What should I ask an allergist before conceiving with pre-existing allergies?

Important Questions to Ask an Allergist Before Conceiving with Pre-existing Allergies

Before conceiving, women with pre-existing allergies should discuss medication safety, allergy management strategies, and potential risks with an allergist to ensure optimal outcomes for both mother and baby.

Medication Safety Questions

Current Medication Review

• "Which of my current allergy medications are safe to continue during pregnancy?"
• "Do I need to switch any medications before trying to conceive?"
• "How long before conception should I make any medication changes?"

Specific Medication Safety

• "Are my antihistamines safe during pregnancy, particularly in the first trimester?"

  • Second-generation antihistamines like cetirizine and loratadine are generally considered safer options during pregnancy 1, 2
  • First-generation antihistamines should be avoided due to their sedative and anticholinergic properties 3

• "Is my nasal corticosteroid spray safe to continue during pregnancy?"

  • Intranasal corticosteroids may be safely used during pregnancy 3
  • Budesonide is often considered the inhaled corticosteroid of choice during pregnancy 2

• "If I use leukotriene modifiers (like montelukast), can I continue them during pregnancy?"

  • Montelukast can be continued during pregnancy, especially for those with recalcitrant asthma 3

• "Are decongestants safe during pregnancy?"

  • Oral decongestants should be avoided during the first trimester 3
  • Topical decongestants should only be used short-term if needed 3

Allergen Immunotherapy Questions

For Women Already on Immunotherapy

• "Should I continue my allergen immunotherapy during pregnancy?"
  • Immunotherapy that has reached maintenance dose can be safely continued during pregnancy 3, 4
  • No significant difference has been found in maternal or fetal complications between women continuing immunotherapy during pregnancy and controls 4

For Women Considering Starting Immunotherapy

• "Should I start immunotherapy before conceiving or wait until after pregnancy?"
  • Immunotherapy should not be initiated during pregnancy 3
  • If considering immunotherapy, it's best to start well before conception and reach maintenance dosing 3, 4
  • Initiation or dose escalation of immunotherapy should not be conducted during pregnancy 3

Asthma Management Questions

Asthma Control Assessment

• "How will my asthma affect my fertility and pregnancy?"

  • Women with asthma may experience prolonged time to pregnancy 5
  • Well-controlled asthma decreases risks of maternal and fetal complications 5

• "What is my current level of asthma control, and what changes should I make before conceiving?"

  • Poorly controlled asthma before pregnancy increases the likelihood of worsening symptoms during pregnancy 3
  • Uncontrolled asthma poses risks to the fetus including hypoxia, growth restriction, preterm birth, and low birth weight 3

• "How will my asthma medications need to be adjusted during pregnancy?"

  • Asthma treatment should follow general guidelines regardless of pregnancy status 5
  • Medication dosages, particularly for thyroid replacement therapy, may need to be increased during pregnancy 3

Environmental Control Questions

• "What environmental controls should I implement before conceiving?"
  • "Should I make any changes to my home environment to reduce allergen exposure?"
  • "Are there specific allergens I should be particularly careful to avoid during pregnancy?"

Testing and Monitoring Questions

• "Are there any allergy tests I should have before conceiving?"

  • In vivo allergy tests are generally avoided during pregnancy for legal and psychological reasons 6
  • Consider completing necessary testing before conception

• "How will we monitor my allergies during pregnancy?"

  • For asthma, repeated measurements of fractional exhaled nitric oxide (FENO) can help achieve optimal control 5

Emergency Management Questions

• "What is my action plan for managing severe allergic reactions during pregnancy?"
  • Discuss emergency medication use, including epinephrine autoinjectors
  • Create a written emergency action plan

Special Considerations

• "If I have food allergies, should I avoid certain foods during pregnancy to prevent allergies in my child?"

  • There is currently no evidence supporting avoidance of any particular food during pregnancy or breastfeeding to prevent food allergy development in children 3

• "Will my allergies affect my labor and delivery options?"

  • Discuss any concerns about medication use during labor
  • Consider potential cross-reactivity with medications used during delivery

Follow-up Planning

• "How often should I see you during pregnancy to monitor my allergies?"
• "What symptoms should prompt me to contact you immediately during pregnancy?"

Important Cautions

• Never initiate immunotherapy during pregnancy 3
• Avoid oral decongestants during the first trimester 3
• First-generation antihistamines should be avoided due to sedative effects 3
• Women with uncontrolled asthma should achieve better control before conceiving 5

By discussing these questions with an allergist before conception, women with allergies can develop a comprehensive management plan that minimizes risks and optimizes outcomes for both mother and baby.