From the Guidelines
Intranasal corticosteroids, such as budesonide (Rhinocort), fluticasone (Flonase), and mometasone (Nasonex), are the recommended nasal sprays for treating allergic rhinitis during pregnancy, due to their safety and efficacy profile, as supported by the most recent evidence from 2020 1. The recommended dosage is typically 1-2 sprays in each nostril once daily, though this may vary by product. Some key points to consider when using nasal sprays during pregnancy include:
- Saline nasal sprays are completely safe alternatives for mild symptoms and can be used as needed.
- Azelastine, an antihistamine nasal spray, is generally considered second-line therapy during pregnancy.
- Proper technique is important when using nasal sprays: gently shake the bottle, tilt your head slightly forward, aim the spray away from the nasal septum, and avoid sniffing forcefully after spraying.
- These medications work by reducing inflammation in the nasal passages, decreasing mucus production, and blocking histamine receptors in the case of azelastine.
- They are preferred during pregnancy because they have minimal systemic absorption compared to oral medications, reducing potential risks to the developing fetus, as noted in earlier studies 1. However, the most recent and highest quality study from 2020 1 provides the strongest evidence for the safety and efficacy of intranasal corticosteroids during pregnancy.
From the FDA Drug Label
Azelastine hydrochloride has been shown to cause developmental toxicity. There are no adequate and well-controlled clinical studies in pregnant women. Astelin® Nasal Spray should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus
The recommended nasal spray for treating allergic rhinitis during pregnancy is not explicitly stated in the provided drug label. However, Azelastine (Astelin® Nasal Spray) may be used during pregnancy if the potential benefit justifies the potential risk to the fetus 2. Caution is advised due to the lack of adequate and well-controlled clinical studies in pregnant women.
From the Research
Recommended Nasal Sprays for Pregnancy
The following nasal sprays are recommended for treating allergic rhinitis during pregnancy:
- Fluticasone furoate, as it has been found to be safe if used at the recommended therapeutic dose after a proper medical evaluation 3
- Mometasone, which has been shown to be as effective as fluticasone propionate in treating perennial rhinitis and is well-tolerated 4, 5
- Budesonide, which is suggested to be safe if used at the recommended therapeutic dose after a proper medical evaluation 3
- Azelastine nasal spray, which is a second-generation antihistamine that offers a rapid onset of action and flexibility of both dose and dosage, and has an excellent safety profile 6
Safety Considerations
When using nasal sprays during pregnancy, it is essential to consider the risk-benefit ratio and use the recommended therapeutic dose after a proper medical evaluation 3. Some nasal sprays, such as intranasal triamcinolone, have been found to have a significant association with respiratory tract defects and should be avoided 3.
Alternative Options
In the absence of other intranasal corticosteroid options, fluticasone propionate might be a safe option, although its efficacy during pregnancy is questionable 3, 7. It is crucial to consult with a healthcare provider to determine the best course of treatment for allergic rhinitis during pregnancy.