What are the recommended medications for allergy relief during pregnancy?

From the Guidelines

During pregnancy, the safest allergy medications include second-generation antihistamines like loratadine (Claritin) 10mg once daily, cetirizine (Zyrtec) 10mg once daily, or fexofenadine (Allegra) 60mg twice daily or 180mg once daily, as well as intranasal corticosteroids such as budesonide (Rhinocort) or fluticasone (Flonase) used as 1-2 sprays per nostril daily. These medications are considered first-line treatments due to their minimal placental transfer and long histories of use without significant adverse pregnancy outcomes, as supported by studies such as 1 and 1.

When considering allergy relief during pregnancy, it's crucial to prioritize medications with established safety profiles. Second-generation antihistamines and intranasal corticosteroids are preferred due to their efficacy and safety. Key points to consider include:

• The use of second-generation antihistamines like loratadine and cetirizine, which have been shown to be safe in pregnancy 1.
• The safety of intranasal corticosteroids, such as budesonide and fluticasone, which have negligible systemic absorption and are considered safe for use during pregnancy 1.
• The avoidance of oral decongestants in the first trimester, unless absolutely necessary, due to potential risks 1.
• The consideration of non-medication approaches as first-line treatments, including saline nasal sprays, avoiding allergens, using air purifiers, and keeping windows closed during high pollen seasons.

It's also important to note that allergen immunotherapy may be continued during pregnancy if it is effective and not causing significant reactions, but the initiation of immunotherapy during pregnancy is generally not recommended unless there is a high-risk medical condition, as discussed in 1. Ultimately, the goal is to balance symptom relief with minimal risk to the developing baby, and these recommendations are based on the most recent and highest quality studies available, including 1, which provides a comprehensive overview of the safety of various medications during pregnancy.

From the FDA Drug Label

Fluticasone propionate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. There are no adequate and well-controlled studies in pregnant women

The recommended medication for allergy relief during pregnancy is not explicitly stated in the provided drug label. However, it is mentioned that fluticasone propionate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

• The drug label does not provide a list of recommended medications for allergy relief during pregnancy.
• It is essential to consult a healthcare professional to determine the best course of treatment for allergy relief during pregnancy, as they can assess the individual's situation and provide personalized guidance 2.

From the Research

Recommended Medications for Allergy Relief During Pregnancy

The following medications are recommended for allergy relief during pregnancy:

• Intranasal and inhaled steroids, with budesonide being the drug of choice 3
• Second-generation antihistamines, such as cetirizine and loratadine 3, 4, 5
• Leukotriene receptor antagonists 3
• Immunotherapy, which has not been proven to be teratogenic and is clinically useful in improving symptoms 4, 5, 6
• Intranasal cromolyn, which has an excellent safety profile 4
• Oral and topical decongestants, which can be considered as second-line therapy for short-term relief 4, 5

Medications to Avoid During Pregnancy

The following medications should be avoided during pregnancy:

• Intranasal antihistamines 3
• First-generation antihistamines, except in cases where the benefits outweigh the risks 3, 5, 7
• Mycophenolate mofetil, methotrexate, cyclosporine, azathioprine, and zilueton 3
• Oral, intranasal, and ophthalmic decongestants, except in cases where no safer alternative is available 4, 5

Considerations for Treatment

When treating allergic rhinitis during pregnancy, the best first-line approach is avoidance of allergens 4. If environmental modification is ineffective, pharmacologic agents should be chosen based on their safety profile and efficacy 4, 5. The choice of agent should be based on evidence of fetal safety, as well as efficacy in managing the condition 5. A careful risk/benefit assessment should be done before prescribing any medication during pregnancy 7.