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Hay Fever in Pregnancy

by Airborne Allergens expert, Max Wiseberg

"Hay fever, or seasonal allergic rhinitis to give it its proper name, can bring misery to millions of people in spring and summer. The prevalence of hay fever has trebled over the last three decades (Gupta et al, 2007), and would appear to be on the rise again. There are any number of treatments, depending on the severity of the symptoms and the sufferer’s particular circumstances. But many of these treatments are not available, or at least not recommended, during pregnancy, which is particularly unfortunate as symptoms are likely to be worse than usual as a result of the action of the hormone oestrogen. Many doctors will suggest avoiding any medications at all during pregnancy, so what can medical professionals suggest to ease the discomfort of the streaming nose, watering eyes, and sandpaper throat that sufferers endure? It’s a question that’s likely to confront midwives every spring and summer.

Hay fever is an allergic reaction to pollen in the air. The body contains antibodies called Immunoglobulin E (IgE). Mast cells have special receptors to which IgE can bind. When two of these mast cell bound antibodies are together the allergen is attracted to them and links them together. When enough of these are so linked, the mast cells will then release histamines. The body needs histamines – in the brain they keep us alert, attentive and awake – but when there are too many in the body, it is these histamines which are mainly responsible for causing the unpleasant symptoms of hay fever. Put more simply, we can tolerate certain amounts of pollen, but there is a sensitivity level above which we will suffer an allergic reaction, triggering the release of histamines. Many remedies therefore rely on anti-histamines – such as loratidine or chlorphenamine - as a first resort. (And it is now clear why anti-histamines can result in drowsiness).

Doctors and pharmacists are unlikely to prescribe anti-histamines during pregnancy as little is known about the effect on the foetus. Certain first generation antihistamines have had control studies regarding safety in pregnancy, but “Every drug used in pregnancy carries a risk for teratogenicity and careful risk/benefit assessment should be done before prescribing them.” (Kar S et al 2012). Much more research would be needed to discover cross-placental properties of anti-histamines, taken either orally or as a nasal spray. Although some consider chlorphenamine safe during pregnancy, on their website the NHS advise 'this should be avoided close to labour and childbirth as it can cause problems in the baby, such as irritability or tremor (shaking).'

Doctors may instead recommend steroid nasal sprays which are less likely to have side effects as less of the medication is absorbed into the body. But even these should be used with caution.

For sufferers who experience symptoms mainly the nose and eyes, an alternative treatment is a locally acting medication, for example sodium chromoglycate nasal spray and eye drops. These would need to be used several times a day to be effective and are thought to be suitable in pregnancy. But there have been no formal studies here either, so even these should be used with caution.

If it’s that time of year when there is a lot of pollen in the air, preventing it entering the body in the first place would seem to be the obvious answer. But short of shutting yourself indoors and closing all your windows, what’s a girl to do that can help her feel less miserable, but not harm baby in any way?

There are an increasingly wide range of drug free products with evidence to show their efficacy which are available to help reduce hay fever symptoms. Many people find that remedies work, but don’t work well. So using one or more of the following together may be worth trying – something you would not want to suggest with pharmaceutical products!

Organic allergen barrier balms applied to the nose do not claim to be a cure for hay fever, but they can prevent absorbing enough pollen to trigger an allergic reaction. These balms are applied to the base of the nostrils to trap the pollen before the body can react. They are not drugs and are made with natural products so have no drowsy side effects. Independents studies (NPARU 2009, 2012) have shown they trap significant amounts of pollen as well as pet and dust allergens. (Emberlin et al 2009, Kennedy et al 2012)

Another prevention method which is suitable for pregnant women involves puffing an inert cellulose powder into the nose. This then forms a barrier in a similar way to the balms mentioned above Several studies have shown the effectiveness of this type of pollen barrier. (Josling, Steadman, 2003)

Nasal washes, xylitol and saline, can flush out irritants in the nose, and stop new irritants sticking to membranes in the nasal passage. Indeed nasal irrigation has been a feature of the ancient Indian practice of Ayurvedic medicine for centuries.

Another practice imported from eastern medicine, acupuncture has proved effective for some sufferers. There are studies which appear to indicate that acupuncture works (Xue CC et al, 2007) but it is not easy to find any studies on such treatments in pregnancy. (Acupressure bands which are marketed for use with hayfever are not advised for use during pregnancy).

Finally, light therapy allergy relievers are becoming popular. The manufacturers suggest checking with the doctor or midwife before using them in pregnancy as there has been no research to prove these are safe for pregnant women.

One thing needs no research. No mother-to-be, however badly afflicted with this troublesome condition, would wish to introduce into her body something which could damage her baby."


How can you help your child suffering with Hayfever? Click HERE

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