Diagnosis and treatment of rhinitis during pregnancy and lactation

Many women develop rhinitis during pregnancy. However, to call this "rhinitis of pregnancy" may be misleading. Many of these women who seem to have "developed" rhinitis during pregnancy turn out, on careful questioning, to have had similar preexisting symptoms. Furthermore, these women and those who truly appear to have developed their symptoms for the first time during pregnancy are often found to have common causes for their rhinitis. Certain factors have been cited to account for the frequent appearance (or reappearance) of rhinitis during pregnancy (Table 1). Nasal vascular pooling from the increased circulating blood volume and possibly from progesterone induced vascular smooth muscle relaxation will enhance nasal stuffiness. Stress associated with even a normal pregnancy may have a similar effect. Hormonally induced increased nasal mucous gland activity also has been suggested. The peak age of onset of classical inhalant allergic disease falls within the child bearing time of life, and hence could be coincidental with a pregnancy. Even routine episodes of bacterial rhinosinusitis are increased up to 6-fold during pregnancy. This report will review the clinical approach to rhinitis in the pregnant patient with reference to pathophysiology, differential diagnosis, and treatment during this complex time in a woman's life.