Safety in Lactation: Drugs used for allergic conditions

Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

Antihistamines

Non-sedating antihistamines (NSA) preferred over sedating antihistamines (SA) unless clinically justified. Cetirizine or loratadine are the preferred NSAs as limited published evidence and more clinical experience, although no NSA has been reported to cause any problems in breastfed infants. If use of an SA is required, for example to manage pruritus associated with an allergy, chlorphenamine is preferred due to significant clinical experience, although lack of published evidence of safety. Monitor infant for drowsiness if an SA is used.

Allergen extracts

Allergen extracts contain protein and carbohydrates components which are unlikely to appear in breast milk.  If possible, delay desensitisation therapy until no longer breastfeeding.

Drugs for angioedema

Adrenaline is indicated for the emergency treatment of laryngeal oedema associated with allergic angioedema.

C1-esterase inhibitor, conestat and icatibant are used for the acute management of hereditary angioedema caused by with C1-esterase inhibitor deficiency. Conestat and icatibant are only used in adults.

Danazol is unlicensed for this indication in the UK.

AcrivastineAdrenalineAlimemazineBee venomBilastineC1-esterase inhibitorCetirizineChlorphenamineClemastineConestat alfaCyproheptadineDanazolDesloratadineFexofenadineGrass pollenHydroxyzineIcatibantKetotifenLevocetirizineLoratadineMizolastineObstetrics and gynaecologyPaediatric and neonatal medicinePromethazine hydrochlorideRespiratory disordersRupatadineSafety in LactationTree pollenWasp venom