Pregnancy
· Avoid all medication if possible – Avoid allergen
· 1st line topical
· BNF – “If a pregnant woman cannot tolerate the symptoms of allergic rhinitis, treatment with nasal beclometasone, budesonide, fluticasone, or sodium cromoglicate may be considered.”
· Nasal [beclomethasone] +- [(sodium cromoglicate … (Rynacrom = nasal)] or [(nedocromil sodium = eye)]
· 2nd line oral
· [Chlorphenamine] or [loratadine] – 2nd line is [cetirizine] due to less clinical experience
· BNF – “Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor.”
Breast feeding
· 1st line topical
· BNF – No comment on use of topical Rx.
· 2nd line oral
· All appear in breast milk, but not known to be harmful – use for shortest duration possible
· [cetirizine] or [loratadine] NOT [Chlorphenamine – has been reported to cause drowsiness and poor feeding]
· BNF – “Most antihistamines are present in breast milk in varying amounts; although not known to be harmful; most manufacturers advise avoiding their use in mothers who are breast-feeding.”