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I’m pregnant. What medicines are safe to take for my allergies?

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Updated May 15, 2014

Question: I’m pregnant. What medicines are safe to take for my allergies?
Answer: It’s understandable that a lot of women don’t like to take unnecessary medicines when they’re pregnant. No mother-to-be would ever want to place her baby at an increased risk of a birth defect caused by medication. However, allergies can make some woman so miserable that medications may be needed just so that allergy symptoms are not taking over their lives.

According to the Food and Drug Administration (FDA), no medicines are considered completely safe in pregnancy. This is because no pregnant woman would want to sign up for a medication safety study while she is pregnant.

Therefore, the FDA has assigned risk categories to medications based on use in pregnancy:

  • Category “A” medications are medications in which there are good studies in pregnant women showing the safety of the medication to the baby in the first trimester. Few medications are in this category and no asthma medications are rated category A.
  • Category “B” medications have been studied in pregnant animals, which show that they are relatively safe, but no human studies are available.
  • Category “C” medications may result in adverse effects on the fetus when studied in pregnant animals, but the benefits of these drugs may outweigh the potential risks in humans.
  • Category “D” medications show clear risk to the fetus, but there may be instances in which the benefits outweigh the risks in humans.
  • Category “X” medications show clear evidence of birth defects in animals and/or human studies and should not be used in pregnancy.

Antihistamines. Older antihistamines, such as chlorpheniramine, are the preferred agents to treat allergic rhinitis during pregnancy, and are both category B medications. Newer antihistamines such as over-the-counter loratadine (Claritin, generic forms) and cetirizine (Zyrtec, generic forms) are also pregnancy category B medications. A newer prescription antihistamine that is pregnancy category B is Xyzal (levocetirizine).

Decongestants. Pseudoephedrine (Sudafed®, many generic forms) is the preferred oral decongestant to treat allergies during pregnancy, although should be avoided during the entire first trimester, as it has been associated with infant gastroschisis. This medication is pregnancy category C.

Medicated nasal sprays. Cromolyn nasal spray (NasalCrom) is helpful in treating allergic rhinitis if it is used before exposure to an allergen and prior to the onset of symptoms. This medication is pregnancy category B and is available over the counter. If this medication is not helpful, one nasal steroid, budesonide (Rhinocort Aqua), received a pregnancy category B rating (all others are category C), and therefore would be the nasal steroid of choice during pregnancy.

Immunotherapy. Allergy shots can be continued during pregnancy, but it is not recommended to start this treatment while pregnant. Typically the dose of the allergy shots is not increased, and many allergists will cut the dose of the allergy shot by 50% during pregnancy. Some allergists feel that allergy shots should be stopped during pregnancy, given the risk of anaphylaxis and possible danger to the fetus as a result. Other than anaphylaxis, no data shows that the allergy shots themselves are actually harmful to the fetus.

Learn more about the diagnosis and treatment of allergies in pregnancy, including conditions that mimic allergies during pregnancy.

Sources:

Allergen Immunotherapy Practice Parameters. Ann Allergy Asthma Immunol. 2003; 90:S1-40.

Dykewicz MS, Fineman S, editors. Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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