Allergy Medicine While Pregnant

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Antihistamine medications work by blocking the effects of histamine, which is a trigger for allergy symptoms.

Allergy Medications During Pregnancy

Allergic diseases are common in women of childbearing age. Both asthma and atopic conditions may worsen, improve or remain the same during pregnancy. Primary care physicians commonly encounter women receiving multiple medications for pre-existing atopic conditions, who then become pregnant and require medication changes to avoid potential fetal injury or congenital malformations. Each medication should be evaluated; intranasal and inhaled steroids are relatively safe to continue during pregnancy (budesonide is the drug of choice), second-generation antihistamines of choice are cetirizine and loratadine, leukotriene receptor antagonists are safe, sparing use of oral decongestants during the first trimester and omalizumab may be used for both uncontrolled asthma and for antihistamine-resistant urticaria. Medications to avoid during pregnancy include intranasal antihistamines, first-generation antihistamines, mycophenolate mofetil, methotrexate, cyclosporine, azathioprine and zilueton. Common allergic diseases may develop de novo during pregnancy, such as anaphylaxis.

Keywords: Allergic diseases; Pregnancy; Treatment safety.

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Pregnant with Allergies? 5 Treatments That Are Safe for Baby

If you’ve lived with seasonal allergies you already know what usually eases your symptoms. But if your allergies flare up while you’re pregnant, your choices may become more limited.

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It’s hard to predict how things you normally experience will affect your baby (and yourself) differently during your pregnancy. It also takes time and a little digging to learn what’s safe, and what can pose a risk.

For allergy sufferers, the good news is that whether your seasonal allergy symptoms are mild or severe during pregnancy, the actual symptoms themselves likely won’t affect your baby, says OB/Gyn Salena Zanotti, MD. But you may need to change up how you’d normally treat those symptoms to limit any risks to your child.

Dr. Zanotti offers some interesting facts about how allergies can change when you’re pregnant.

One-third of lucky women find that their allergy symptoms clear up.
Another one-third of women find that their allergy symptoms worsen.
The remaining one-third find that their allergy symptoms are about the same as before pregnancy.

“It’s funny, with pregnancy we see allergies go all three ways,” says Dr. Zanotti. “And we see that with asthma as well.”

Whichever way it goes for you, make sure to choose treatments that are safe for you and your baby.

Dr. Zanotti suggests five ways to safely manage your symptoms while you’re expecting.

1. Avoid allergy triggers as much as possible

Environmental allergens such as mold, pollen and animal dander are most often to blame for allergy symptoms. They’re also the most difficult allergens to avoid.

Dr. Zanotti’s advice when pollen or pollution levels are high is to limit your time outside. Keep your windows closed and turn on your air conditioning or a fan to help limit your exposure.

For mold and animal dander that commonly occur indoors, you may want to try the opposite and open your windows (during times when pollen and pollution levels are low outside).

2. Treat mild symptoms with home remedies

Nasal congestion is common during pregnancy, Dr. Zanotti says.

Using a humidifier in your home can sometimes help solve this problem. It won’t remove allergens from the environment but it will moisten the air. And that can help soothe your irritated nasal passages.

3. Be picky about over-the-counter allergy medications

Many allergy medications really aren’t safe to take during pregnancy.

But loratadine (found in Claritin®) and cetirizine (found in Zyrtec® and Alleroff®) are two over-the-counter (OTC) antihistamine medications that doctors consider as being safe to use during pregnancy and while breastfeeding, Dr. Zanotti says.

Antihistamine medications work by blocking the effects of histamine, which is a trigger for allergy symptoms.

“These medications are really the first-line medications for treating allergies in pregnant women,” she says.

4. Try an intranasal steroid spray

If your allergies are severe and you aren’t getting relief from OTC allergy drugs, there’s still hope. You can try an intranasal steroid spray like Nasonex® or Flonase®.

These sprays are safe to use throughout pregnancy and the regular recommended dosage is still appropriate, Dr. Zanotti says.

5. Take care with allergy shots, pseudoephedrine and herbal remedies

“If you’ve received allergy shots before pregnancy and thought they helped your symptoms, it’s safe to continue them,” says Dr. Zanotti. “But we don’t recommend starting allergy shots during your pregnancy, because you don’t know what reaction you’ll have.”

Many expectant mothers ask about taking decongestants or pseudoephedrine (Sudafed®). She recommends that you avoid it in your first trimester. But you may take it in the second and third trimesters as long as you don’t have high blood pressure, she says.

As for herbal remedies and aromatherapy, Dr. Zanotti says their effects on pregnant women haven’t been studied sufficiently. It’s best to just steer clear of these, she says.

Hang in there

If you’ve tried Dr. Zanotti’s treatment options but aren’t getting much relief, remind yourself that the problem is only temporary.

“Your symptoms may be unpleasant but bear in mind that neither pregnancy nor seasonal allergy symptoms last forever,” she says. “There’s light at the end of the tunnel, and you’ll be happy you made the rights choices for your little one.”

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Taking Allergy Medicine While Pregnant

Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.

Updated on July 02, 2022

Jurairat J. Molina, MD, MBA is a board-certified allergist who has been practicing in field of allergy and clinical immunology for the past two decades.

Table of Contents
Table of Contents

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.

Brand	Generic	Pregnancy*	Breastfeeding**
Benedryl	diphenhydramine	High doses linked to contractions	Large/frequent doses linked to irritability, colic May lower milk supply
Zyrtec	cetirizine	No known problems	Large/frequent doses linked to irritability, colic May lower milk supply
Claritin	loratadine	Risk suggested in one study, not others	Minor sedation possible May lower milk supply
Chlor-Trimeton	chlorpheniramine	No known problems	Large/frequent doses linked to irritability, colic May lower milk supply
Ala-Hist, Bromfed, Veltane	brompheniramine	No known problems Limited data	Large/frequent doses linked to irritability, colic, poor sleep May lower milk supply
Allegra	fexofenadine	Discouraged Limited data show risk of miscarriage	May be linked to irritability May lower milk supply

Sources: *FDA AccessData, **Drugs and Lactation Database (LactMed)

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

It’s considered safest to avoid decongestants during the first trimester. Talk to your healthcare provider about whether you could consider taking them later in your pregnancy.

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.

Brand	Generic	Pregnancy*	Breastfeeding**
NasalCrom	cromolyn	No known problems	Levels negligible Risk unlikely
Atrovent	ipratropium bromide	Use only if need is high	Levels negligible Risk unlikely
Flonase	fluticasone	Side effects in animal studies	Levels negligible Risk unlikely
Nasacort	triamcinolone	Side effects in animal studies	Risk unlikely
Afrin	oxymetazoline	Some evidence of birth defects	Levels negligible Risk unlikely

Sources: *FDA AccessData, **Drugs and Lactation Database (LactMed)

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.

Stopping Medications

Don’t stop any prescription allergy or asthma medications without talking to your healthcare providers. Leaving symptoms untreated can open up you and your baby to serious risks.

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.

Can I Keep Getting Allergy Shots?

Allergy shots, also called immunotherapy, are considered safe to continue when you get pregnant.

However, they’re usually not started during pregnancy due to the risk of anaphylaxis (a severe allergic reaction).

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

What About Supplements?

Some nutritional or herbal supplements may help ease allergy symptoms. But don’t assume they’re safe just because they’re natural. Plenty of natural products can harm you and your baby. Always check with your healthcare provider before starting supplements.

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.

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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Additional Reading

Andersson NW, Torp-Pedersen C, Andersen JT. Association between fexofenadine use during pregnancy and fetal outcomes [published correction appears in JAMA Pediatr. 2020 Sep 1;174(9):913]. JAMA Pediatr. 2020;174(8):e201316. doi:10.1001/jamapediatrics.2020.1316
Etwel F, Faught LH, Rieder MJ, Koren G. The risk of adverse pregnancy outcome after first trimester exposure to H1 antihistamines: A systematic review and meta-analysis. Drug Saf. 2017;40(2):121-132. doi:10.1007/s40264-016-0479-9
Servey J, Chang J. Over-the-counter medications in pregnancy [published correction appears in Am Fam Physician. 2015 Sep 1;92 (5):332]. Am Fam Physician. 2014;90(8):548-555.

By Pat Bass, MD
Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians.

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