatment And Care
Avoid triggers. If you know you have an allergic reaction to peanuts, for example, do not eat them. Go out of your way to avoid foods prepared with or around peanuts.
Self-care at home is not enough in severe reactions. A severe reaction is a medical emergency. Do not attempt to treat or “wait out” severe reactions at home. Go immediately to a hospital emergency department.
If no one is available to drive you right away, call 911 for emergency medical transport. For more information on what to do in a severe reaction, see Anaphylaxis. Small reactions with mild symptoms usually respond to nonprescription allergy medications.
An oral antihistamine, such as diphenhydramine (Benadryl). These may make you too drowsy to drive or operate machinery safely. They can affect concentration and interfere with children’s learning in school. These medications should be taken for only a few days. For rashes, an anti-inflammatory steroid cream such as hydrocortisone
For small, localized skin reactions, try cold, wet cloths or ice. Try applying a bag of frozen vegetables wrapped in a towel.
Generally, medication is the treatment of choice after the allergen is removed. For more information on removing environmental allergies from your home, see Allergy-proof your home.
Very severe reactions may require other therapy, such as oxygen for breathing difficulties or intravenous fluids to boost blood pressure in anaphylactic shock. Patients with very severe reactions usually require hospitalization.
Anti-allergy medications are of many types. The choice of medication and how it is given depends on the severity of the reaction.
For relief of long-term allergies such as hay fever or reactions to dust or animal dander, the following medications may be prescribed:
Long-acting prescription antihistamines, such as cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin), can relieve symptoms without causing sleepiness. They are meant to be taken for months at a time, even indefinitely. Most have to be taken only once a day and last for 24 hours.
Nasal corticosteroid sprays are widely prescribed for nasal symptoms not relieved by antihistamines. These prescription medications work very well and are safe, without the side effects of taking steroids by mouth or injection. These sprays take a few days to take effect, and must be used every day. Examples are fluticasone (Flonase), mometasone (Nasonex), and triamcinolone (Nasacort).
In some people, cromolyn sodium nasal spray prevents allergic rhinitis, inflammation of the nose that occurs as an allergic reaction.
Decongestants can restore sinus drainage, relieving symptoms such as nasal congestion and swelling and runny nose and sinus pain (pain or pressure in the face, especially around the eyes). They are available in oral forms and as nasal sprays. They should be used for only a few days, as they may have side effects such as high blood pressure, rapid heartbeat, and nervousness.
Allergic Reaction Therapy And Medications
Allergy shots are given to some people who have persistent and disruptive allergy symptoms. The shots do not treat symptoms, but by altering the immune response they prevent future reactions. (This is referred to as immunotherapy.) Treatment involves a series of shots, each containing a slightly greater amount of the antigen(s) that cause the reaction. Ideally, the person will become “desensitized” to the antigen(s) over time. The effectiveness of shots varies by individual.
Anti-allergy medications are of many types. The choice of medication and how it is given depends on the severity of the reaction.
For relief of long-term allergies such as hay fever or reactions to dust or animal dander, the following medications may be prescribed.
Long-acting prescription antihistamines, such as cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin), can relieve symptoms without causing sleepiness. They are meant to be taken for months at a time, even indefinitely. Most have to be taken only once a day and last for 24 hours.
Nasal corticosteroid sprays are widely prescribed for nasal symptoms not relieved by antihistamines. These prescription medications work very well and are safe, without the side effects of taking steroids by mouth or injection. These sprays take a few days to take effect, and must be used every day. Examples are fluticasone (Flonase), mometasone (Nasonex), and triamcinolone (Nasacort).
In some people, cromolyn sodium nasal spray prevents allergic rhinitis, inflammation of the nose that occurs as an allergic reaction. Decongestants can restore sinus drainage, relieving symptoms such as nasal congestion and swelling and runny nose and sinus pain (pain or pressure in the face, especially around the eyes). They are available in oral forms and as nasal sprays. They should be used for only a few days, as they may have side effects such as high blood pressure, rapid heartbeat, and nervousness.
Self-care at home is not enough in severe reactions. A severe reaction is a medical emergency. Do not attempt to treat or “wait out” severe reactions at home. Go immediately to a hospital emergency department. If no one is available to drive you right away, call 911 for emergency medical transport. For more information on what to do in a severe reaction, see Anaphylaxis.
An oral antihistamine, such as diphenhydramine (Benadryl). Caution these may make you too drowsy to drive or operate machinery safely. They can affect concentration and interfere with children’s learning in school. These medications should be taken for only a few days. For rashes, an anti-inflammatory steroid cream such as hydrocortisone
