Can pregnancy exacerbate allergic rhinitis?

From the Guidelines

Yes, pregnancy can exacerbate rhinitis, with approximately 30% of pregnant women experiencing pregnancy rhinitis, characterized by nasal congestion, increased mucus production, and nasal obstruction. This condition typically begins after the first trimester and resolves within two weeks after delivery. The primary cause is hormonal changes during pregnancy, particularly increased estrogen and progesterone levels, which can lead to increased blood flow to mucous membranes, causing swelling and congestion 1.

Key Points to Consider

• Treatment options include saline nasal sprays, nasal strips, and elevation of the head while sleeping.
• Some medications like intranasal corticosteroids (budesonide) are considered relatively safe during pregnancy, but oral decongestants should generally be avoided, especially in the first trimester 1.
• Intranasal cromolyn sodium is another safe option.
• Women with pre-existing allergic rhinitis may find their symptoms worsen during pregnancy.
• It's essential for pregnant women experiencing significant rhinitis symptoms to consult with their healthcare provider before using any medications to ensure safety for both mother and baby.

Recommendations

• Intranasal corticosteroids, such as budesonide, can be used for CRS maintenance therapy during pregnancy at recommended doses 1.
• Oral corticosteroids in short bursts may be safe after the first trimester, but their use should be justified in severe CRS, especially if causing exacerbation of asthma, and in consultation with the patient’s obstetrician 1.
• Oral antibiotics that do not harm the fetus, such as penicillin and cephalosporin, can be used for ABRS or acute exacerbations of CRS 1.

Safety Considerations

• The use of intranasal corticosteroids during pregnancy has demonstrated no convincing evidence of congenital defects, and they are considered relatively safe 1.
• Oral corticosteroids use during pregnancy may be associated with slightly increased risk of cleft lip with or without cleft palate, increased incidence of preeclampsia, and the delivery of both preterm and low birth weight infants 1.

From the Research

Rhinitis and Pregnancy

• Rhinitis is a common condition during pregnancy, affecting about 30% of women 2.
• The hormonal changes during pregnancy can contribute to nasal congestion and exacerbate rhinitis symptoms 2, 3.
• Pregnancy rhinitis is a defined clinical entity that affects one in five pregnant women, and its cause is multifactorial 4, 3.

Types of Rhinitis

• The most common forms of rhinitis are allergic, drug-induced, infectious, and vasomotor rhinitis 2.
• Allergic rhinitis occurs when disruption of the epithelial barrier allows allergens to penetrate the mucosal epithelium of nasal passages, inducing a T-helper type 2 inflammatory response and production of allergen-specific IgE 5.
• Nonallergic rhinitis presents primarily with nasal congestion and postnasal drainage, frequently associated with sinus pressure, ear plugging, muffled sounds, and pain 5.

Treatment of Rhinitis during Pregnancy

• The safety profile of drugs is the primary item to be considered when treating rhinitis during pregnancy 2.
• Cromones are considered the safest drugs, but they require multiple daily administrations 2.
• Antihistamines should be considered as second-choice drugs and their use is not recommended during the first three months of pregnancy 2.
• Topical steroids are useful in moderate to severe rhinitis, with beclometasone being the most documented molecule 2.
• Simple measures such as elevated head end of the bed, physical exercise, nasal saline washings, and nasal alar dilation can improve nasal breathing 4.