What is the management for pregnancy rhinitis?

From the Guidelines

Pregnancy rhinitis is best managed through a combination of non-pharmacological approaches and cautious use of medications when necessary, prioritizing fetal safety and maternal quality of life. The management of pregnancy rhinitis should start with non-pharmacological interventions, including:

• Saline nasal irrigation or sprays to safely moisturize nasal passages and remove irritants without risk to the fetus 1
• Physical interventions like elevating the head of the bed by 30-45 degrees, using a humidifier in the bedroom, and avoiding known triggers (such as dust, smoke, and strong odors) to provide significant relief 1
• External nasal dilator strips to improve airflow without medication if symptoms persist 1

For medication options,

• Intranasal corticosteroids like budesonide (Rhinocort) are generally considered first-line when needed, as they have minimal systemic absorption 1
• Antihistamines should be used cautiously, with second-generation options like loratadine or cetirizine preferred if necessary 1
• Decongestants containing pseudoephedrine or phenylephrine should be avoided, especially in the first trimester, due to potential risks including vasoconstriction affecting placental blood flow 1

It is essential to weigh the strength of evidence regarding specific interventions while balancing maternal health against potential fetal risks, and these recommendations should be utilized and modified as determined after careful and thoughtful, individualized review of the pregnant patient, and in consultation with their Obstetrician 1. Pregnancy rhinitis typically resolves within two weeks after delivery as hormone levels normalize, particularly estrogen which contributes to nasal mucosa swelling and increased mucus production during pregnancy 1.

From the Research

Management of Pregnancy Rhinitis

The management of pregnancy rhinitis involves a combination of non-pharmacological and pharmacological interventions.

• Non-pharmacological interventions include:
  • Saline irrigations 2, 3, 4
  • Exercise 2, 4
  • Mechanical alar dilators 2, 3, 4
  • Nasal valve dilators 4
  • Positioning 4
  • Saline nasal douching/lavage 4
• Pharmacological interventions include:
  • Topical corticosteroids, which have generally shown to be safe with budesonide having the strongest recommendations 4
  • Oral corticosteroids, which are mostly used in moderate-severe disease and should be avoided in the first trimester 4
  • Loratadine and cetirizine, which are generally considered safe 4
  • Anticholinergics or cromones, which have no reported increased risk of teratogenicity 4
  • Immunotherapy, which can be continued if already initiated prior to pregnancy 4

Safety Considerations

When managing pregnancy rhinitis, it is essential to consider the safety of the fetus and the mother.

• Nasal decongestants provide only temporary relief and can lead to the development of rhinitis medicamentosa 2, 3
• Oral decongestants have associations with cardiac, ear, gut, and limb abnormalities and are not recommended in the first trimester 4
• Systemic administration of corticosteroids should be avoided during pregnancy 3

Treatment Options

The treatment options for pregnancy rhinitis depend on the severity of the symptoms and the presence of any underlying conditions.

• For mild symptoms, non-pharmacological interventions may be sufficient 2, 4
• For moderate to severe symptoms, pharmacological interventions may be necessary 4
• It is essential to distinguish between the causes of rhinitis, as this can influence treatment 4