Women with Intermittent Allergic Rhinitis (IAR) during pregnancy can be treated with a number of medicines without increasing the risk of an adverse pregnancy outcome. However, the decision to treat should always be based on a risk versus benefit assessment of each case.
The choice of medicine should be based on symptom type and severity, evidence of foetal safety, product efficacy as well as patient preference. Rhinitis and especially rhinitis during pregnancy is not always due to allergens and may not respond to standard therapies.
• Avoid / minimise precipitating allergens, if known and if practical.
• Assess risks and benefits – particularly in relation to trimester.
• The preferred treatment for IAR in pregnancy is the application of topical preparations as these act locally and have lower systemic exposure, therefore reducing the risk posed to the foetus.
• If nasal congestion predominates, intranasal corticosteroids are the treatments of choice during pregnancy. Sodium cromoglicate nasal spray is also suitable for use during pregnancy but may be less effective.
• If an intranasal preparation does not fully relieve symptoms or is not tolerated, consider an oral antihistamine. Chlorphenamine has traditionally been the antihistamine of choice in pregnancy but can cause sedation. Loratadine or cetirizine are the antihistamines now recommended for use during pregnancy.
• Intranasal decongestants are of limited benefit in IAR and are generally only recommended in pregnancy for relieving nasal congestion prior to the use of topical corticosteroids.
• Any medication prescribed during pregnancy should be at the lowest effective dose for the shortest time necessary.