Pregnancy and allergic rhinitis

Women who have allergic rhinitis before pregnancy may have worsening, improvement or no change in their symptoms during pregnancy. Most women notice some nasal congestion in the later stages of pregnancy, even if they did not have rhinitis before. This is called rhinitis of pregnancy and is related to hormone levels. Rhinitis of pregnancy does not respond to medications and goes away after delivery.
As a general rule, medications should be avoided or used at the lowest dose that controls symptoms during pregnancy. A woman should always review any medication (over-the-counter or prescription) before taking it during pregnancy. However, several drugs used to treat allergic rhinitis are thought to be safe during this time.
● Saline sprays and nasal irrigation — Women with mild rhinitis may be able to control symptoms using only saline nasal sprays or irrigation, which do not contain any medications.
If medication for rhinitis is needed during pregnancy, the following are considered to be safer choice:
● Nasal sprays — Certain nasal sprays are a sensible option for pregnant women, because much less drug is required to control symptoms when it is sprayed directly into the nose, compared with taking that same medication by mouth.
Cromolyn nasal sprays are safe for use during pregnancy. Only a very small amount of drug is absorbed into the blood stream with this medication and no serious side effects are known to occur.
Nasal glucocorticoids are considered safe for use in pregnancy, and women who are already taking these can simply continue during pregnancy. Although no safety differences have been identified among the different nasal glucocorticoids, budesonide has been approved for use in pregnancy for a longer time than the others.
● Antihistamines — Loratadine, or cetirizine are the antihistamines of choice during pregnancy.
● Decongestants — Pseudoephedrine should be avoided during the first trimester of pregnancy if possible, because its safety has not yet been confirmed. After the first trimester (roughly first three months), it should be used only when needed and only as directed. However, it should not be used at all by women with high blood pressure or pre-eclampsia. Phenylephrine should be avoided altogether during pregnancy.
If untreated, nasal allergy may cause recurrent sinusitis because of the obstruction to the sinus ostia. It may lead to the formation of nasal polyp (sac-like growths of inflamed tissue lining the nose i.e. nasal mucosa or sinuses). Nasal allergy can result in serious otitis media (inflammation of inner ear) and orthodontic problems. Patients of nasal allergy have four times more risk of developing asthma. To avoid these complications, always better to consult with a Ear-Nose-Throat (ENT) specialist.

The writer is an Assistant Professor of Department of ENT-Head & Neck Surgery at M H Samorita Medical College & Hospital, Dhaka.
E-mail: dr.neyamat@gmail.com