What are safe options for allergic rhinitis medication in a pregnant woman?

From the Guidelines

For pregnant women with seasonal allergies, the safest first-line medications are intranasal corticosteroids like budesonide, which has a Pregnancy Category B rating and extensive human safety data 1.

Recommended Medications

• Intranasal corticosteroids: budesonide is preferred due to its Pregnancy Category B rating and extensive human safety data 1
• Second-generation antihistamines: loratadine or cetirizine are considered relatively safe during pregnancy, typically taken once daily at standard adult dosing 1

Non-Drug Approaches

• Avoiding allergens
• Using saline nasal sprays
• Keeping windows closed during high pollen days

Important Considerations

• Use the lowest effective dose for the shortest duration needed to control symptoms
• First-generation antihistamines like Benadryl (diphenhydramine) should be used cautiously due to sedation risks
• Decongestants like pseudoephedrine should generally be avoided, especially in the first trimester
• Always consult with your obstetrician before taking any medication during pregnancy, as individual health circumstances may affect recommendations

Safety of Medications

• Intranasal corticosteroids have a low risk of systemic effect when used at recommended doses 1
• Montelukast, a leukotriene receptor antagonist, can be used for the treatment of allergic rhinitis, but minimal data are available on the use of this medication during pregnancy 1

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 Experience with oral corticosteroids since their introduction in pharmacologic, as opposed to physiologic, doses suggests that rodents are more prone to teratogenic effects from corticosteroids than humans

Options for seasonal allergy medications for pregnant women are limited, and the decision to use any medication should be made with caution.

• Fluticasone propionate may be considered, but only if the potential benefit justifies the potential risk to the fetus 2.
• The use of any medication during pregnancy should be carefully evaluated, and the potential risks and benefits should be discussed with a healthcare provider.
• It is essential to weigh the potential benefits of treatment against the potential risks to the fetus.

From the Research

Seasonal Allergy Medication Options for Pregnant Women

• Intranasal and inhaled steroids, such as budesonide, are considered relatively safe to continue during pregnancy 3, 4
• Second-generation antihistamines, including cetirizine and loratadine, are generally considered safe for use during pregnancy 3, 4, 5, 6
• Leukotriene receptor antagonists are also considered safe for use during pregnancy 3
• Oral decongestants should be used sparingly during the first trimester due to potential associations with cardiac, ear, gut, and limb abnormalities 3, 4
• Anticholinergics and cromones have not been reported to have an increased risk of teratogenicity and may be considered as treatment options 4

Medications to Avoid During Pregnancy

• Intranasal antihistamines 3
• First-generation antihistamines 3
• Mycophenolate mofetil, methotrexate, cyclosporine, azathioprine, and zilueton 3
• Oral corticosteroids should be avoided in the first trimester unless necessary for moderate-severe disease 4

Additional Considerations

• Avoidance of allergens is a recommended first-line approach for managing allergic rhinitis during pregnancy 7
• Allergen immunotherapy may be continued if already initiated prior to pregnancy, but further research is needed to fully understand its safety and efficacy 4