Treating Allergic Rhinitis in Pregnancy

Motherisk Program, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Drug Safety (Impact Factor: 2.82). 05/1999; 20(4):361-75. DOI: 10.2165/00002018-199920040-00005
Source: PubMed


Allergic rhinitis affects approximately one-third of women of childbearing age. As a result, symptoms ranging from sneezing and itching to severe nasal obstruction may require pharmacotherapy. However, product labels state that medications for allergic rhinitis should be avoided during pregnancy due to lack of fetal safety data, even though the majority of the agents have human data which refute these notions. We present a systematic and critical review of the medical literature on the use of pharmacotherapy for the management of allergic rhinitis during pregnancy. Electronic databases and other literature sources were searched to identify observational controlled studies focusing on the rate of fetal malformations in pregnant women exposed to agents used to treat allergic rhinitis and related diseases compared with controls. Immunotherapy and intranasal sodium cromoglycate (cromolyn) and beclo-methasone would be considered as first-line therapy, both because of their lack of association with congenital abnormalities and their superior efficacy to other agents. First-generation (e.g. chlorpheniramine) and second-generation (e.g. cetirizine) antihistamines have not been incriminated as human teratogens. However, first-generation antihistamines are favoured over their second generation counterparts based on their longevity, leading to more conclusive evidence of safety. There are no controlled trials with loratadine and fexofenadine in human pregnancy. Oral, intranasal and ophthalmic decongestants (e.g. pseudoephedrine, phenylephrine and oxymetazoline, respectively) should be considered as second-line therapy, although further studies are needed to clarify their fetal safety. No human reproductive studies have been reported with the ophthalmic antihistamines ketorolac and levocabastine, although preliminary data reported suggest no association between pheniramine and congenital malformations. There are no documented epidemiological studies with intranasal corticosteroids (e.g. budesonide, fluticasone propionate, mometasone) during pregnancy; however, inhaled corticosteroids (e.g. beclomethasone) have not been incriminated as teratogens and are commonly used by pregnant women who have asthma. In summary, women with allergic rhinitis during pregnancy can be treated with a number of pharmacological agents without concern of untoward effects on their unborn child. Although the choice of agents in part should be based on evidence of fetal safety, issue of efficacy needs to be addressed in order to optimally manage this condition.

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Available from: Ronen Loebstein, Sep 30, 2015
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    • "As with asthma, preexisting AR can worsen, improve, or remain unchanged during pregnancy [27]. Furthermore, during pregnancy, nasal congestion can worsen, although the exact mechanism for this is not defined. "
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    ABSTRACT: Asthma and allergic disorders can affect the course and outcome of pregnancy. Pregnancy itself may also affect the course of asthma and related diseases. Optimal management of these disorders during pregnancy is vital to ensure the welfare of the mother and the baby. Specific pharmacological agents for treatment of asthma or allergic diseases must be cautiously selected and are discussed here with respect to safety considerations in pregnancy. Although most drugs do not harm the fetus, this knowledge is incomplete. Any drug may carry a small risk that must be balanced against the benefits of keeping the mother and baby healthy. The goals and principles of management for acute and chronic asthma, rhinitis, and dermatologic disorders are the same during pregnancy as those for asthma in the general population. Diagnosis of allergy during pregnancy should mainly consist of the patient's history and in vitro testing. The assured and well-evaluated risk factors revealed for sensitization in mother and child are very limited, to date, and include alcohol consumption, exposure to tobacco smoke, maternal diet and diet of the newborn, drug usage, and insufficient exposure to environmental bacteria. Consequently, the recommendations for primary and secondary preventive measures are also very limited in number and verification.
    World Allergy Organization Journal 03/2009; 2(3):26-36. DOI:10.1097/WOX.0b013e31819b0a86
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    • "(c) The prevalence of pregnancy complications was analyzed by the comparison of mothers with or without AR and POR with 95% CI were calculated. (d) The prevalence of AR during the study pregnancy in the different CA-groups was compared with the prevalence of AR in their all [1] [2] [3] matched control pairs. The adjusted POR with 95% CI for confounders was evaluated in a conditional logistic regression model. "
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    ABSTRACT: Allergic rhinitis is frequent in women of childbearing age including pregnancy. The present study aimed to estimate the effect of maternal allergic rhinitis on birth outcomes, in particular congenital abnormalities, preterm birth and low birthweight newborns. Analysis of the population-based data of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. The evaluation of data did not reveal any teratogenic potential of allergic rhinitis and indeed a lower prevalence of total congenital abnormalities was found. In addition, a protective effect could be observed for preterm birth due to longer gestational age (adjusted t=2.97, p=0.003). Allergic rhinitis is not risk factor for pregnant women.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 04/2007; 131(1):21-7. DOI:10.1016/j.ejogrb.2005.11.035 · 1.70 Impact Factor
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    ABSTRACT: This article provides a practical overview of dermatologic medication use in pregnancy. The therapeutics of the following common dermatoses are reviewed: acne, psoriasis, and bacterial, fungal, viral, and parasitic infections. Antipruritic, analgesic, and topical anesthetic use in pregnancy is reviewed as well. At the end, the reader is challenged with a series of applied clinical scenarios that highlight the presented material and provide information on additional important medications.
    Journal of Cutaneous Maedicine and Surgery 10(4):183-92. · 0.94 Impact Factor
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