Hay fever (also known as allergic rhinitis) is inflammation of the lining of the nose. Symptoms include itchy, swollen, runny nose and/or eyes, and post-nasal drip (mucus in the back of the throat). Hay fever is usually seasonal (e.g in Spring and Summer) though in a small subset of patients it can occur all year round.
Seasonal triggers include allergens in the air such as pollens from trees, grasses or weeds. Other triggers include household allergens such as dust mites, cockroaches, animal dander or moulds.
Although hay fever is not a life-threatening medical condition, it can seriously negatively effect your quality of life and day to day function. In pregnancy, symptoms of allergy can increase by up to 30%.
Medical treatment of hay fever for pregnant women
Avoiding allergy triggers is often impossible. The choice of medical treatment depends on the nature of your symptoms and how severe they are. In general, nasal sprays and eye drops enter the bloodstream in very small amounts and are preferred in pregnancy as the amount of medication reaching the unborn baby is very small compared to an oral medicine (taken by mouth). However, oral antihistamines (both sedating and non- sedating) are considered safe to use while pregnant.
If symptoms of hay fever are infrequent (less than 4 days per week) or mild, consider taking a nasal or oral antihistamine only when you need it. If symptoms occur on four or more days of the week, steroid nasal sprays may be a better option. With more severe hay fever, a combination of oral and nasal medication may be required to adequately control symptoms and is considered safe. Medication options are listed below:
Nasal irrigation and saline nasal sprays
Rinsing the nose with a saline (salt water) solution or saline spray helps to clean the nasal lining and rinse out allergens and irritants from the nose. They can be used before applying medicated sprays to get a better effect from the medication. These are considered safe to use in pregnancy and breastfeeding. Examples include:
- Fess®
- Flo nasal mist ™
Oral and nasal antihistamines
Anti-histamines act to reduce symptoms of itching, sneezing and runny nose due to allergy but generally won’t help reduce nasal congestion. Antihistamines can be divided into two categories: sedating and non-sedating formulations. The older antihistamines such as doxylamine, promethazine and dexchlorpheniramine are sedating. Less sedating antihistamines include loratadine, desloratadine, cetirizine, levocetirizine, and fexofenadine. All these antihistamines are considered safe to use as there has been adequate follow up regarding safety in pregnancy. Choice of antihistamine depends on what has worked before and the nature of the symptoms. Sometimes it may take a trial of a number of different anti-histamines to find the best option. Avoid using sedating anti-histamines at the time of delivery and when breast feeding. Oral anti-histamines should be used only when required as opposed a preventative fashion. Commonly used examples include:
Non-sedating:
- Loratadine (Claratyne)
- Fexofenadine (Telfast)
- Cetirizne (Zyrtek)
- Desloratidine (Desonex)
Sedating:
- Promethazine (Allersoothe, Phenergan)
- Dexchlorpherinamine (Polaramine)
- Doxylamine (Restavit)
Azelastine (Azep) and Levocabastine (Zyrtek Antihistamine Hayfever & Allergy Nasal Spray) are both over-the-counter antihistamine nasal spray ingredients that can be used daily or when needed to relieve symptoms of post-nasal drip, congestion, and sneezing. They have a rapid onset. While there is limited evidence, expert opinion is that they are safe to use in pregnancy.
Corticosteroid nasal sprays
Corticosteroid nasal sprays work by reducing inflammation in the nose. Examples of over-the-counter corticosteroid nasal sprays include:
- Mometasone (Nasonex Aqueous, Sensease, Azonaire)
- Fluticasone (Flixonase Allergy and Hayfever, Avamys).
- Budesonide (Rhinocort).
Some relief occurs after a few days though most effect occurs only after 2 weeks of regular use. These medications are considered safe in pregnancy.
Oral and nasal decongestants
Oral and nasal decongestants are not usually effective in the treatment of hay fever or allergic rhinitis, although they are commonly used.
- Phenylephrine nasal spray is safe to use in pregnancy (Nyal Decongestant Nasal Spray)
- Ephedrine nasal spray is safe to use in pregnancy.
- Oxymetazoline nasal spray is safe to use in pregnancy. (Drixine, Vicks Sinex, Logicin Rapid Relief).
Eye drops
Eye drops include single ingredients such as naphazoline, azelastine, ketotifen, levocabastine, olopatadine, sodium cromoglycate and varying combinations of naphazoline, antazoline and pheniramine. There is little evidence either way for safety in pregnancy. They act locally at the eyes and enter the mother’s bloodstream in very small amounts only. Because of this they are generally considered safe to use in pregnancy.
Breastfeeding while experiencing hay fever
When breastfeeding the symptoms of allergy and hay fever can be treated safely mostly in the same way as during pregnancy though certain precautions should be taken with oral antihistamines.
If you require oral antihistamines it is recommended that you use non-sedating options (e.g. Loratadine, Fexofenadine, Cetirizine) instead of sedating options (e.g. Promethazine, Dexchlorpherinamine, Doxylamine) due to the risk of sedating medication passing on to the baby via breast milk.
References:
- Australian Medicines Handbook. (2024). Retrieved September 2024,
- Hay Fever in Pregnancy and Breastfeeding. NSW Health June 2021.
