Pregnancy, breastfeeding, and allergies

August 14, 2002

What can an expectant mother take for severe allergy headaches, previously on Zyrtec before pregnancy? -- M.M., Mississippi

When allergy testing is performed according to guidelines established by the JCAII we have found systemic reactions are extremely rare. However it is usually recommended that pregnant women not be tested because of the possibility that a severe systemic reaction could occur. The reaction itself, or medications to counteract it, could potentially damage your unborn child.

If you did not experience a systemic reaction to your allergy testing, most likely you have nothing to worry about. However you should discuss your concerns about this with your obstetrician.

At our clinic, we do not discontinue allergy injections for women who become pregnant. However, we do advise them to ask the physician managing their pregnancy if it is safe to continue them. Your obstetrician is the one most knowledgable of medications and treatments you can safely use during pregnancy.

It is generally recommended that allergy injections not be initiated during pregnancy because there is a greater chance for systemic reactions during the early weeks of immunotherapy.

We've seen many women deliver healthy babies while taking allergy shots. We've also had a few patients who have miscarried while on immunotherapy. There was nothing to indicate that the miscarriages were in any way related to the allergy injections.

Because four out of five miscarriages (80%) occur during the first trimester of pregnancy, some obstetricians feel it is best to wait until the second trimester to resume allergy shots. Some physicians feel it may be more risky to try to establish a safe dosage after a 2 1/2 to 3 months lapse than to continue the injections throughout the first trimester.

Most of the older allergy medications are generally thought to be safe to use in pregnancy. Newer medications have not been tested. Inhaled medications have less systemic effects, thus are considered safer. Many physicians feel it is best to severely limit all medications during the first trimester.

Always check with the physician managing your pregnancy before taking any medication.

It is not generally thought that the benefits of allergy injections can be passed on to the unborn child, nor through breast milk. However, a study cited by the Australian government on 01/02/2000 testing over 2000 children has indicated that breastfeeding can reduce the risk of childhood allergies and asthma. See footnote below.

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