Allergies in pregnancy & breastfeeding
Hormones can make nasal symptoms better, worse or brand new in pregnancy. The reassuring news: several effective options are considered safe — here is what the evidence and guidelines say.
What pregnancy does to your nose
Up to 1 in 5 pregnant people develop pregnancy rhinitis — congestion caused by hormonal swelling of the nasal lining, not allergy. It can appear at any stage, often in the second half, and usually resolves within two weeks after delivery. If you already have allergic rhinitis, pregnancy may improve, worsen or not change it — roughly a third each way.
Safe relief, step by step
- Start with the safest optionsSaline rinses and sprays, allergen reduction at home, and elevating the head of the bed are safe at any stage.
- If you need more: nasal corticosteroid spraysCommonly used in pregnancy with a long safety record — budesonide has the most pregnancy data and is often the preferred choice when a spray is needed.
- If antihistamines are neededSome oral antihistamines (such as loratadine and cetirizine) have reassuring safety data and are commonly recommended; others are best avoided. Your doctor or midwife will choose based on your trimester and history.
- Review anything you already takeDo not stop effective treatment suddenly — uncontrolled allergy and poor sleep are not good for pregnancy either. Review together.
What to avoid (unless your doctor says otherwise)
- Oral decongestants (pseudoephedrine, phenylephrine) — especially in the first trimester
- Decongestant nasal sprays for more than a few days — rebound congestion, and best discussed first
- Starting immunotherapy during pregnancy (continuing an established, tolerated maintenance course may be possible — specialist decision)
- Herbal remedies with unknown safety profiles — “natural” does not mean safe in pregnancy
Breastfeeding
Most allergy medicines pass into breast milk in very small amounts. Non-sedating antihistamines (loratadine, cetirizine) and nasal corticosteroid sprays are generally considered compatible with breastfeeding. Sedating antihistamines can make some babies drowsy — another reason to prefer modern options. Confirm your specific medicine with your clinician, pharmacist or a medicines-in-breastfeeding information service.
The golden rule: never start, stop or switch medication in pregnancy or breastfeeding without checking — but do not suffer in silence either. Effective, considered-safe options exist, and your care team can tailor them to your trimester.
Non-allergic congestion at night? Saline rinse before bed, a head-elevating pillow, and fresh humidified air help many pregnant people sleep better without any medicine.