Cindy Heller asked:

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.

Bryan Morris asked:


Approximately 50 million Americans have asthma, hay fever or other allergy related conditions.

You can spot them from across the room – tissue in hand, sneezing, sniffling, blowing their nose, tearing, and rubbing their eyes. This is a common presentation for millions of children and adults who suffer from the misery of allergies. If fortunate, these symptoms are but a minor inconvenience, but, if severe, they can significantly affect one’s quality of life.

Allergies involving the nose (rhinitis) and eyes (conjunctivitis) are almost always caused by contact of an offending “allergen” to the mucous membrane lining of the nose or eyes. Constant exposure for the allergic individual can cause daily symptoms, resulting in what your physician would diagnose as persistent, chronic, or perennial allergic rhinitis. Common allergens responsible for these chronic symptoms may include house dust mites, mold spores, indoor pets, cockroach allergen, or feathers.

Symptoms of allergic rhinitis can also be acute or intermittent, presenting only when one is exposed to a relevant allergen. One of the most common presentations of allergies is seasonal allergic rhinitis or “hay fever”. As its name implies, symptoms will present during the pollen seasons, most typically in the spring during the tree and grass pollinating times, and in the fall when ragweed and other weed pollens are present.

You may want to consider a visit to an allergist if the following symptoms are present on a daily basis or seasonally:

• Itchy, swollen, red, tearing eyes

• Itching of the nose, ears, eyes, or throat

• Runny nose

• Sneezing

• Nasal congestion

• Persistent post-nasal drip

Allergic rhinitis is actually one of the easiest diagnoses for your physician to make. If the medical history suggests allergic rhinitis, an allergist will likely perform allergy testing in order to confirm the diagnosis, identify the offending allergen(s), and ascertain the severity of the allergy. The preferable testing method by most allergists is skin testing. This method allows the testing of multiple allergens simultaneously, with the results being immediately available. Alternatively, similar results can be obtained through a blood test called RAST or ImmunoCap.

Once the relevant allergens have been identified, an allergist will recommend a comprehensive treatment plan. This plan may include one or all of the following:

• Environmental control – minimizing exposure to allergens that you are sensitive to

• Pharmacotherpy – medicines including antihistamines, steroid nasal sprays, and other non-steroidal blockers of inflammation

• Immunotherapy or desensitization – extracts of allergens (pollens, dust, molds, etc.) are introduced into the body to induce an immunologic response, resulting in the eventual reduction or elimination of the allergic reaction. Historically, this form of treatment was available only by injection. Recent advances now allow the desensitization process to be given, in selected patients, by taking drops under the tongue, a process called sublingual immunotherapy (SLIT).

The most severe allergic reaction is called anaphylaxis. The most common causes of anaphylaxis include the ingestion of a highly allergenic food, such as peanuts, tree nuts, and shell-fish, or a medicine. The sting of a yellow jacket, wasp, hornet, or honeybee, or the bite of a fire ant can also result in a severe allergic reaction in a susceptible individual.

The symptoms of anaphylaxis vary from person to person. For some, they may be mild and include only generalized itching and urticaria (hives). In more severe reactions, however, they can include involvement of the respiratory, circulatory, and digestive systems, and can be fatal if not treated quickly and aggressively by the administration of epinephrine. Epinephrine can be self injected with the use of an EpiPen or Twinject.

Symptoms of full blown anaphylaxis may include:

• Difficulty breathing

• Hives or swelling

• Tightness of the throat

• Hoarse voice

• Nausea

• Vomiting

• Abdominal pain

• Diarrhea

• Dizziness

• Low blood pressure

• Cardiac arrest

• Shock

Those who have had anaphylaxis or are at risk for anaphylaxis should be evaluated by a board certified allergist for confirmation, identification of the allergen(s), and education regarding prevention, recognition, and self treatment of anaphylaxis.

There are many preventative measures allergy sufferers can take to protect themselves from potentially dangerous allergic reactions. Education is the best medicine. And, consider consulting an allergist for the most complete and up-to-date treatments available.

More detailed descriptions of common allergies and asthma can be found on the website, allergymedsites.com.