What medicine can you take for allergies while pregnant

More than 50 million Americans suffer from allergies each year, according to the Centers for Disease Control and Prevention (CDC). In fact, allergies are the sixth leading cause of chronic illness in the U.S.

What’s more, pregnancy can sometimes make allergy symptoms worse. Every woman’s body is different, and every pregnancy is different, so it’s impossible to predict exactly how allergies will affect an individual pregnant woman.

But in general, pregnant women may experience some of the following symptoms differently from other allergy sufferers:

• Pregnancy hormones might cause the inner lining of your nose to swell. This causes nasal congestion and a runny nose.
• This enhanced congestion makes seasonal allergy symptoms worse.
• Severe congestion could lead to poor stress and poor sleep quality.

If you’re expecting and suffering from symptoms like these, here’s what you need to know about taking allergy medicine while pregnant.

Avoid certain allergy medicine while pregnant

There are a number of medications that are not safe to take during pregnancy. First among them are oral decongestants.

“Oral decongestants are best avoided altogether during the first trimester because of an uncertain risk of several rare birth defects,” says Ciara Staunton, a family nurse practitioner and owner of Staunton Primary Care in Cincinnati. “However, Sudafed (pseudoephedrine), which is locked up behind the pharmacy counter, can be used in the second and third trimesters in women without hypertension.”

But Staunton warns that Sudafed-PE (phenylephrine), the over-the-counter option, should never be taken during pregnancy. It is less effective than pseudoephedrine. But more importantly, its safety for pregnant women is questionable.

Ms. Staunton also recommends against using any herbal therapies during pregnancy. “In the United States and most other countries, herbal medicines are minimally regulated and not monitored for adverse events.”

How to safely treat allergies during pregnancy

While it would be best to avoid allergens that bother you, that’s not always a possibility. Many pregnant women and their providers prefer to start with a non-pharmaceutical treatment plan whenever possible. Dr. Janelle Luk, medical director and co-founder of Generation Next Fertility in New York City, suggests an over-the-counter saline nasal spray.

Dr. Luk also recommends physical activity to reduce nasal inflammation. In addition, she says patients with a stuffy nose might be able to sleep better if they elevate the head of the bed by 30 to 45 degrees during sleep.

However, sometimes those non-pharmaceutical options just don’t do the trick, and you need something stronger (aka allergy medicine) to ease your misery. In that case, there are several options that are safe to try.

“For moderate to severe allergies, your physician may recommend a nonprescription corticosteroid spray or an oral antihistamine,” Dr. Luk says. “Some nasal spray options include Rhinocort Allergy, Flonase, and Nasonex.”

For oral antihistamines, Staunton says she recommends Claritin (loratadine) or Zyrtec (cetirizine) because of their good safety history. Both are rated pregnancy category B by the FDA. This means that controlled studies in animals have shown no adverse effects to the developing fetus.

Benadryl (diphenhydramine) is considered fairly safe during pregnancy, according to the CDC. However, Benadryl Allergy Plus Congestion is not safe for pregnant women because it contains phenylephrine.

You can also take one of the oral antihistamines together with a nasal spray if neither one controls your symptoms on its own.

As for subcutaneous allergen immunotherapy (SCIT), aka allergy shots—if you were on them before pregnancy, your doctor may continue them. But they wouldn’t be started during pregnancy because of “the potential harm that could result if a reaction were to occur,” Staunton says.

If you are suffering from allergy symptoms, speak with your provider about your best options for allergy medicine while pregnant.

Pregnant woman talking to her doctor about medication use.

In a new CDC study, researchers reviewed more than 50 published scientific articles to see if there was a risk of birth defects from using antihistamines, like allergy medication, during pregnancy. Researchers found the evidence to be generally reassuring: most antihistamines do not appear to be linked to birth defects. However, researchers need to study certain antihistamine medications further to determine if they increase the risk for birth defects. You can read the article’s abstract hereexternal icon. Read more below for a summary of the findings from this article.

Main findings from this study

• Scientific research suggests that using most types of antihistamines during pregnancy is not linked to birth defects.
• Out of 54 studies examined, 9 studies showed potential links between certain antihistamines and certain birth defects. Researchers need to study these potential links further.
• Researchers found many studies on antihistamine medications typically used to treat allergies, asthma, or nausea and vomiting (H1-receptor antagonists).
  • Examples of H1-receptor antagonists include diphenhydramine (Benadryl®), dimenhydrinate (Dramamine®), loratadine (Claritin®), and cetirizine (Zyrtec®).
• In contrast, researchers found relatively few studies on antihistamines typically used to treat indigestion (H2-receptor antagonists).
  • Examples of H2-receptor antagonists include ranitidine (Zantac®), famotidine (Pepcid®), and cimetidine (Tagamet®).

• Talk with your doctor if you are pregnant and you have taken any medicine or are thinking of taking any medicine. This includes prescription and over-the-counter medications, as well as dietary or herbal products.
• Pregnant women should not stop or start taking any type of medication that they need without first talking with a doctor.
• If you are planning a pregnancy and are using any medications, please talk to your doctor about which medications are necessary and should be continued.

About antihistamines and this study

About antihistamines

Antihistamines include both prescription and over-the-counter medications. They typically are used to treat

• Asthma and/or allergies;
• Nausea and vomiting; or
• Indigestion (heartburn or stomach ache).

About 10-15% of women report taking antihistamines during pregnancy.

About this study

Researchers reviewed more than 50 published scientific articles that looked at the link between antihistamine use during pregnancy and birth defects. They evaluated the articles based on certain criteria: how researchers selected their study populations, how researchers determined antihistamine use in pregnancy, and how researchers identified babies with birth defects.

Treating for Two: Safer Medication Use in Pregnancy

In collaboration with federal and external partners, CDC’s Treating for Two initiative is a national strategy to improve the health of mothers and babies through better research, reliable guidance, and informed decisions related to medication treatment in pregnancy.

• Research: CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study (births 1997-2011) and the Birth Defects Study To Evaluate Pregnancy exposures (started with births in 2014). Researchers engaging in these studies work to identify factors that increase the risk for birth defects and to answer questions about the effects of some medications taken during pregnancy.
• Technical expertise: CDC works with staff from the U.S. Food and Drug Administration (FDA) and other professionals to help conduct studies on the effects of medication use during pregnancy and ways to prevent harmful effects.
• Collaboration: As part of the Treating for Two: Safer Medication Use in Pregnancy Initiative pdf icon[PDF – 1 MB], CDC is committed to working with its partners, other federal agencies, and the public to build a comprehensive approach to improve the quality of data on medication use during pregnancy, translate this information into safe and effective health care for pregnant women, and make this information easily accessible to women and their healthcare providers.

More Information

For more information on medications and pregnancy, visit www.cdc.gov/treatingfortwo

Key Findings Reference

Gilboa SM, Ailes EC, Rai R, Anderson J, Honein MA. Antihistamines and Birth Defects: A Systematic Review of the Literature. Expert Opinion on Drug Safety. 2014. [epub ahead of print]