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.

Nonallergic rhinitis is a syndrome resulting from nasal inflammation that encompasses several distinct diagnoses. Nonallergic rhinitis may be diagnosed by means of clinical evaluation or by means of allergen skin testing or radioallergosorbent testing. This type of rhinitis is not as well understood. Although not triggered by allergy, the symptoms are often the same as seen with allergic rhinitis. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but no allergy is involved. Nonallergic rhinitis affects approximately 17 million people in the U.S.- both children and adults. The distinction between allergic and nonallergic rhinitis can be difficult to distinguish clinically, but the distinction may be important for prognosis and treatment decisions. Many symptoms of nonallergic rhinitis are similar to allergic rhinitis, but are more chronic, occurring year-round, and are often worse in winter. Irritants such as fumes, fresh newsprint, strong odors, smoke and various types of dust may bring on symptoms. A diagnosis of nonallergic rhinitis is made after an allergy cause is ruled out. This often requires allergy skin or blood tests. A physical examination, allergy testing and a CT scan of the nose and sinuses are often used to assess and diagnose the condition of nonallergic rhinitis.

Causes of Nonallergic rhinitis

The common causes and risk factor’s of Nonallergic rhinitis include the following:

Blood vessels in your nose expanding (dilating), filling the nasal lining with blood and fluid.

Inflammation of the lining of the nose.

Smoke and other irritants.

Temperature or atmospheric changes.

Alcohol.

Psychological and Emotional factors.

Prolonged use of decongestant nasal drops or sprays.

Exposure to irritants.

Symptoms of Nonallergic rhinitis

Some sign and symptoms related to Nonallergic rhinitis are as follows:

Stuffy nose.

Congestion.

Mucus (phlegm) in the throat (postnasal drip).

Sneezing.

Postnasal drainage.

Itchy nose, throat, eyes, and ears.

Treatment of Nonallergic rhinitis

Here is list of the methods for treating Nonallergic rhinitis:

Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.

Antihistamines help to reduce the effects of histamine, which can decrease the symptoms of itching, sneezing, or runny nose.

Turbinate reduction is also used.

If your symptoms aren’t easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as budesonide (Rhinocort), fluticasone (Flonase), mometasone (Nasonex) or triamcinolone (Nasacort).

Pseudoephedrine-containing drugs (Sudafed, Actifed, others) and phenylephrine.

Surgery has a limited role.