Taking Allergy Medicine While Pregnant

Being pregnant means having to be extra mindful of what you take, including medications you use to treat allergies. Generally speaking, antihistamines and nasal sprays are considered safer to use during pregnancy than decongestants. But there is a lot of nuance to this that is important to know before heading to the pharmacy.

Since pregnancy sometimes makes allergies worse or causes sinus issues with similar symptoms, what's known as pregnancy rhinitis, it can be helpful to learn about your options before you are sniffling and sneezing and discuss them with your healthcare provider.

This article walks you through the allergy pills and nasal sprays that effective for you and safe for your unborn baby. You'll also learn about non-drug ways to manage allergy symptoms during pregnancy.

Antihistamines

When you encounter something you're allergic to, your body releases a chemical called histamine. That's what leads to allergy symptoms as your body tries to flush out the allergen.

Antihistamines are drugs that counter this allergic response. They have long been used during pregnancy, and many of them are generally considered safe.

The U.S. Food and Drug Administration (FDA) used to rank medications' risk in pregnancy using the letters A, B, C, D, and X. A was reserved for the safest drugs, and X meant they shouldn't be taken.

Now, the agency has changed the labeling system to include informative statements instead of a letter grade. However, you may still find the old letter grades online.

Most antihistamines were classified as B or C:

• B: No first-trimester risk found in animal studies OR first-trimester risks found in animal studies that didn't show up in human studies; no evidence of risk later in pregnancy.
• C: Animal studies reveal risk and no human studies have been done OR no studies are available.

Chlor-Trimeton (chlorpheniramine) and Benedryl (diphenhydramine) have the longest record of use and are considered first-line treatments.

Claritin (loratidine) and Zyrtec (cetirizine), both newer drugs, are the next best options. They technically have a better safety profile but they also have much less research and real-world data behind them. That makes experts more comfortable with the older drugs.

Some drugs in this class need more research. Others have tentative links to birth defects if they're taken during the first trimester.

Decongestants

Decongestants narrow blood vessels in your nose, which widens nasal passages and helps relieve stuffiness. The most common ones include Sudafed (pseudoephedrine) and Suphedrin PE/Sudafed PE (phenylephrine).

These drugs aren't considered as safe as antihistamines during pregnancy.

The overall safety of decongestants isn't established. Studies have suggested possible links between first-trimester use and birth defects, including:

• Gastroschisis: Intestines and possibly other organs protruding through an opening near the belly button
• Small intestinal atresia: A blockage in the small intestine
• Hemifacial macrosomia: One side of the face doesn't develop or grow properly

Nasal Sprays

Nasal sprays work directly on the inflamed tissues in your nose to help you breathe better. Their safety during pregnancy varies.

A benefit of sprays is that they work quickly and at the site of the problem. Many of them don't get into your blood at all, meaning they don't reach a developing baby.

Some of the less-safe ones are absorbed into the bloodstream in small amounts. That raises the possibility that they'll have an impact on your baby.

Oxymetazoline and xylometazoline aren't recommended. That's not solely due to risks to your baby, though. Frequent use of these medications can make your symptoms worse by causing rebound congestion. That means the medication begins to increase your congestion rather than clearing it up.

Is It Really Allergies?

Rhinitis is inflammation of the mucous membranes in your nose. It's usually caused by allergies or a viral illness like the common cold.

But it can also strike when you're pregnant—and it has nothing to do with allergies or acute illness.

Research shows this pregnancy rhinitis affects between 20% and 40% of pregnancies. Symptoms include:

• Nasal congestion
• Sneezing
• Runny nose

Researchers suspect hormonal changes in pregnancy make some mucus-producing glands more active.

Also, your blood volume increases during pregnancy. That means blood vessels widen and take up more space. In a tight space like nasal passages, this can lead to allergy-like symptoms.

A healthcare provider uses the following criteria to diagnose pregnancy rhinitis:

• Symptoms are present during the last six or more weeks of pregnancy
• There are no signs of a respiratory tract infection
• There is no known allergic cause
• Symptoms disappear in the two weeks after delivery

If you have rhinitis symptoms but antihistamines aren't helping, this may be why. Talk to your healthcare provider about the possibility of pregnancy rhinitis.

Non-Drug Treatments

Want to avoid the worry over medications? Or maybe you want more symptom relief than medications offer. You have several safe options you can use instead of or along with allergy drugs:

• Saline nasal sprays
• A humidifier to prevent dry nasal passages
• Exercise, which reduces nasal inflammation
• Adhesive strips (like Breathe Right) that open your nostrils
• Raise the head of your bed or use an extra pillow to help sinuses drain
• Acupuncture

Also, do what you can to limit contact with allergens:

• Use dust-proof covers on bedding
• Wash bedding frequently
• Keep windows closed
• Shower after spending time outside
• Keep damp areas of the home (bathroom, kitchen, basement) clean and well aired

It's a bad idea to let your allergy symptoms go unchecked. If these methods don't work, safeguard your health by knowing what you can take when symptoms crop up.

Summary

You have several options for safe allergy treatments during pregnancy. Antihistamines are the drug of choice for pregnancy. They're not all equal, though. The safest ones are Chlor-Trimeton, Benedryl, Claritin, and Zyrtec. Oral decongestants are less safe.

Some nasal sprays are considered safe. The favored ones are NasalCrom and Atrovent. Afrin and Triaminic spays are discouraged as they pose possible problems for you and your baby.

Non-drug options include saline nasal spray, exercise, acupuncture, and avoiding allergens.

A Word From Verywell

Whether or not to take any medications during pregnancy is both a medical and personal decision that is best made with the help of your healthcare team, including your pharmacist. Still, with knowledge about the options in hand, the choice can seem like a scary one to make.

You may want to consider the severity of your symptoms and the extent to which they are impacting you day to day. But regardless, remember that any recommended treatments are so because of research that supports them.

Have an open conversation with your providers about any concerns you have and get answers to all of your questions so you can feel more confident about whatever choice you make.