Hayfever or allergic rhinitis: treatment during pregnancy

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Signposting evidence-based information on the treatment of hayfever or allergic rhinitis in pregnancy

Condition management

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.

NICE CKS Allergic rhinitis is a good general resource, however it does not include specific information on treatment selection or use in pregnancy.

You should check if there is local guidance for you to use in your area.

Non-pharmacological options

A stepwise approach is recommended starting with non-pharmacological measures such as allergen avoidance, use of barrier ointment around the nostrils, nasal filters and nasal saline irrigation.

Pharmacological options

Topical therapy

Topical (intranasal/ocular) mast cell stabilisers, such as sodium cromoglicate or intranasal corticosteroids, should be considered if non-pharmacological measures are insufficient.

These act locally and have lower systemic absorption (and fetal exposure) than oral preparations.

Oral therapy

If local topical therapy fails to control symptoms, oral antihistamines may then be considered. Non-sedating antihistamines are generally preferred because they are less sedating and have fewer cholinergic side effects compared with first-generation agents.

First line
  • Cetirizine and loratadine are considered first choice oral antihistamines in pregnancy.
  • Levocetirizine is an isomer of cetirizine and desloratadine is the active metabolite of loratadine. Both may also be considered.
Second line
  • Chlorphenamine is recommended if a first generation sedating antihistamine is needed.
Other options
  • Safety data on the use of acrivastine, bilastine or mizolastine is lacking.
  • Fexofenadine should be reserved for cases where no other suitable treatment is available.
  • Decongestants are not recommended for use at any stage of pregnancy as they could reduce blood flow in the placenta and to the baby.

Pregnancy outcome information

UK Teratology Information Service (UKTIS) provides an overview of treatment of hay fever (allergic rhinitis) in pregnancy and more detailed pregnancy outcome data on individual medicines including chlorphenamine, loratadine, cetirizine, and fexofenadine

Patient information

Each of the UKTIS summaries has corresponding Best Use of Medicine in Pregnancy (BUMPS) patient information.

Support for prescribing decisions in people on interacting medicines, those with swallowing difficulties, renal impairment, or who are pregnant or breastfeeding
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SPS PGD template for the intrapartum administration of benzylpenicillin for prevention of early-onset Group B Streptococcus (GBS) infection in neonates.
Opioid analgesics may be used at any stage of pregnancy at the lowest effective dose for the short-term relief of pain when other analgesics are not effective.
Intramuscular hydroxocobalamin is the preferred treatment choice for management of clinically relevant vitamin B12 deficiency, including during pregnancy.
SPS PGD template for the supply of folic acid 5mg tablets to reduce risk of neural tube defect or compensate for increased folate demand during pregnancy.
SPS PGD template for the supply of aspirin tablets to individuals at risk of pre-eclampsia during pregnancy.
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Update history

  1. Added advice about avoiding decongestants during pregnancy
  2. Removed SPS Further information on which medicines can be used to treat allergic rhinitis in pregnancy. 
  1. Published

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