Abstract
Medical treatment options for patients with rhinitis during pregnancy need careful
considerations. It is important to distinguish between the causes of rhinitis, as
this can influence treatment. Conservative options are important for patients with
pregnancy-induced rhinitis (PIR) and pre-existing allergic or non-allergic rhinitis.
Education and knowledge that PIR symptoms will resolve after pregnancy can offer some
relief. Other strategies such as exercise, positioning, saline nasal douching/lavage,
and nasal valve dilators are safe in pregnancy and can have a benefit in these patients
with rhinitis of any aetiology. The main medical therapies usually used in rhinitis
cannot always be directly translated to pregnant patients due to potential teratogenic
effects. Topical corticosteroids have generally shown to be safe with budesonide having
the strongest recommendations. Oral corticosteroids are mostly used in moderate-severe
disease and should be avoided in the first trimester. Oral decongestants have associations
with cardiac, ear, gut and limb abnormalities and are not recommended in the first
trimester. Loratadine and cetirizine have been the most well-studied second-generation
antihistamines and are generally considered safe. There has been no reported increased
risk of teratogenicity with anticholinergics or cromones, with the latter being one
of the first line options in pregnant women with allergic rhinitis. The role of allergen
immunotherapy needs further research, but current guidance states it can be continued
if already initiated prior to pregnancy. The management of rhinitis in pregnancy can
therefore be complex. This review aims to evaluate the current medical management
options for rhinitis in pregnancy.
Keywords
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Article Info
Publication History
Published online: February 04, 2022
Accepted:
January 26,
2022
Received:
December 4,
2021
Identification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
