Allergic rhinitis (AR) affects 20-30% of women in the childbearing age group with an annually increasing prevalence. Show
The classical clinical symptoms include sneezing, itching, nasal blockage, and nasal discharge. In patients who had allergic rhinitis before, the symptoms may worsen, improve or remain the same during pregnancy. Rhinitis of PregnancyMany pregnant mothers notice some kind of nasal obstruction towards the last part of pregnancy which is termed as rhinitis of pregnancy. Rhinitis of pregnancy is a clinical condition in pregnant women, characterized by persistent nasal congestion and rhinorrhea for 6 weeks without any shreds of evidence of respiratory infection or history of rhinitis. The exact cause for this rhinitis in pregnancy is unknown and is suspected to be due to hormonal variations. This usually occurs after the second trimester (6th month) and resolves itself after delivery. Rhinitis of pregnancy usually doesn’t respond to anti-allergic medications, but intranasal steroid sprays are can be prescribed as a trial. Management of allergic rhinitis in pregnancyAs a general rule, a pregnant mother should avoid most of her medications, or use the lowest possible dose of medications to control her symptoms in pregnancy. All medications the mother is on needs to be reviewed once she is found to be pregnant. The initial management of allergic rhinitis is to avoid exposure to allergens. This includes closing the windows, usage of sunglasses or masks, limiting outdoor exposure when pollen levels are high, avoiding exposure to animal dandruff, etc. If the mother is having only mild symptoms, not affecting her quality of life adversely, then she can use saline nasal drops or nasal washing as advised by her doctor. Drug therapy is recommended when avoidance of allergens is not possible or when avoidance measures fail to control symptoms. Medical management of rhinitis in pregnancyIf medications are needed in pregnancy, selection of anti-allergic medications should be based on the US Food and Drug Administration (FDA) risk categories.
Category A and B drugs are considered to be safe, while category D and X are avoided during pregnancy. Category C drugs should be judiciously used in pregnant women. As of today, there exists no category A anti-allergic medications. Most of the medications belong to group B or C. Intranasal steroids (INS) INS also called as corticosteroid nasal sprays are considered to be the most effective drug (drug of choice) in treatment of allergic rhinitis. They include various formulations like – Fluticasone, Mometasone, Budesonide, Flunisolide, and Triamcinolone. Though guidelines consider all these as safe during pregnancy, all these drugs except budesonide belong to category C, while Budesonide is the only category B drug. If not budesonide, the least absorbed medications like mometasone or fluticasone is considered to be the alternatives in pregnant ladies with rhinitis.
However, Intranasal triamcinolone has been found to have a significant association with respiratory tract defects like choanal atresia. A recent review of literature by Alhussein et al made the following conclusion
Intranasal antihistamines Azelastine is the most commonly used intranasal antihistamine. But it is found to be associated with minor adverse effects in animal fetus and its safety data for humans are not available. Generally, the use of intranasal antihistamines during pregnancy is not recommended. Oral antihistamines First-generation antihistamines like diphenhydramine are associated with the development of cleft palate in the fetus and is not recommended. Second-generation antihistamines labeled as category B (cetirizine, loratadine) are preferred over first-generation in pregnant and nonpregnant individuals. Third generation antihistamines like fexofenadine and desloratadine are associated with low birth weight in animal models and are currently categorized as C. Oral decongestants Use of oral decongestants during pregnancy is found to be associated with small intestinal atresia and development of gastroschisis (abdominal wall birth defect) in newborns. Hence they are not recommended in pregnancy. Leukotriene antagonists Drugs like Montelukast, Zafirlukast are considered to be safe during pregnancy. But Zileuton, a 5-lipoxygenase inhibitor is contraindicated during pregnancy. Immunotherapy in pregnancyImmunotherapy for allergy should not be started during pregnancy because of the fear of anaphylactic reaction. But if the mother is already on immunotherapy, then the treatment can be continued throughout the pregnancy without increasing the dosage. Home remedies for allergic rhinitis treatment
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References
Is fluticasone nasal spray safe during pregnancy?Conclusion: Lacking sufficient clinical trials on the use of intranasal corticosteroid sprays in pregnancy, we suggest that the intranasal use of fluticasone furoate, mometasone, and budesonide is safe if they are used at the recommended therapeutic dose after a proper medical evaluation.
What pregnancy category is fluticasone?"Flonase is currently category C per the FDA for use in pregnancy," says Neeta Ogden MD, an allergist and immunologist and a medical advisor for Curex. "This means the drug can be taken if there is a clinical need for it where the benefits outweigh the risks."
Are any nasal sprays safe during pregnancy?If you're suffering from a cold or allergies during pregnancy, nasal sprays are most likely safe to use. Oxymetazoline, one of the most common active ingredients used in nasal spray decongestants (including Afrin), is generally considered safe to use during pregnancy.
What happens if you use nasal spray while pregnant?Nasal spray decongestants are even safer since the medication is almost entirely absorbed within the nose and does not travel through the body. As a general rule, physicians advise patients if they can buy it without visiting the pharmacy counter, short-term use will not harm the baby during pregnancy.
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