Key takeaways

Pregnancy can exacerbate allergy symptoms due to hormonal changes causing nasal congestion and runny nose.
Certain allergy medicines, such as oral decongestants and herbal therapies, should be avoided during pregnancy due to potential risks to the fetus.
Non-pharmaceutical treatments like saline nasal sprays and physical activity are recommended first for managing allergy symptoms in pregnant women.
If needed, certain allergy medications, including over-the-counter corticosteroid nasal sprays and/or oral antihistamines like Claritin or Zyrtec, are considered safe during pregnancy.

More than 50 million Americans suffer from allergies each year, according to the Centers for Disease Control and Prevention (CDC). In fact, allergies are the sixth leading cause of chronic illness in the U.S.

What’s more, pregnancy can sometimes make allergy symptoms worse. Every woman’s body is different, and every pregnancy is different, so it’s impossible to predict exactly how allergies will affect an individual pregnant woman.

But in general, pregnant women may experience some of the following symptoms differently from other allergy sufferers:

Pregnancy hormones might cause the inner lining of your nose to swell. This causes nasal congestion and a runny nose.
This enhanced congestion makes seasonal allergy symptoms worse.
Severe congestion could lead to poor stress and poor sleep quality.

If you’re expecting and suffering from symptoms like these, here’s what you need to know about taking allergy medicine while pregnant.

Avoid certain allergy medicine while pregnant

There are a number of medications that are not safe to take during pregnancy. First among them are oral decongestants.

“Oral decongestants are best avoided altogether during the first trimester because of an uncertain risk of several rare birth defects,” says Ciara Staunton, a family nurse practitioner and owner of Staunton Primary Care in Cincinnati. “However, Sudafed (pseudoephedrine), which is locked up behind the pharmacy counter, can be used in the second and third trimesters in women without hypertension.”

But Staunton warns that Sudafed-PE (phenylephrine), the over-the-counter option, should never be taken during pregnancy. It is less effective than pseudoephedrine. But more importantly, its safety for pregnant women is questionable.

Ms. Staunton also recommends against using any herbal therapies during pregnancy. “In the United States and most other countries, herbal medicines are minimally regulated and not monitored for adverse events.”

How to safely treat allergies during pregnancy

While it would be best to avoid allergens that bother you, that’s not always a possibility. Many pregnant women and their providers prefer to start with a non-pharmaceutical treatment plan whenever possible. Dr. Janelle Luk, medical director and co-founder of Generation Next Fertility in New York City, suggests an over-the-counter saline nasal spray.

Dr. Luk also recommends physical activity to reduce nasal inflammation. In addition, she says patients with a stuffy nose might be able to sleep better if they elevate the head of the bed by 30 to 45 degrees during sleep.

However, sometimes those non-pharmaceutical options just don’t do the trick, and you need something stronger (aka allergy medicine) to ease your misery. In that case, there are several options that are safe to try.

“For moderate to severe allergies, your physician may recommend a nonprescription corticosteroid spray or an oral antihistamine,” Dr. Luk says. “Some nasal spray options include Rhinocort Allergy, Flonase, and Nasonex.”

For oral antihistamines, Staunton says she recommends Claritin (loratadine) or Zyrtec (cetirizine) because of their good safety history. Both are rated pregnancy category B by the FDA. This means that controlled studies in animals have shown no adverse effects to the developing fetus.

Benadryl (diphenhydramine) is considered fairly safe during pregnancy, according to the CDC. However, Benadryl Allergy Plus Congestion is not safe for pregnant women because it contains phenylephrine.

You can also take one of the oral antihistamines together with a nasal spray if neither one controls your symptoms on its own.

As for subcutaneous allergen immunotherapy (SCIT), aka allergy shots—if you were on them before pregnancy, your doctor may continue them. But they wouldn’t be started during pregnancy because of “the potential harm that could result if a reaction were to occur,” Staunton says.

If you are suffering from allergy symptoms, speak with your provider about your best options for allergy medicine while pregnant.