Allergy symptoms, such as nasal congestion and sneezing, are common during pregnancy and can even worsen due to hormonal shifts or increased blood volume that cause swelling in the nasal lining. Treating these symptoms is important, especially when they interfere with sleep or cause significant discomfort, but the selection of medication requires careful consideration. Because a developing fetus is highly sensitive to external substances, it is necessary to weigh the benefits of symptom relief against any potential risks associated with drug exposure. All decisions about allergy management, particularly involving medication, should be discussed with an obstetrician or other healthcare provider to ensure a safe and personalized treatment plan.
Managing Allergies Without Medication
The first line of defense against allergies involves non-pharmacological interventions designed to minimize exposure to irritants and provide physical relief. Simple environmental controls can greatly reduce the presence of indoor allergens like dust mites and pet dander. Utilizing high-efficiency particulate air (HEPA) filters in the home and diligently dusting and vacuuming frequently helps clear the air of common triggers. Keeping windows closed during high pollen seasons and using air conditioning prevents outdoor allergens from entering the living space.
Physical treatments offer immediate, localized relief without the concern of systemic absorption. Saline nasal rinses, administered via a Neti pot or a squeeze bottle, effectively flush allergens and excess mucus from the nasal passages, reducing congestion and irritation. Applying a cool, damp compress over the eyes can soothe the itch and redness caused by allergic conjunctivitis. Wearing a mask during outdoor activities like gardening or yard work provides a physical barrier against airborne pollen.
Recommended Oral Antihistamines During Pregnancy
When non-drug methods are insufficient, oral antihistamines are often considered the next step for managing widespread allergy symptoms. Healthcare providers typically recommend second-generation H1 antihistamines because they are less sedating and have favorable safety data from extensive use in pregnant individuals. These medications block histamine, the chemical responsible for allergy symptoms, with minimal transfer across the blood-brain barrier.
Loratadine (Claritin) and Cetirizine (Zyrtec) are the most commonly suggested options, particularly after the first trimester, when major fetal organs have finished forming. These drugs have been studied in large populations of pregnant women and have not shown a consistent association with birth defects. Taking the lowest effective dose for the shortest necessary duration is advised to manage symptoms effectively while minimizing fetal exposure.
First-generation antihistamines, such as Diphenhydramine (Benadryl), have been used for many years during pregnancy and are generally considered safe for occasional use. However, these older compounds cause significant drowsiness and are not preferred for regular, long-term relief. For chronic, daily use, the newer, non-sedating options are superior as they maintain maternal quality of life without the risk of performance impairment. Any guidance on specific dosing or medication timing must come from a medical professional.
Addressing Localized Symptoms: Nasal Sprays and Eye Drops
Localized treatments are highly beneficial during pregnancy because they deliver the medication directly to the affected area, minimizing systemic absorption. Corticosteroid nasal sprays are often the most effective choice for persistent nasal inflammation and congestion. Fluticasone (Flonase) and Budesonide (Rhinocort) are frequently recommended due to their very low systemic absorption when applied topically.
Budesonide is generally preferred among intranasal corticosteroids because it has the most extensive human safety data available during pregnancy. These sprays reduce inflammation in the nasal passages, controlling symptoms like rhinorrhea and post-nasal drip. They are used daily for preventative control rather than for immediate, acute relief.
Cromolyn sodium nasal spray is another excellent localized option, often classified as Pregnancy Category B, indicating a very low risk. Cromolyn sodium is a mast cell stabilizer that prevents the release of histamine and other inflammatory chemicals. Because it acts primarily as a preventative agent, it must be used consistently, making it a preferred choice for patients seeking an alternative to corticosteroids. For eye symptoms, simple saline washes can help, but for severe itching, a physician may recommend specific antihistamine eye drops with a low absorption rate.
Medications to Avoid or Use Only Under Strict Medical Supervision
Certain allergy medications are generally discouraged during pregnancy due to potential risks, especially during the first trimester. Oral decongestants containing Pseudoephedrine (Sudafed) or Phenylephrine are typically avoided. These medications work by causing vasoconstriction, or the narrowing of blood vessels, which can impair blood flow to the placenta and the developing fetus.
Some studies have suggested a link between the use of oral decongestants in the first trimester and a slightly increased risk of rare birth defects, such as gastroschisis (an abdominal wall defect). Combination products that include a decongestant, often indicated by a “D” after the name (e.g., Claritin-D), should also be avoided. The risks associated with these drugs, particularly in the first 12 weeks of pregnancy, often outweigh the benefit of temporary congestion relief.
Although occasional use of first-generation antihistamines like Diphenhydramine is usually acceptable, regular or high-dose use should be avoided in the third trimester. High levels of this drug have been associated with rare reports of uterine contractions or withdrawal symptoms in the newborn. Allergy shots (immunotherapy) should not be initiated during pregnancy due to the risk of a systemic allergic reaction, or anaphylaxis, which could compromise the pregnancy. Continuing a previously established immunotherapy regimen, however, is often considered safe under close medical supervision to prevent symptom relapse.