Use non-pharmacological treatments for the initial management of hay fever during pregnancy. If insufficient, use topical treatments or oral antihistamines.

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.

Allergic rhinitis is an inflammatory disorder of the nose that occurs when the nasal mucosa becomes exposed and sensitized to allergens. Symptoms can negatively impact on quality of life, and include sneezing, nasal itching, rhinorrhoea, and congestion. Treatments for allergic rhinitis can help relieve symptoms, but may not be essential if symptoms are mild and do not affect the quality of life.

Guidelines

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

The British Society for Allergy & Clinical Immunology (BSACI) guidance on the diagnosis and management of allergic and non-allergic rhinitis  includes information about treatment during pregnancy.

Treatment options

Allergic rhinitis should be treated using a stepwise approach, starting with non-pharmacological options.

Decongestants are not recommended for use at any stage of pregnancy as they could reduce blood flow in the placenta and to the baby.

Non-pharmacological options

Treatment options include:

  • avoidance of allergens and triggers
  • application of a barrier ointment around the nostrils
  • nasal irrigation with saline

Topical pharmacological options

Topical treatment with ocular mast cell stabilisers (for example, sodium cromoglicate) or intranasal corticosteroids (for example, fluticasone) can be considered if non-pharmacological management is insufficient.

Topical treatments act locally and have lower systemic absorption (and fetal exposure) than oral preparations. Intranasal corticosteroids are also the most effective treatment for allergic rhinitis.

Alternative oral treatments are available if topical treatments fail to control symptoms.

Antihistamines

If local topical therapy fails to control symptoms, oral antihistamines may be considered.

Non-sedating antihistamines are preferred because of the risks associated with drowsiness in the mother.

Loratadine and cetirizine are the preferred antihistamines for pregnant women. Chlorphenamine can be used if a sedating antihistamine is needed. Human pregnancy data for the use of acrivastine or fexofenadine is limited. Fexofenadine should be reserved for cases where no other suitable treatment is available.

Montelukast

Due to a lack of information, montelukast should not be used solely to treat allergic rhinitis, but may be used to treat concomitant asthma.

Monitoring in pregnancy

Use of sodium cromoglicate, topical corticosteroids, loratadine, cetirizine, chlorphenamine or fexofenadine during pregnancy is not usually regarded as grounds for additional fetal monitoring. Other risk factors may be present. Healthcare professionals should consider these when completing risk assessments.

Pregnancy outcome information

UK Teratology Information Service (UKTIS) has guidance about the treatment of hay fever (allergic rhinitis) in pregnancy. Safety and pregnancy outcome information for the use of topical steroids, sodium cromoglicate, loratadine, cetirizine and chlorphenamine is also available.

Patient information

UKTIS has corresponding BUMPS leaflets on the treatment of allergic rhinitis, and use of loratadinecetirizinechlorphenaminefexofenadinetopical corticosteroids and sodium cromoglicate.

The NHS have a Health A to Z page on antihistamines, and Medicines A to Z pages on loratadinecetirizine and chlorphenamine.

Update history

  1. Full review and update of article. Minor changes to structure of article made.
  2. Published
  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. 

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