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.
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.
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.
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.
- 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.
- Chlorphenamine is recommended if a first generation sedating antihistamine is needed.
- 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
Each of the UKTIS summaries has corresponding Best Use of Medicine in Pregnancy (BUMPS) patient information.