Allergies and Pregnancy
At 13 weeks pregnant, Denise Daniel first noticed that she might be having problems with her pregnancy. While vacationing in Japan, Daniel, of Mamaroneck, New York, couldn’t fall asleep one night. She suddenly felt a tightening grip her whole body, started gasping for breath, and finally blacked out. Although she didn’t know it at the time, Daniel was experiencing anaphylactic shock brought on by allergies. While Daniel’s life-threatening allergic reaction was severe—and rare—many women find that pregnancy can worsen their allergies and for some, even trigger allergy-like symptoms they’ve never experienced before.
What Causes Allergies
“Allergies are an inappropriate response by our body to things in our environment,” explains Dr. Paul Gluck, MD, a clinical professor of Obstetrics and Gynecology at the University of Miami School of Medicine.
Dust, mold, pollen, pet dander, even cockroaches can all trigger a body’s immune system to go into defense mode and consider these substances harmful foreign bodies. Mounting the attack, the body responds to these airborne invaders by releasing histamines and other mediators as part of a chemical defense system. These chemical mediators react in different ways in various parts of the body: the nose becomes runny, eyes itchy and watery, skin may develop rashes or hives, and in the lungs histamines can create difficult breathing, as with asthma.
If histamines and the other chemicals go into overdrive throughout the body, a person can go into anaphylactic shock, which is a total system reaction shutdown that can be fatal.
Nearly 20 to 25 percent of women of childbearing age suffer from allergies. Of pregnant women, seven to eight are affected by asthma. While allergies are known to be a genetically predisposed condition, it’s not as clear why allergic symptoms may become more severe during some women’s pregnancies and hardly noticeable in others.
Allergic symptoms also vary in each pregnancy. So while a woman’s first pregnancy may have been riddled with rhinitis (better known as a runny nose), in her second pregnancy she may be breathing easily.
Pregnancy Changes Affect Allergies
Without a doubt, pregnancy puts a great deal of strain on a woman’s body. Breathing becomes labored for a variety of physiological reasons, not the least of which is the added weight around the belly. A growing abdomen complicates the problem by pushing up on the diaphragm so that a woman’s breathing becomes shallow and she tends to breathe faster.
To compensate for the labored breathing, pregnant women tend to breathe more through their mouths instead of their noses, meaning that more air passes into the body without the benefit of the nose’s filtration system. The nasal passages swell and narrow during pregnancy in response to certain hormones.
Chemical changes affect a pregnant woman’s response to allergies as well. For instance, increased hormone levels and changes in the immune system make it more difficult to combat the flu and other illnesses, explains Dr. Gluck. So, if a woman is already prone to allergies, her weakened immune system may react to irritants more strongly than it would normally.
“Overall there are two approaches to avoid triggering factors with allergies in pregnancy,” says Dr. Michael Schatz, MD, president of the American Academy of Allergy, Asthma and Immunology and chief of the Department of Allergy at Kaiser Permanente in San Diego. First, he advises pregnant women avoid their known allergy triggers, whatever they may be. For Daniel that meant encasing her mattresses in special covers that minimize dust-mite exposure, throwing out old pillows in favor of new ones, and using an air purifier throughout her pregnancy.
The second approach is to steer clear of smoking, chemical fumes, and other non-specific irritants, in an effort to lessen allergy symptoms.
“Allergy medications are much safer than most women think,” says Dr. Schatz, explaining that any over-the-counter and prescription allergy and asthma medications, especially topical nasal sprays and antihistamines, have a long, safe track record in helping a pregnant woman have a more comfortable pregnancy while not affecting the unborn baby.
“You don’t want to use any medication if you don’t need to during pregnancy,” advises Dr. Gluck. “However you need to weigh the potential benefits to the patient versus the risks.” Untreated allergies can lead to more serious allergic reactions such as asthma, even in women who have never had symptoms previously.
Dr. Gluck cautions pregnant women to work closely with their doctors or midwives and their allergists to come up with a treatment plan. For example, if a woman went off her allergy medication regimen once she became pregnant, assuming it was harmful for her baby, she might actually put her baby at greater risk. Labored breathing from pregnancy and allergies may lead to higher blood pressure, which can in turn cause preeclampsia (pregnancy-induced hypertension) or preterm labor. Allergy symptoms may also affect the flow of oxygen to the baby—if the woman has difficulty drawing in breath, the baby may not receive the oxygen he or she needs to develop properly.
For Daniel, allergies triggered such intense sneezing fits that her cervix would open, putting her unborn baby at significant risk. A combination of nasal sprays, antihistamines, and steroids brought her allergy symptoms under control.
Both Dr. Gluck and Dr. Schatz suggest women tell their doctors or midwives about any medication that they are taking, especially those sold over the counter. Not only can some over-the-counter allergy medicines lead to overuse—they can become ineffective and even harmful if used incorrectly. Equally important, Dr. Gluck says that some medicines are not recommended due to side effects. Many over-the-counter antihistamines can cause extreme drowsiness, especially in pregnant women who are already prone to tiredness.
Rhinitis of Pregnancy
One phenomenon of pregnancy is known as the rhinitis of pregnancy. According to Dr. Schatz, 20 to 30 percent of women may experience a rhinitis or stuffy nose during pregnancy that may be confused with allergies but is actually caused by hormones, which swell nasal passages. A woman may falsely assume that she is having allergies, yet using over-the-counter antihistamines will have no effect on nasal stuffiness because her symptoms are not from histamines.
If a woman’s symptoms are truly related to this phenomenon, the usual doctor recommendation is for her to make do with the discomfort that will end almost immediately after delivery or use an external nasal dilator, which is available over the counter.
Unexplained discomfort with nasal stuffiness may also have other causes. It may be due to undiagnosed allergies that have become more prominent during pregnancy. Or even more common, a pregnant woman, who is more susceptible to colds, may simply have a mild sinus infection, which occurs with greater frequency in pregnant than non-pregnant women.
Working with Your Provider
When it comes to allergies in pregnancy, the most important key to combating the symptoms is talking to your doctor or midwife. Work with your provider to come up with a treatment that will be right for your level of discomfort. If you are suffering from a constant stuffy nose, the treatment may be endurance; but for true allergies, especially extreme cases, you may need prescription allergy medications. Remember that you won’t be pregnant forever, but just because you’re pregnant doesn’t mean that you have to suffer.
After a complete regimen of antihistamines, sprays, and steroids, in her previously troubled pregnancy, Daniel expected the same with her next. She was pleasantly surprised when her next pregnancy was without a stuffy nose and asthma free!
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