Safe Allergy Medications During Pregnancy: What You Need to Know

About 20% of pregnant people experience allergies, according to the American College of Allergy, Asthma, and Immunology. Managing these symptoms safely isn’t simple-you’re not alone in wondering which medications are safe for you and your baby. Allergy medications during pregnancy are a critical healthcare consideration for expectant parents, balancing symptom relief with fetal safety. Allergy medications during pregnancy require careful consideration because safety varies by trimester and drug type. Let’s break down the facts so you can make informed choices.

How Trimesters Change Medication Safety

Your baby’s development happens in stages, and each trimester brings different risks. The first trimester (weeks 1-12) is when organs form, so avoiding non-essential medications is crucial. The second and third trimesters are generally safer for medication use, but you still need to be careful. For example, nasal corticosteroids like Rhinocort (budesonide) are safe all through pregnancy, but oral decongestants like Sudafed (pseudoephedrine) should be avoided in the first trimester due to a 2.4-fold increased risk of gastroschisis-a birth defect where the baby’s intestines develop outside the body. Always check with your doctor before taking anything, even over-the-counter meds.

Nasal Steroids: Your Best Bet for Relief

Nasal corticosteroids are often the go-to for allergy relief during pregnancy because they work locally with minimal absorption into the bloodstream. Rhinocort (budesonide) has the strongest safety data and is recommended as the top choice. Flonase Sensimist (fluticasone furoate), Nasonex (mometasone), and Flonase Allergy Relief (fluticasone propionate) are also considered safe throughout pregnancy. However, avoid Nasacort (triamcinolone) entirely-GoodRx’s 2023 review flagged it as having insufficient safety data. These sprays reduce inflammation in your nose without affecting your baby. Just make sure to use them as directed: one spray per nostril daily, not more.

Oral Antihistamines: What’s Safe?

Antihistamines help with itching, sneezing, and runny noses. First-generation options like Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine) have been used safely for decades. The American Academy of Family Physicians confirms they don’t increase the risk of birth defects. But they cause drowsiness, so take them at night. Second-generation antihistamines like Zyrtec (cetirizine) and Claritin (loratadine) are generally safe after the first trimester. They’re non-sedating and effective for daily use. Fexofenadine (Allegra) has a Pregnancy Risk Category C from the FDA due to limited human studies, though animal data is reassuring. Always choose single-ingredient versions-avoid products labeled "-D" like Claritin-D, which contain decongestants.

Decongestants: Proceed with Caution

Decongestants like Sudafed (pseudoephedrine) and phenylephrine can worsen blood pressure and should be avoided in the first trimester. A 2009 study in the American Journal of Obstetrics and Gynecology linked pseudoephedrine to gastroschisis risk. Mayo Clinic updated its guidance in December 2023 to allow limited use (30-60 mg every 4-6 hours, max 240 mg/day) in the second and third trimesters for severe congestion, but only if you don’t have high blood pressure. Nasal sprays like Afrin (oxymetazoline) can be used for up to 3 days, but longer use risks rebound congestion. Always ask your doctor before using decongestants-there’s rarely a need for them during pregnancy.

Non-Medication Alternatives That Work

Before reaching for meds, try simple, drug-free solutions. Saline nasal rinses (like Neti Pots) clear allergens without side effects. HEPA air filters reduce indoor pollen and dust. Keep windows closed during high-pollen seasons, and shower after being outdoors to wash off allergens. Wear sunglasses outside to protect your eyes from pollen. These steps can cut symptoms significantly and are safe at any stage of pregnancy. If symptoms persist, talk to your doctor about safe medication options tailored to your trimester.

Expert Insights You Can Trust

Dr. Matthew Ziff, an OB/GYN at Nebraska Medicine, says: "Pseudoephedrine (Sudafed) has been possibly related to birth defects in the first trimester. It also raises blood pressure, so I avoid it in pregnancy." The American College of Obstetricians and Gynecologists (ACOG) reaffirmed in 2022 that most antihistamines don’t increase birth defect risks based on data from over 200,000 pregnancies. Dr. Purvi Parikh, an allergist with the Allergy & Asthma Network, adds: "Antihistamines are useful for nasal and eye symptoms during pregnancy, but benefits must outweigh risks." The FDA’s Pregnancy and Lactation Labeling Rule (PLLR), in effect since 2018, replaced old A-B-C-D-X categories with detailed descriptions, but many doctors still reference older data. Always rely on current guidelines from ACAAI or ACOG.

Practical Tips for Every Trimester

First trimester: Focus on non-drug methods. If you need medication, use saline rinses or nasal steroids like Rhinocort. Avoid all decongestants and multi-symptom products. Second trimester: You can safely use second-gen antihistamines like Zyrtec (10 mg daily) or Claritin (10 mg daily). Continue nasal steroids. Third trimester: Maintain safe medication use but avoid decongestants. If you have asthma, inhaled corticosteroids are safe-oral ones should be avoided unless absolutely necessary. Always check labels for hidden decongestants in "all-in-one" products. For example, Claritin-D contains pseudoephedrine and is unsafe during pregnancy.

What About Allergy Shots?

If you were already getting allergy shots before pregnancy, you can usually continue them under your allergist’s supervision. But never start allergy shots during pregnancy-ACAI guidelines advise against it. Shots can cause severe reactions, and the risks outweigh benefits while you’re pregnant. Your doctor might adjust your dose to keep you safe. Always inform your allergist and OB/GYN if you’re receiving immunotherapy while pregnant.