pregnancy rhinitis symptoms

Self-Care of Rhinitis During Pregnancy

W. Steven Pray, PhD, Professor DPhBernhardt, nonprescription products and DevicesCollege of PharmacySouthwestern UniversityWeatherford Oklahoma State, Oklahoma

Gabriel E. Pray, PharmDPharmacist-in-Charge, Walmart PharmacyWatonga, Oklahoma

Pharmacists consult with patients on a number of medical problems, some of which agree to personal care and some that require referral to a recipe. When the patient becomes pregnant, treatment is much more complicated, because it is very important to avoid damage to the fetus.

The pregnant woman is subject to the same type of nasal problems as the general population. These include allergic rhinitis and the common cold. Both conditions have been discussed in the pharmaceutical literature, but the problem of what wise pharmacist should recommend for pregnant patients is puzzles that constantly.

Doctors have long consulted with pregnant women who have continuous nasal problems that do not look for a common cause. Finally, doctors began to question whether this nasal congestion may be caused by pregnancy itself. The theory is controversial, and, according to one expert, the rhinitis of pregnancy "as a phenomenon observed for ages, but until now not recognized as worthy condition is defined to be taken seriously." 1-3 Researchers now have defined pregnancy rhinitis as distinct entities and developing the following diagnostic criteria: "nasal congestion is present for six or more weeks of pregnancy without other signs of respiratory tract infection and without allergens known, disappeared completely within two weeks after giving birth. " 1

pregnancy rhinitis (also known as vasomotor rhinitis of pregnancy) affects as many as 20% of pregnant women.4 patients reported nasal congestion as characteristic features, but they also may have a clear secretions that vary from watery to thick in consistency.

cause rhinitis of pregnancy is considered to be the hormonal changes of pregnancy. Estrogen would be logical cause, because the rate of increase during pregnancy due to the secretion of the corpus luteum enlarges and placenta.2 However, in one study, only 35% of subjects experienced a worsening of congestion during pregnancy, and 39% actually breathe easier as proceeded. 1 pregnancy role of progesterone, prolactin, stress, and increases blood volume has been explored, but the actual cause of pregnancy rhinitis remnants elusive.1,5

risk factors for rhinitis of pregnancy including smoking history. maternal age, parity, and the sex of the fetus is not predictive factors.5

nonprescription products and devices for nasal problems during pregnancy can be divided into two groups. The first group did not bring any preventive measure for patients who are pregnant. It will be considered first.

There are several interventions for rhinitis during pregnancy that can suggest.1,3 pharmacists pharmacists can reassure the patient that the condition is temporary and will resolve after delivery. They can also mention some interventions that would help rhinitis and nasal congestion regardless of the cause, such as environmental control and allergen avoidance.

Lying in the supine position is widely known to improve the resilience of the nose for air travel. Thus, pregnant patients can be advised to raise the head of the bed at least 30 degrees, and perhaps as much as 45 degrees to obtain greater patency of the nostrils. He may also be advisable to engage in mild to moderate exercise, activities that also opens the nasal passages.

Saline lavage may provide some relief for allergies or pregnancy rhinitis, and one expert advised both sniffing soft homemade salt of a cupped hand or using a product such as a neti pot to manage saline.1 Unfortunately, none of the methods the use of sterile saline, which will preferable.6

a safer way is the use of nonprescription an isotonic salt products like Simply Saline Nasal Spray Help. It is sterile when sprayed from the container. Following use, the patient may try to remove dirt using a small light nose known as nasal aspirators. While they are often regarded as limited devices used in nasal congestion in newborns and children, they also can help patients get pregnant.

external nasal dilator is a potential treatment option.7 Breathe Right Nasal Strips nostril adhere to the outside, slightly open the nasal passages to facilitate air movement. They are safe during pregnancy and can be recommended as a potential aid for pregnancy rhinitis and nasal congestion from other causes.

The second group interventions potential nasal problems during pregnancy include OTC products for nasal congestion due to the common cold or allergy and / or rhinitis of pregnancy (eg, nasal topical and oral decongestants) and for rhinorrhea due to allergies and / or pregnancy rhinitis (eg, oral antihistamines, mast cell stabilizers intranasal or corticosteroids). However, each of these products carry FDA-mandated warnings directing patients who are pregnant or breastfeeding to talk with the "health professionals" before use. Healthcare professionals as highly visible and accessible, pharmacist because it will be able to give a pregnant woman oral consent for the use of the product.

The most prudent advice for pharmacists is to refer the patient to their obstetrician. It is wise for several reasons. First, the pharmacist does not have the complete medical records of pregnant patients, and a list of other medications he takes may not be comprehensive. Second, the pharmacist was not privy to medical complications patients may experience as a result of pregnancy (eg, pre-eclampsia, hyperemesis gravidarum, threatened early delivery due to polyhydramnios). Third, the pharmacist may not be aware of the patient's medical condition at the same that complicate treatment, like diabetes, glaucoma, heart problems, hypertension, and kidney or liver compromise.

Finally, the pharmacist should not attempt to diagnose potential problems associated with pregnancy by performing a physical examination of patients for several reasons: 1) Pharmacists should not ask patients to undress for examination; 2) pharmacies rarely have even the most basic diagnostic tools (eg otoscopes); and 3) a state pharmacy practice acts, pharmacists are prohibited from diagnosing a patient, and therefore not protected by law if they are "wrong diagnosis" for such activities.

It will be very difficult for pharmacists to collect the data needed to make recommendations that are competent in self-care counseling sessions in a busy pharmacy. Interviews with patients is often unreliable because of memory lapses and lack of medical understanding of a person's health status and a list of current medications. It will be almost impossible to develop a complete picture the unique situation of patients would be equivalent to a comprehensive information already in its files a gynecologist's office. For this reason and others (eg, legal responsibility in cases of birth defects), obstetricians are best suited to choose between products with the pregnancy prevention measures.

Doctors advise their counterparts in the appropriate treatment of nasal problems during pregnancy in journals such as American Journal of Rhinology. In one such article, the authors placed a medical intervention for allergic rhinitis during pregnancy into two tiers.7 They are on the first level including intranasal cromolyn, intranasal corticosteroids, and antihistamines first generation. Drug relegated to the second level, including decongestants and antihistamines second generation. It should be noted that no nonprescription products carry indications for pregnancy rhinitis.

Mast Cell Stabilizer: intranasal cromolyn (eg, Nasalcrom) is FDA Pregnancy Category B (ie, there is no evidence of risk in humans) for pregnant patients.4 It can be recommended as first-line agents by doctors for help from rhinorrhea, sneezing, and nasal itching allergic rhinitis.7

Intranasal Corticosteroids: The nonprescription single intranasal corticosteroid is triamcinolone acetonide (eg, Nasacort Allergy 24HR). As the product category C pregnancy, the risk can not be ruled out, and pregnant patients were never included in any of the studies on the efficacy and safety.1 While the potential benefits justify the potential risk to the fetus, this will be the best decision left to the gynecologist. Materials that reduce nasal congestion, rhinorrhea, nasal itching, and sneezing associated with fever or other upper respiratory allergies

First-Generation Antihistamines :. The most common nonprescription first generation antihistamines diphenhydramine, chlorpheniramine, and clemastine (respectively Category B). the relative freedom of the risk of birth defects justify their inclusionon the first level. They relieve rhinorrhea, nasal pruritus and sneezing from allergies or the common cold rhinitis

Topical Nasal Decongestant :. Topical nasal decongestants are classified as second-tier product for nasal problems in pregnancy.7 An expert discusses pregnancy rhinitis recommended strongly against the use of topical nasal decongestants such as oxymetazoline (eg, Afrin, Category C) for rhinitis of pregnancy, the main objection is the potential development of rhinitis medicamentosa, even if the patient only managed nightly.1,3 one dose

Oral nasal decongestant: Oral nasal decongestants include pseudoephedrine (such as Sudafed) and phenylephrine (eg, Sudafed PE), both Category C. They also rank as a second-tier agents for nasal rhinitis during pregnancy.7 one author points that there is no data to show the efficacy of this product in pregnancy rhinitis.1,3

in addition, there is the potential for adverse effects on the fetus with their use for con dition in pregnancy. Registrations for the pseudoephedrine risk including gastroschisis (abdominal wall defects) and vascular disorders defects.8-10 Good decongestants have assured cleared of potential risks.11 Some authorities recommend phenylephrine should be avoided completely during pregnancy, and that pseudoephedrine used cautiously and only after the first trimester.12

the second-generation antihistamine: Also on the second level, second-generation antihistamines include those with ratings B category, such as cetirizine (eg, Zyrtec), and loratadine (eg, Claritin), whereas fexofenadine (eg, Allegra allergy) has a category C rating. In the words of some experts, "The absence of controlled trials in humans and the crossing of the placental barrier makes avoiding their prescription needed during pregnancy." 13

colds are the number one cause of both nasal congestion and runny nose, along with a sore throat and cough. Allergic rhinitis ( "hay fever") is a major cause of the common cold and stuffy nose, usually accompanied by itching nose, sneezing, and watery eyes. The problem is less known is pregnancy rhinitis, similar conditions are not due to a cold or allergies, but due to the pregnancy itself.

It is tempting to talk to friends or family about the treatment of nasal problems when you are pregnant. This option is not the best, because these people usually have little medical training. You may also want to talk to your pharmacist for advice on the subject of the nose. Your pharmacist can provide advice on non-medical interventions to relieve runny nose and nasal congestion, and can also describe a method that is as safe as saline lavage and nasal dilators.

However, some nonprescription products such as nasal decongestants, antihistamines and steroid nasal sprays carry a warning against the use in pregnancy before you talk to a health professional. It is true that your pharmacist is an expert on nonprescription products and their safe use, but this is probably not the best approach when a product has a warning this pregnancy, because the pharmacist's ability to make fully informed decisions is hampered by a lack of information about your unique situation.

Your gynecologist is the best source for advice on how to use the OTC product for nasal problems during pregnancy. doctor's offices keep your medical records in one file easily taken, and will have your latest test results and lab work ordered. your gynecologist will also be aware of your pregnancy complicated special conditions, such as kidney or liver problems, heart disease, hypertension, diabetes, and threatened early delivery. All this (and a number of other potential problems) can be important in making sound decisions about whether to use nonprescription products and, if so, which one. the strength of your gynecologist even want to schedule an appointment to determine whether you need a prescription or OTC products.

nonprescription products may interact with medications you are currently taking. Your pharmacist can help determine whether the product is safe or not in this case, but you should be able to remember all the medications you take to your pharmacist to make a fully informed decision.

Be sure to take prenatal vitamins and minerals as recommended by your gynecologist. However, it is wise to avoid during pregnancy something that is not proven to be safe and effective for your medical problem. This includes all herbal supplements, Homeopathics, and other dietary supplements. None of these products were never proven to be safe or effective, especially during pregnancy. Each could have a harmful effect on the fetus. In addition, it is considered immediately stop the use of addictive substances, such as alcohol and tobacco in all its forms and all drug abuse.

Remember, if you have any questions, consult your pharmacist.

1. Ellegard EK. Clinical and pathogenetic characteristics of rhinitis of pregnancy. Clin Rev Allergy Immunol. 2004; 26 (3): 149-159. 2. R. Mabry pregnancy rhinitis. South Med J. 1986; 79 (8): 965-971. 3. Ellegard EK. Special considerations in the treatment of rhinitis of pregnancy. Women's health. 2005; 1 (1): 105-114. 4. Shah R, McGrath KG. allergic rhinitis. Allergy Asthma Proc. 2012; 33 (3): S19-S21. 5. Rambur B. Pregnancy rhinitis and rhinitis medicamentosa. J Am Acad Nurse Pract. 2002; 14 (12): 527 to 530.6. Garavello W, Somigliana E, Acaia B, et al. Nasal lavage in pregnant women with seasonal allergic rhinitis: a randomized study. Int Arch Allergy Immunol. 2010; 151 (2): 137-141. 7. Keles N. Treatment of allergic rhinitis during pregnancy. Am J Rhinology. 2004; 18 (1): 23-28. 8. Gilbert C, Mazzotta P, Loebstein R, Koren G. fetal safety of drugs used in the treatment of allergic rhinitis. Drug safety. 2005; 28 (8): 707-719. 9. Mazzotta P, Loebstein R, Koren G. Treating allergic rhinitis in pregnancy. Drug safety. 1999; 20 (4): 361-375. 10. MM Werler. Teratogen update: pseudoephedrine. Birth Defects Res A Clin Mol Teratol. 2006; 76 (6): 445-452. 11. Vlastarakos PV, Manolopoulos L, Ferekidis E, et al. Treating common problems of the nose and throat in pregnancy: what's safe? Eur Arch Otorhinolaryngol. 2008; 265 (5): 499 to 508.12. DeShazo RD, Kemp SF. patient information: allergic rhinitis (seasonal allergies). Uptodate. www.uptodate.com/contents/allergic-rhinitis-seasonal-allergies-beyond-the-basics. Accessed July 17, 2014. 13. Piette V, Daures JP, Demoly P. Treating allergic rhinitis in pregnancy. Curr Allergy Asthma Rep 2006; 6 (3): 232-238 ..

To comment on this article, contact rdavidson@uspharmacist.com .

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