Management of Allergic Rhinitis During Pregnancy

Introduction to Treatment

Effective management of asthma and allergic rhinitis during pregnancy is crucial to prevent maternal hypoxia and adverse effects on the fetus, with the benefits of controlling maternal asthma generally outweighing the potential risks of medication, as supported by the American College of Allergy, Asthma and Immunology 1

Inhaled corticosteroids (particularly budesonide) should be considered as first-line therapy for asthma during pregnancy, due to their efficacy and safety profile 2
Montelukast can be considered for women with recalcitrant asthma not adequately controlled with inhaled medications, as well as for those who have shown a favorable response to montelukast before pregnancy, as recommended by the European Respiratory Society, Thoracic Society of Australia and New Zealand, and the American Congress of Obstetricians and Gynecologists 1, 3, 4

The American College of Allergy, Asthma and Immunology recommends montelukast as a safe treatment for allergic rhinitis during pregnancy, particularly for those who cannot tolerate or do not respond to intranasal corticosteroids or have shown good response to montelukast before pregnancy 3
Intranasal corticosteroids may be preferred as first-line therapy for allergic rhinitis during pregnancy, although montelukast is also considered safe 3

Expert panels recommend avoiding anti-leukotrienes, such as montelukast, for CRS maintenance during pregnancy, instead preferring saline nasal rinses and topical corticosteroid nasal sprays as maintenance therapy 4

Montelukast is excreted in breast milk, but the benefits of breastfeeding generally outweigh the risk of exposure, and to minimize exposure, consider breastfeeding prior to medication intake, as recommended by the American Congress of Obstetricians and Gynecologists 4