Allergic Rhinitis: Is this an issue for Your Pregnancy?

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Health issues occurring during pregnancy can range from extremely serious, such a life threatening traumatic injury, to very minor – a hangnail, for instance. As for allergic rhinitis, known commonly as hay fever, consequences are more toward the minor end of the spectrum, but you may need to be careful because of the medications used to treat it. This condition is very common. In the United States, 10 to 30 percent of adults suffer from allergic rhinitis. In childhood, boys typically are affected more than girls, but the gender difference flip-flops during adulthood, when women are affected more often than men. This means that allergic rhinitis is very common during pregnancy. In fact, it may be the most common long-term medical condition occurring in pregnant women.

In allergic rhinitis, the inner lining of your nasal passage swells up. It is nasal inflammation, caused by sensitivity to allergens that stimulate production of a type of immunoglobulin, or antibody, called IgE. Allergic rhinitis can hit you any time throughout the year (perennial allergic rhinitis) or it can be episodic, meaning that it happens in episodes due to the presence of an inhaled allergen, such as dust. Allergic rhinitis also can be seasonal, such that it occurs at certain times of the year, due to an increase in certain out-door allergens, such as pollen. Pets, laboratory animals, mites, also cause allergic rhinitis.

Typically, allergic rhinitis is diagnosed during childhood or adolescence, though it’s possible for it to be evaluated for the first time when you are pregnant. Evaluation begins with an assessment of your history of nasal symptoms in connection with allergen exposure and the presence of signs, such as a swollen inner lining of the nose and pale mucous membranes, and irritated, watery eyes. To confirm the diagnosis, tests must demonstrate presence of allergen-specific IgE-mediated sensitivity. To test for this, your physician may perform a skin prick test. Alternatively, the physician may run tests for you for specific IgE, meaning IgE antibodies that are specific for the suspected type of allergen, such as a pollen.

In some women, the same allergies that can trigger rhinitis can lead to an asthma attach, which potentially can threaten life. However, the main effects of allergic rhinitis are a stuffed and/or runny nose, sometimes a bloody nose, Eustachian tube problems, sinusitis, and an increased number of upper respiratory infections (common cold). Sometimes known as rhinosinusitis (inflammation of the nasal cavity and sinuses), sinusitis is inflammation of the infection of one or more sinuses, which are spaces inside the bones of the skull. Sinusitis can be acute, meaning with intense symptoms that develop rapidly (over hours to days), or chronic, meaning ongoing, with symptoms being mild to moderate and waxing and waning over a long period. Sinusitis usually is the result of infection, which can be viral (caused by virus such as the kind of virus that causes the common cold), or bacterial (caused by infection with bacteria). As for the fetus, there are no serious consequences, unless you do suffer an asthma attack, putting both your life and the fetus’s life at risk. There is a hereditary component to allergic rhinitis, so if you have the condition, your baby does have a higher-than normal chance of having allergic rhinitis as well.

Pregnant women with allergic rhinitis can be given medications are to alleviate symptoms in order to improve their quality of life. Medications include oral antihistamines, many of which are known to be safe during pregnancy. Commonly used antihistamine medications include loratadine and cetirizine, both of which are thought to be pregnancy-safe. Both of these drugs also are safe for lactating mothers and their nursing infants. Longer-lasting treatments include cromolyn sodium and the corticosteroid beclomethasone. Both of these medications are taken as nasal sprays. Both also are safe during pregnancy. Since there is very little absorption into the mother’s blood, cromolyn sodium and beclomethasone also are considered to be safe during breastfeeding.

In addition to medications, you can reduce your allergic rhinitis symptoms by using air conditioning and various air filters. Allergen immunotherapy can prevent future sensitization to various air allergens and also can help prevent asthma attacks in those who are at risk. There is a surgical option for those with anatomic problems that aggravate rhinitis, such as a deviated nasal septum, or nasal polyps. In almost all cases, you would not have such a surgical procedure during pregnancy.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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