Clinical and pathogenetic characteristics of pregnancy rhinitis

Pregnancy rhinitis is a very common condition. Defined as "nasal congestion present during the last 6 or more weeks of pregnancy without other signs of respiratory tract infection, and with no known allergic cause, disappearing completely within 2 wk after delivery," it strikes one in five pregnant women, and it starts in almost any gestational week. The pathogenesis is not clear, but placental growth hormone is suggested to be involved. Smoking and sensitization to house dust mites are probable risk factors. It is often difficult to make a differential diagnosis from sinusitis, which may in pregnancy present with nasal congestion as the only symptom. Antral irrigation is diagnostic for purulent sinusitis and often needs to be repeated, as it should be treated intensively. Because of changes in pharmacokinetics, increased dosage of betalactam antibiotics is needed during pregnancy. As pregnancy rhinitis reduces quality of life and possibly also affects the fetus, there is often need for treatment. Nasal corticosteroid shave not been shown to be effective. Systemic administration should be avoided,but nasal corticosteroids could be used in pregnancy when indicated for other sorts of rhinitis. Nasal decongestants give good temporary relief, so pregnancy rhinitics tend to overuse them, giving an additional rhinitis medicamentosa. Therefore, use of nasal decongestants should be restricted to a few days. Invasive methods of turbinate reduction may be effective but are not recommendable in this self-limiting condition because of side effects. Nasal saline washings, exercise, and mechanical alar dilators are safe general means to relieve nasal congestion, but the ultimate treatment remains to be found.