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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    • "In this sample, inheritance seems less important for eczema in pregnancy but the extrinsic risk factors. Multiple interplays of genetic factors, shared and non-shared environmental exposures were found responsible for liability to asthma in previous studies [28] [29]. The prominent role of genetic liability decreases over the life span individuals and particularly in old age. "
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    ABSTRACT: Background: Allergic disorders have become a major public health concern worldwide. No Nigerian study has examined the epidemiology of allergic diseases among women. Aim: To document the prevalence, risk factors and the changes in the symptoms of allergic disorders during pregnancy. Settings and Design: Cross-sectional study conducted at the booking and antenatal clinics of LAUTECH Teaching Hospital and Millennium Development Goals (MDG) Clinic of the Comprehensive Health Center, Oja Igbo, Ogbomoso, Nigeria. Materials and Methods: Study enrolled 432 women from two public hospitals. Sociodemographic and clinical history were obtained and allergic disorders were diagnosed using ISAAC questionnaires. Results: The prevalence of wheezing, eczema and rhinitis in pregnancy are 7.5%, 4.0% and 5.8% respectively. The prevalence of wheezing and eczema was slightly higher among the pregnant in past 12 months. Wheeze worsened in 70% (18/26), improved in 15% (2/26), and stable in 15% (2/26). Eczema worsened in 50% (7/14), improved in 7.1% (1/14) and stable in 42.9% (6/14), while allergic rhinitis worsened in 50% (11/22), improved in 22.7% (5/22) and stabilized in 27.3 % (6/22). In multivariate analysis, the risk of allergic diseases in pregnancy was increase 2 times by low income earning (CI: 1.2 – 2.1, p = 0.002), low level education (OR = 0.6, CI: 0.3 – 0.9, p = 0.011) and by family history of asthma, OR-4.3, CI – 1.3 – 13.9, p = 0.015. Family history of asthma increase the chances of asthma by 18.7 times, CI-2.3 – 152.2, p = 0.006, while the odd of eczema was increased 9.1 times (CI-2.7 – 30.6, p<0.001) and 2.4 times (CI: 1.2 – 4.7, p = 0.008) by second hand home smoking and low-family income respectively. The risk of allergic rhinitis were raised 1.8 times by low family income (CI 1.1 – 2.8, p = 0.013) and 3.9 times by family history of rhinitis (OR = 3.9, CI 1.2 – 12.7, p = 0.024). Conclusion: Prevalence of wheezing and eczema are higher in pregnancy probably due to exacerbation induced by pregnancy. Social and genetic factors are important risk factors for allergic disorders in pregnancy. © 2015,Journal of Clinical and Diagnostic Research. All rights reserved.
    Full-text · Article · Sep 2015 · Journal of Clinical and Diagnostic Research
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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.
    Full-text · Article · Mar 2009 · World Allergy Organization Journal
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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.
    Full-text · Article · Apr 2007 · European Journal of Obstetrics & Gynecology and Reproductive Biology
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