Management of rhinitis and asthma in pregnancy

To objectively critique recent available data on the proper management of allergy and asthma during pregnancy, with an emphasis on understanding the risk and benefit of medications used during pregnancy for these disorders.

Data for this article were obtained from a MEDLINE search of literature from 1975 until the present published in English.

It was the expert opinion of the author to select and synthesize recently published articles and reviews on this broad subject.

Asthma is estimated to affect up to 4% of pregnancies, whereas rhinitis complicates up to 20%. The cornerstones of management are environmental avoidance procedures, pharmacologic treatment, and allergen immunotherapy. Pharmaceutical treatment for allergic rhinitis should start with the first-generation antihistamines, chlorpheniramine and tripelennamine. In pregnant women, who cannot tolerate first-generation antihistamines, use of a second-generation agent, either loratadine or cetirizine, should be considered. Though data are lacking, intranasal corticosteroids appear to be safe during pregnancy. For pregnant women with persistent asthma, the use of inhaled cromolyn should be the first-line therapy, followed by inhaled budesonide if symptoms worsen. Other agents such as salmeterol, leukotriene modifiers, and newer inhaled corticosteroids may be considered in women who exhibited a good response to these agents before pregnancy. Immunotherapy is the only disease-modifying treatment for allergic rhinitis and asthma. It can be continued during pregnancy.

Understanding the important differences in treatment for the pregnant patient is vital for all physicians caring for these patients. Proper medical management needs to take into consideration possible adverse effects of different agents used in asthma and rhinitis.