What is the treatment for rhinitis of pregnancy?

From the Guidelines

Pregnancy rhinitis should be managed with saline nasal sprays or rinses, and for more persistent symptoms, nasal steroid sprays like budesonide or fluticasone can be considered relatively safe during pregnancy, as recommended by expert panels and supported by studies such as 1 and 1.

Management Approaches

• Start with non-medication approaches: saline nasal sprays or rinses to moisturize nasal passages and reduce congestion.
• Use nasal strips (like Breathe Right) to physically open nasal passages during sleep.
• For persistent symptoms, consider nasal steroid sprays like budesonide (Rhinocort) or fluticasone (Flonase), which are considered relatively safe during pregnancy, as noted in 1.

Medication Considerations

• Avoid oral decongestants, particularly pseudoephedrine and phenylephrine, especially in the first trimester, due to potential risks highlighted in 1.
• Topical decongestants may have a better safety profile than oral agents for first trimester use, but should be used with caution and under healthcare provider guidance.

Additional Recommendations

• Use a humidifier in the bedroom to add moisture to the air.
• Elevate the head while sleeping with extra pillows to reduce congestion.
• Stay hydrated to thin out mucus.
• Avoid known irritants like smoke or strong fragrances.

Underlying Causes and Symptoms

• Pregnancy rhinitis occurs due to increased estrogen causing nasal tissue swelling and enhanced mucus production, while progesterone relaxes smooth muscles in blood vessels, leading to nasal congestion.
• Symptoms typically resolve shortly after delivery as hormone levels normalize.
• If symptoms are severe or accompanied by fever, facial pain, or green/yellow discharge, consult a doctor as these may indicate an infection requiring different treatment, as suggested in 1.

From the Research

Treatment Options for Rhinitis of Pregnancy

The treatment for rhinitis of pregnancy involves a combination of conservative management and medical therapies. Some of the key treatment options include:

• Education and knowledge that symptoms will resolve after pregnancy 2
• Exercise, positioning, saline nasal douching/lavage, and nasal valve dilators, which are safe in pregnancy and can have a benefit in patients with rhinitis of any aetiology 2, 3
• Topical corticosteroids, such as budesonide, which have generally shown to be safe 2, 4, 5
• Oral corticosteroids, which are mostly used in moderate-severe disease and should be avoided in the first trimester 2
• Second-generation antihistamines, such as loratadine and cetirizine, which are generally considered safe 2, 4, 5
• Anticholinergics and cromones, which have no reported increased risk of teratogenicity and can be used as first-line options in pregnant women with allergic rhinitis 2, 5

Medical Management

The medical management of rhinitis in pregnancy requires careful consideration of the potential risks and benefits of different treatments. Some key points to consider include:

• The importance of distinguishing between the causes of rhinitis, as this can influence treatment 2
• The need to balance the benefits of symptom control with the potential risks to the fetus 6, 4
• The use of nasal decongestants, which should be used with caution and only for a short period of time 2, 4
• The role of allergen immunotherapy, which can be continued if already initiated prior to pregnancy, but requires further research 2

Non-Pharmacological Interventions

Non-pharmacological interventions can also play an important role in the management of rhinitis in pregnancy. Some examples include:

• Saline irrigations, which can help to relieve nasal congestion 3
• Exercise, which can help to improve symptoms and quality of life 2, 3
• Mechanical alar dilators, which can help to improve nasal breathing 3