Allergy medication safe during pregnancy is a common concern for expectant mothers in the UK, where conditions such as hay fever, urticaria, eczema, and asthma frequently flare due to hormonal changes. Choosing the right treatment requires balancing effective symptom control with minimising foetal exposure to medicines. Poorly managed allergies can themselves pose risks, so avoiding all medication is not always the safest approach. This article outlines which allergy treatments are considered appropriate during pregnancy, which to avoid, and when to seek advice from your GP or midwife, in line with NHS, NICE, BNF, and BUMPS/UKTIS guidance.

Managing Allergies During Pregnancy in the UK

Allergic conditions including hay fever, asthma, and eczema are common in pregnancy and may worsen due to hormonal changes; UK guidelines emphasise that untreated allergy can pose risks, so medication decisions should be made with a GP or midwife.

Allergic conditions are common during pregnancy in the UK. Conditions such as allergic rhinitis (hay fever), urticaria (hives), eczema, and asthma can all flare during pregnancy, sometimes for the first time. Hormonal changes — particularly rising oestrogen and progesterone levels — can alter immune responses and affect nasal mucosa, making symptoms feel more pronounced.

Managing these conditions effectively is important not only for maternal comfort but also for foetal wellbeing. Poorly controlled asthma, for example, has been associated with adverse pregnancy outcomes including preterm birth and low birth weight. UK guidelines, including NICE NG80 on asthma management, emphasise that maintaining good asthma control during pregnancy is essential and that the risks of uncontrolled asthma outweigh the risks of continuing appropriate treatment. The challenge lies in balancing symptom control with the need to minimise foetal exposure to medications, particularly during the first trimester when organogenesis is occurring.

In the UK, guidance from the NHS, NICE, the British National Formulary (BNF), and resources such as BUMPS (Best Use of Medicines in Pregnancy)/UKTIS help clinicians and patients navigate these decisions. The general principle is to use the lowest effective dose of the safest available treatment for the shortest necessary duration. Importantly, untreated allergy symptoms can themselves pose risks, so avoiding all medication is not always the safest option. Open discussion with a GP or midwife is always the recommended starting point.

Which Allergy Medications Are Considered Safe in Pregnancy?

Loratadine, cetirizine, and chlorphenamine are considered acceptable oral antihistamines in pregnancy; intranasal corticosteroids, inhaled asthma treatments, and adrenaline auto-injectors are also supported by UK guidance.

No medication can be considered entirely risk-free during pregnancy, but several allergy treatments have a well-established safety profile based on decades of clinical use and post-marketing surveillance data.

Antihistamines are among the most commonly used allergy medications in pregnancy. Three oral antihistamines are widely considered acceptable for use in pregnancy in the UK: chlorphenamine (chlorpheniramine) (e.g., Piriton), loratadine, and cetirizine. None are known to cause foetal harm based on available evidence. Non-sedating antihistamines such as loratadine and cetirizine are often preferred in practice because they are less likely to cause drowsiness, which can affect daily functioning. Chlorphenamine has the longest safety record and remains an acceptable option, but patients should be aware that it can cause significant drowsiness — they should avoid driving or operating machinery if affected. The choice between these agents should be individualised in discussion with a GP or pharmacist. BUMPS/UKTIS evidence summaries and NHS Medicines A–Z pages for each of these antihistamines provide further detail on their use in pregnancy.

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Intranasal corticosteroids such as beclometasone (e.g., Beconase) and budesonide are considered appropriate first-line treatments for moderate-to-severe allergic rhinitis during pregnancy, as recommended by the NICE Clinical Knowledge Summary (CKS) on allergic rhinitis. These agents reduce local nasal inflammation with minimal systemic absorption, making them preferable to oral treatments. The BNF supports the use of intranasal corticosteroids in pregnancy, noting their low systemic bioavailability. Sodium cromoglicate eye drops and nasal sprays are also considered low-risk and can be useful for ocular and nasal allergy symptoms.

For asthma — which is closely linked to allergic disease — inhaled corticosteroids (ICS) and short-acting beta-agonists (SABAs) such as salbutamol should be continued during pregnancy. NICE NG80 and BTS/SIGN asthma guidelines support continuation of established ICS therapy; budesonide has a particularly extensive pregnancy safety dataset, though continuing whichever ICS is already providing effective control is the recommended approach. Stopping asthma medication without medical advice carries greater risk than continuing treatment.

For patients with known severe allergies, adrenaline auto-injectors (AAIs) are safe to use in pregnancy and should be used promptly if anaphylaxis occurs. Delaying adrenaline in anaphylaxis is dangerous — call 999 immediately after use. Always confirm any medication use with a healthcare professional.

Treatments to Avoid and Why Caution Is Advised

Oral decongestants such as pseudoephedrine and phenylephrine should be avoided in pregnancy, especially in the first trimester; allergen immunotherapy should not be initiated, and oral corticosteroids require medical supervision.

Whilst many allergy treatments are considered relatively safe, some carry specific concerns during pregnancy and should be avoided or used only under close medical supervision.

Oral decongestants such as pseudoephedrine and phenylephrine — commonly found in combination cold and allergy remedies — are generally not recommended during pregnancy, particularly in the first trimester. Product SmPCs (Summaries of Product Characteristics) for these medicines typically advise against use in pregnancy, and NHS and BUMPS/UKTIS resources similarly advise avoidance. Some studies have suggested a possible association with a small increased risk of certain birth defects when used in the first trimester, though evidence is not conclusive. Pharmacists may advise against supplying these products to pregnant women and can suggest safer alternatives. Always check with a pharmacist or GP before taking any decongestant-containing product during pregnancy.

Topical nasal decongestants (such as xylometazoline or oxymetazoline sprays) should also generally be avoided during pregnancy, or used only very short-term and after professional advice, due to limited safety data and the risk of rebound congestion with prolonged use.

Oral corticosteroids (such as prednisolone) are sometimes necessary for severe allergic reactions or asthma exacerbations, and prednisolone is the preferred oral corticosteroid when systemic treatment is clearly indicated in pregnancy. However, prolonged use has been associated with risks including gestational diabetes, hypertension, and low birth weight. BUMPS/UKTIS provides a balanced summary of the evidence, including the uncertain signal around orofacial clefts with first-trimester exposure. When prolonged courses are required, monitoring for maternal complications is recommended. Oral corticosteroids should only be used when clearly indicated and under medical supervision.

Immunotherapy (allergen desensitisation) is not recommended to be initiated during pregnancy due to the risk of systemic allergic reactions, in line with BSACI and EAACI guidance. If a patient is already established on a maintenance dose of immunotherapy and tolerating it well, continuation may be considered on a case-by-case basis with specialist input.

Many over-the-counter combination products contain multiple active ingredients, some of which may not be suitable in pregnancy. Pregnant women should always check with a pharmacist before purchasing any over-the-counter allergy remedy.

If you experience an unexpected reaction to any medication during pregnancy, you can report it via the MHRA Yellow Card scheme (available at yellowcard.mhra.gov.uk).

NICE and NHS Guidance on Antihistamines and Pregnancy

NICE CKS, NHS Medicines A–Z, and BUMPS/UKTIS all support the use of cetirizine, loratadine, and chlorphenamine in pregnancy, with intranasal corticosteroids recommended as first-line for moderate-to-severe rhinitis.

NICE guidance and NHS clinical resources provide a framework for prescribing decisions around allergy medication in pregnancy, though it is important to acknowledge that robust randomised controlled trial data in pregnant populations is inherently limited for ethical reasons. Much of the evidence base relies on observational studies, registry data, and animal studies.

NHS Medicines A–Z pages for chlorphenamine, cetirizine, and loratadine all indicate that these antihistamines can be used in pregnancy. Non-sedating options (cetirizine or loratadine) are commonly used first due to their lower risk of drowsiness; chlorphenamine is also acceptable, particularly where its longer safety record is considered relevant, but patients should be counselled about its sedating effects. BUMPS/UKTIS evidence summaries support the use of all three agents in pregnancy. All antihistamines should be used at the lowest effective dose.

NICE's Clinical Knowledge Summary (CKS) on allergic rhinitis recommends intranasal corticosteroids as the most effective treatment for moderate-to-severe rhinitis symptoms and supports their use in pregnancy. Beclometasone and budesonide nasal sprays are both commonly recommended due to their low systemic bioavailability and reassuring safety data; the BNF supports this approach. The CKS also highlights that:

• Sodium cromoglicate nasal spray is an alternative with a good safety profile

• Saline nasal irrigation is a safe, non-pharmacological adjunct

• Referral to a specialist should be considered if symptoms are severe or poorly controlled

Women should be reassured that following evidence-based guidance and using recommended treatments appropriately is far safer than leaving significant allergy symptoms unmanaged throughout pregnancy.

Non-Medication Approaches to Relieving Allergy Symptoms

Saline nasal rinses, wearing wraparound sunglasses, monitoring pollen forecasts, regular emollient use, and allergen avoidance are safe non-pharmacological strategies that can reduce allergy symptom burden throughout pregnancy.

For many pregnant women, non-pharmacological strategies can meaningfully reduce allergy symptom burden and may reduce the need for medication altogether. These approaches are safe at all stages of pregnancy and can be used alongside prescribed treatments.

For hay fever and allergic rhinitis:

• Saline nasal rinses or sprays help clear allergens from the nasal passages and reduce congestion. If using a neti pot or similar device, always use sterile, distilled, or previously boiled and cooled water to reduce the risk of infection — tap water is not recommended for nasal irrigation

• Wearing wraparound sunglasses outdoors can reduce pollen exposure to the eyes

• Checking pollen forecasts and limiting outdoor activity on high-pollen days, particularly in the morning and evening when counts are highest

• Showering and changing clothes after being outdoors to remove pollen

• Keeping windows closed during high-pollen periods and using air conditioning where available

For eczema and skin allergies:

• Regular use of emollients (moisturisers) is safe and effective throughout pregnancy and should be applied frequently to maintain the skin barrier

• Mild-to-moderate potency topical corticosteroids can be used in pregnancy when clinically indicated, as directed by a healthcare professional. Very potent topical corticosteroids or use over large areas of skin should be avoided unless specifically advised by a doctor. BUMPS/UKTIS provides further guidance on topical corticosteroid use in pregnancy

• Identifying and avoiding trigger factors such as certain fabrics, soaps, or detergents

• Using fragrance-free, hypoallergenic skincare and laundry products

For food allergies, strict avoidance of the identified allergen remains the cornerstone of management. Pregnant women with known severe food allergies should ensure they carry an adrenaline auto-injector (AAI) if previously prescribed. Adrenaline is safe to use in pregnancy and should be administered promptly if anaphylaxis occurs — do not delay use out of concern about the pregnancy. Call 999 immediately after use.

These measures, whilst not always sufficient on their own, form an important part of a holistic allergy management plan during pregnancy.

When to Seek Advice From Your GP or Midwife

Seek prompt GP or midwife advice if allergy symptoms are new or worsening, asthma is poorly controlled, or you are unsure whether a medication is safe; anaphylaxis requires immediate use of adrenaline and a 999 call.

Knowing when to seek professional advice is an essential part of safe allergy management during pregnancy. Whilst mild, well-controlled allergy symptoms can often be managed with guidance from a pharmacist, there are several situations where prompt contact with a GP or midwife is strongly advised.

Contact your GP or midwife if:

• Your allergy symptoms are new, worsening, or significantly affecting your quality of life or sleep

• You are unsure whether a medication is safe to take during pregnancy — never assume a product is safe simply because it is available over the counter

• You have asthma that is poorly controlled — for example, if you are using your reliever inhaler three or more times a week, or your symptoms are waking you at night. This threshold aligns with UK guidance (NICE NG80; BTS/SIGN) and warrants prompt review

• You develop signs of a severe allergic reaction (anaphylaxis), including throat swelling, difficulty breathing, or collapse — this is a medical emergency. Use your adrenaline auto-injector immediately if you have one — adrenaline is safe and lifesaving in pregnancy and should never be withheld — then call 999 without delay

• You experience a skin rash, urticaria, or angioedema that is new or rapidly spreading

• You are considering stopping a prescribed allergy or asthma medication — always discuss this with your doctor first, as abrupt discontinuation can be harmful

Pregnant women with complex or severe allergic disease — including those with multiple allergies, severe asthma, or a history of anaphylaxis — may benefit from referral to an NHS allergy clinic or respiratory specialist for tailored management throughout their pregnancy. Your midwife or GP can facilitate this referral. The Resuscitation Council UK and NICE NG196 (anaphylaxis) provide further guidance on emergency management, including in pregnancy. Open, honest communication with your healthcare team ensures that both you and your baby receive the safest possible care.

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