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Allergic rhinitis during pregnancy: opt for the lowest risk

When drug treatment for allergic rhinitis is recommended in a pregnant woman, there are various options that expose the patient to few risks: sodium cromoglicate or azelastine nasal inhaler or an oral or nasal non-sedating and non-antimuscarinic antihistamine.

Allergic rhinitis is a benign allergic reaction. Sometimes causing extreme discomfort, it has no known effect on pregnancy outcome. Sodium cromoglicate nasal spray is moderately effective, but can have rare adverse effects, including in women who are or could be pregnant (local irritations, headaches in particular). It is the topical treatment of choice for mild allergic rhinitis in pregnant women.

Nasal antihistamines, especially preservative-free azelastine, have not been linked to any particular risk during pregnancy.

Oral non-sedating and non-antimuscarinic antihistamines are an alternative to topical treatments when the allergic rhinitis is troublesome: cetirizine is an acceptable option throughout pregnancy; loratadine is another, but should be avoided during the first trimester due to the risk of hypospadias (an anomaly of the penis), observed in animals and not to be ruled out in humans.

Corticosteroid inhalers are third-line treatments since they expose patients to more dose-dependent adverse effects, but they probably have few harmful effects on the unborn child. Low doses of beclometasone or budesonide over a short period are the first-choice local corticosteroids.

Other treatments (such as sedating and antimuscarinic H1 antihistamines) have a harm-benefit balance that is less favourable, and for some treatments (hydroxyzine, Atarax° or other brands) the balance is clearly unfavourable.

©Prescrire 1 April 2016

"Allergic rhinitis during pregnancy" Prescrire Int 2016; 25 (170): 101-104. (Pdf, subscribers only).

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