As for herbal remedies and aromatherapy, Dr. Learn more about vaccine availability. Advertising Policy. You have successfully subscribed to our newsletter. Related Articles. Lupus and Pregnancy: Is It Safe? When pollen grains get into the nose, the immune system mistakenly labels them as foreign and releases antibodies to attack these allergens. That leads to the release of chemicals called histamines into the blood.
Histamines trigger runny noses, itchy eyes and other symptoms. Avoiding triggers is the first and best option, although it is admittedly difficult.
Pollens circulate more on windy days. The higher the pollen count, the more miserable one will be. Many cities publicize daily pollen counts. When counts are high or when it is windy, keep windows and doors closed. If possible, stay inside. FDA has categorized the first generation antihistamines according to the pregnancy complications [ Table 1 ].
Michigan Medicaid Birth Defects study has linked hydroxyzine to cleft palate in new borns. Pregnancy category B means the drug has failed to demonstrate a risk to the fetus in animal reproduction studies and there is a lack of well-controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Pregnancy category C means that animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks. The second generation antihistamines include drugs such as loratadine, fexofenadine, cetirizine, and azelastine.
They have a high therapeutic index, with highly selective actions and are nonsedating. They are long acting, but are poorly lipophilic and hence have no entry to the central nervous system. Side effects of the second generation antihistamines include photosensitivity, tachycardia, and prolongation of the Q—T interval.
FDA has categorized the second generation antihistamines as shown in [ Table 2 ]. Fexofendine and desloratidine have been classified as pregnancy category C. Reduction in pup weight and survival were observed with fexofenadine. There are no human data on fexofenadine and loratadine for them to be categorized as safe during pregnancy.
Loratadine had previously been proposed as a possible factor for the increased incidence of hypospadiasis in infants born to mothers who had taken loratadine during pregnancy. FDA pregnancy category classification for second-generation antihistamines[ 10 ]. Although pruritus is not a life-threatening medical condition, it can be extremely troublesome for pregnant women.
Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration. At one point, the physician will have to use the antihistamines and weigh the benefits against the teratogenic effects of the antihistamines. Physicians must decide whether to select an older, better-studied antihistamine, thought to be relatively safe during pregnancy, or a newer agent that has less adverse effect on quality of life but has a potential teratogenic effect.
Various recommendations and studies favor the use of first generation antihistamines for use during pregnancy. More data are available about the various effects of the first generation antihistamines in pregnancy. In , the National Asthma Education and Prevention Program NAEPP Working Group on Asthma and Pregnancy recommended the first-generation agents chlorpheniramine and tripelennamine as the antihistamines of choice during pregnancy, based on duration of availability as well as reassuring animal and human data.
In general, second-generation antihistamines are more potent, have a longer duration of action, and produce minimal sedation. Other studies suggest that there is insufficient evidence to support the first-line use of cetirizine and loratadine during pregnancy and recommend first considering chlorpheniramine, tripelennamine, or hydroxyzine if an antihistamine is needed during pregnancy.
In every pregnant case with pruritus the basic cause of pruritus should first be sought out before starting the antihistamines. Appropriate investigations should also be done. The patient should be explained the fact that though no definite teratogenic effects have been reported to be associated with the intake of antihistamines in pregnancy, they are not licensed by the FDA as category A or the safe group.
Also it is important to mention that in India no definitive guidelines have been given or followed by the government to prevent the use of H1-antihistamines as over the counter medicines. Even for prescription purposes, no definitive guidelines have been given by the government and practitioners generally follow the FDA criteria.
If possible the pruritus and other allergic manifestations in the first trimester of pregnancy should be managed using topical medications like bland emollients and systemic antihistamines should be avoided as none of the antihistamines are categorized as safe by the FDA and in India no specific guidelines exist regarding their use in pregnancy.
If antihistamines have to be prescribed then first generation agents should be preferred and among them chlorpheniramine, dexchlorpheniramine and hydroxyzine should be the first choice of agents. The results suggest that Allegra can be added to other second-generation antihistamines currently considered safe for use by pregnant women. Allergic rhinitis is the most common cause of rhinitis in pregnancy and it can affect the quality of life. This study provides reassurance that the OTC antihistamine, Allegra not Allegra-D though , may be safe in use during pregnancy.
Keep in mind that intranasal sprays have been shown to be superior to oral antihistamines for rhinitis treatment. Rhinocort budesonide is considered safe during pregnancy as well.
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