First Exposure

Seasonal Allergies and Allergic Rhinitis in Pregnancy and Lactation

Authored by Dr. Samira Jeimy and reviewed by First Exposure Medical Review Team.

 Dr. Samira Jeimy is a Clinical Immunologist and Allergist at London Health Sciences Centre and an Assistant Professor at Western University.

 This health topic is an expert opinion about Seasonal Allergies and Allergic Rhinitis during pregnancy and lactation.  

* The information provided is the expert opinion of the First Exposure Medical Advisors. It is for informational purposes only and does not replace medical care and advice from a healthcare provider. Please contact your healthcare provider if you have any concerns or to discuss any questions that you believe may be relevant to you or your baby. In case of emergency, please go to the emergency room or call 911 


If you do not have a healthcare provider please go to: Finding a Healthcare Provider 

Clinical scenario:

I’m 10 weeks pregnant and my allergies are out of control. What can I do?

Q. What are seasonal allergies?

A. Allergies are caused by our immune system overreacting to substances known as allergens. Some common allergens are pollen, dust mites, mold, and pet dander. Some of the common allergy symptoms caused by these allergens are stuffy/blocked nose (nasal congestion), sneezing, itchy eyes, and runny nose (rhinorrhea). These symptoms can affect sleep and daily activities.

Seasonal allergies, also sometimes called “hay fever” or seasonal allergic rhinitis, are caused by pollens from trees, grass, ragweed etc. and are mostly experienced during the spring and fall.

Q. How do I know what I’m allergic to?

A. Skin prick testing, a test that can be performed by an allergist, can help determine what someone is allergic to.  Skin prick testing has a very low risk of a systemic reaction (whole body allergic reaction). Although the risk of a reaction is small, some allergists prefer not to do the skin prick test during pregnancy and prefer to wait to do it postpartum (after delivery).

Q. What happens to seasonal allergies in pregnancy?

A. Usually allergies, including seasonal allergies, will improve in a third of pregnancies, worsen in a third, and stay the same in a third.

Q. Can seasonal allergies harm me or my baby?

A. Symptoms of seasonal allergies do not pose a direct harm to you or your baby during pregnancy. However, they can cause discomfort and affect your sleep and quality of life. Some individuals with seasonal allergies may also have asthma, which can worsen during pregnancy and requires careful management.


Q. What can be done to help manage allergy symptoms?
A. The key to managing allergy symptoms in pregnancy is avoiding or reducing exposure to the allergen(s) as much as possible:
  • To help reduce exposure to pollen:
    • You can check your local pollen conditions (counts) on your local weather network
    • Try keeping windows closed during the hours of 4 AM and 10 AM, when pollen counts peak
    • When counts are moderate/high try to minimize time spent outside exposed to pollen
    • If exposed to pollen, change clothes, shower (wash hair), and use saline rinses for the nose
  • To help reduce exposure to indoor allergens such as dust mites and pet dander:
    • Use dust mite-proof bed covers
    • Wash bedding in hot water weekly
    • Reduce indoor humidity
    • Try avoiding exposure to carpets, upholstered furniture, and stuffed toys, especially in bedrooms

Q. Are there medications that can be used during pregnancy to control allergy symptoms?

A. There are several over the counter and prescription options for the management of allergy symptoms. These include:

  • Saline nasal (into the nose) sprays/rinses: Saline nasal sprays/rinses contain a mixture of salt and water and can be used in pregnancy. Regular use of saline sprays may help clear nasal passages and relieve nasal congestion. For nasal rinses, use distilled water or boiled water that is cooled to room temperature.
  • Nasal corticosteroid sprays: These are sprayed into the nose to control nasal inflammation and help relieve nasal congestion. When used as directed they are expected to act locally and reach the blood stream in very small amounts. Based on the available information, the use during pregnancy of nasal corticosteroid sprays containing budesonide, ciclesonide, fluticasone, or mometasone is not expected to result in harmful effects to the pregnancy or the baby.
  • Antihistamines: Antihistamines are commonly used to manage symptoms such as runny nose, sneezing, and itchiness. The available information on use of antihistamines in pregnancy has not suggested harmful effects to the pregnancy or the baby. Second-generation antihistamines like loratadine and cetirizine are often preferred since they are not expected to cause drowsiness in most people.


Q. Can allergy shots be continued during pregnancy?

A. Allergen immunotherapy (AIT) is an intentional exposure of an allergic person to small, gradually increasing doses of an allergen, in order to develop tolerance to the allergen. AIT can be given by injection (allergy shots) or a tablet under the tongue. It is not recommended to start AIT or increase doses (build-up phase) during pregnancy. For those who have reached the maintenance phase and become pregnant, AIT may be continued, sometimes at a reduced dose.Based on the available information, AIT in pregnancy is not expected to result in harmful effects. Please discuss your treatment plan with your allergist/immunologist if you are planning a pregnancy or have become pregnant.

Q. Are there medications that can be used to control symptoms while nursing?

A. Saline nasal sprays/rinses, antihistamines and nasal corticosteroid sprays can be used while nursing. Second-generation antihistamines, like loratadine and cetirizine, are preferred as they pass into breastmilk in small amounts, and they are not expected to cause drowsiness. As well, no concerns in the breastfed infant have been raised. Nasal corticosteroid sprays containing budesonide, ciclesonide, fluticasone, or mometasone act locally and reach the blood stream in very low amounts. Because of this, they are not expected to result in harmful effects to the breastfed infant.

Q. What other condition(s) can cause symptoms similar to seasonal allergies in pregnancy?

A. Pregnancy rhinitis is a condition that begins in pregnancy. The symptoms are nasal congestion, without other signs of respiratory tract infection and with no known allergic cause. It lasts more than 6 weeks and disappears within two weeks after delivery. It affects 20-30% of pregnancies. Pregnancy rhinitis occurs due to swelling (edema) of the lining inside the nose. Treatment is not always required, and nasal corticosteroid sprays are typically not helpful. Saline rinses and exercise (leads to narrowing of nasal blood vessels (vasoconstriction)), nasal strips, and elevation of head of bed may be helpful.

Key References

Alhussien AH, Alhedaithy RA, Alsaleh SA. Safety of intranasal corticosteroid sprays during pregnancy: an updated review. Eur Arch Otorhinolaryngol. 2018 Feb;275(2):325-333. [PMID: 29164323].

Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, Nelson M, Weber R, Bernstein DI, Blessing-Moore J, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011 Jan;127(1 Suppl):S1-55. Erratum in: J Allergy Clin Immunol. 2011 Mar;127(3):840. [PMID: 21122901].

Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020 Oct;146(4):721-767. [PMID: 32707227].

Gani F, Braida A, Lombardi C, Del Giudice A, Senna GE, Passalacqua G. Rhinitis in pregnancy. Eur Ann Allergy Clin Immunol. 2003 Oct;35(8):306-13. [PMID: 14653050].

Hansen C, Desrosiers TA, Wisniewski K, Strickland MJ, Werler MM, Gilboa SM. Use of antihistamine medications during early pregnancy and selected birth defects: The National Birth Defects Prevention Study, 1997-2011. Birth Defects Res Part A Clin Mol Teratol. 2020;112(16):1234-52. [PMID: 32657014].

Li Q, Mitchell AA, Werler MM, Yau WP, Hernández-Díaz S. Assessment of antihistamine use in early pregnancy and birth defects. J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):666-74.e1. Epub 2013 Sep 12. [PMID: 24565715] [PMC4140658].

Oykhman P, Kim HL, Ellis AK. Allergen immunotherapy in pregnancy. Allergy Asthma Clin Immunol. 2015 Nov 10;11:31. [PMID: 26561490] [PMC4641390].

Pali-Schöll I, Namazy J, Jensen-Jarolim E. Allergic diseases and asthma in pregnancy, a secondary publication. World Allergy Organ J. 2017 Mar 2;10(1):10. [PMID: 28286601] [PMC5333384].

UpToDate Lexi-Drugs. Ciclesonide (Nasal) [Internet] Hudson, OH: UpToDate; 2016 [updated April 15, 2024; cited 2024 June 20]. Available from:


First Exposure does not offer health care treatment. If you have an urgent question about your pregnancy or your baby’s health, you should contact your health care provider directly. If you don’t have a health care provider and you live in Ontario, you have a variety of health care options. In the case of an emergency, visit a hospital emergency room or call 911.