| 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 3-6 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% 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.
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