Treatment of allergic rhinitis

Date: January 2019, Version 3

What is allergic rhinitis?

Allergic rhinitis is an allergic reaction caused by breathing in particles from the air such as dust, mould, or small flakes of skin from some animals (dander). Hay fever is a specific type of allergic rhinitis caused by breathing in pollen. Symptoms of allergic rhinitis can include sneezing, a runny and itchy nose, and itchy watery eyes.

How can I treat allergic rhinitis during pregnancy?

There are no official guidelines on the best way to treat allergic rhinitis during pregnancy. Treatment may not be necessary in cases of mild allergic rhinitis, and studies have shown no links between having allergic rhinitis during pregnancy and birth defects in the baby, preterm birth, or stillbirth.

Pregnant women with allergic rhinitis who are not able to cope with their symptoms are generally advised to try the following steps one at a time:

(1) If possible, avoid or limit exposure to the substance causing the allergy (such as dust, animal dander, or pollen).

(2) Apply petroleum jelly (Vaseline) or a wax-based ointment around the nostrils to trap dust, pollen etc.

(3) Rinse inside the nose frequently with a salt water solution (saline). Pre-prepared nasal saline powders and solutions are available from pharmacies. You should not prepare a saline solution yourself without following reliable instructions, as using the wrong amount of salt can irritate the nasal membranes.

(4) If this does not help, you can consider using nasal sprays containing medicines called corticosteroids, mast cell stabilisers or antihistamines, and/or eye drops that contain mast cell stabilisers or antihistamines. Although some of these can be bought without a prescription, it is best to seek your doctor’s advice. The medicines in nasal sprays and eye drops enter the blood stream in very small amounts. The dose of medicine that reaches the baby in the womb is therefore very small and would not be expected to cause any adverse effects. However, nasal sprays containing medicines called decongestants should ideally not be used (see below).

(5) If the above measures are not effective, you could speak to your doctor about using antihistamine tablets in pregnancy. There is much more pregnancy safety information for some antihistamines compared to others, and some antihistamines cause drowsiness and may therefore not be suitable for use while pregnant. Your doctor will bear these things in mind, along with your specific symptoms and medical history when recommending the best antihistamine for you.

bump leaflets are available on use in pregnancy of the antihistamines cetirizine, loratadine, fexofenadine and chlorphenamine

Can I use decongestants during pregnancy?

Decongestant medicines (e.g. Sudafed^®, Galpseud^®) often contain pseudoephedrine which helps to relieve a blocked nose by causing the blood vessels to narrow, thereby reducing swelling of the nasal membranes and mucus production. Decongestants are not recommended for use at any stage of pregnancy as they could also reduce blood flow in the placenta and to the baby.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

There is no evidence that using treatments for allergic rhinitis during pregnancy will cause any problems that would require extra monitoring for your baby.

Are there any risks to my baby if the father has used an allergic rhinitis treatment?

No studies have specifically investigated whether treatments for allergic rhinitis used by the father can harm the baby through effects on the sperm, however most experts agree that this is very unlikely. More research on the effects of drug and medicine use in men around the time of conception is needed.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org

How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.