Treating Allergies and Asthma During Pregnancy

Congratulations! You’re pregnant! Now your doctor gives you the bad news — the medications that keep your allergies under control are forbidden during pregnancy. How are you going to survive the next nine months of sniffling, sneezing and wheezing?

The first step to allergy relief is avoidance. Substances such as pollens, molds, animals, dust mites and even drugs such as aspirin can trigger allergic reactions. Eliminating these triggers from your environment is the biggest improvement you can make.

There are medications that can provide relief, but check with your doctor before you try anything, especially during the first trimester when the most development occurs in your baby.

Antihistamines are sometimes used to treat nose and eye symptoms, hives and eczema. But as with any medication used during pregnancy, your doctor will weigh the benefits of these drugs against possible risk to your baby.

Decongestants, especially nasal sprays containing a chemical called oxymetazoline, may be dangerous. In “The Complete Idiot’s Guide to Pregnancy and Childbirth,” Dr. Michele Isaacs Glikman, chief of obstetrics at the Boston Medical Center, explains that oxymetazoline clears the sinus by tightening the small blood vessels in the nasal passages. It can also tighten the arteries that lead to the uterus, reducing the supply of blood and oxygen to your baby. In addition, over-the-counter nasal sprays tend to make your congestion worse if you use them for more than three consecutive days, a condition called “rebound congestion.”

In “I’m Pregnant & I Have A Cold,” Dr. Craig Towers states that an over-the-counter drug called Nasalcrom, which contains the chemical cromolyn sodium, may provide some welcome relief. It is an anti-inflammatory nasal inhaler that prevents your respiratory symptoms from occurring in the first place. Antihistamines work by blocking the effects of histamine after it has been released. Cromolyn sodium prevents the release of histamine, before it gets the chance to cause symptoms.

This drug is poorly absorbed into the bloodstream, so the risk to your baby is minimal. Several studies have shown no increase in major birth defects when pregnant women use it as directed. Again, it is important to discuss this drug with your doctor before using it.

Allergy shots, also known as immunotherapy, are another option. If you are already receiving allergy shots, you may continue this therapy with careful monitoring from your doctor. Immunotherapy usually takes several months to become effective, so starting it after you become pregnant will not do much good.

According to the ACAAI, asthma and allergies are often connected. Asthma is an inflammation of the lung airways that causes coughing, shortened breath and a feeling of tightness in the chest. Allergy triggers, as well as exercise, infections and stress usually cause it. It affects up to 15 million Americans, and 7 percent of expectant mothers.

For about a third of pregnant women who already had asthma, the problem becomes worse. Another third actually improve during pregnancy. The final third see no difference at all. Statistics from the American Medical Association show that asthma symptoms usually become most severe between the 29th and 36th weeks of pregnancy. About 1 in 10 women with asthma experience it during labor and delivery.

If severe asthma is uncontrolled during pregnancy, an expectant mother may suffer from high blood pressure, hypoxemia (low oxygen) or pre-eclampsia. Risks to the baby include premature birth and low birth weight.

“Women are often told to eliminate or restrict the use of many things during pregnancy, including many over-the-counter and prescription medications,” said Michael Schatz, M.D., co-chair of the ACAAI’s pregnancy committee. “In the case of asthma, the potential benefits of using the appropriate medication to control asthma outweigh the potential risks of the medication and uncontrolled asthma.”

According to ACAAI, most asthma medications are not harmful to unborn babies. Inhaled medications are preferred because they have a localized effect, with only small amounts entering the bloodstream.

Inhaled beta2-agonists, sometimes called rescue medications, may help control acute asthma symptoms, especially at night when asthma can make sleeping difficult. Anti-inflammatory medications, or asthma controllers, help prevent the symptoms, and are usually used daily.

An influenza (flu) vaccine may help expectant mothers who suffer from severe asthma. These injections generally pose no risk to the baby.