Allergy medication you can take while pregnant is a common concern, as many women experience sneezing, nasal congestion, itchy eyes, and skin reactions during pregnancy. Hormonal changes can worsen symptoms, making safe and effective management essential. Not all allergy treatments suitable outside pregnancy are appropriate during gestation, and the risk–benefit balance shifts with each trimester. This article outlines which antihistamines, nasal sprays, and other treatments are considered safe, which to avoid, and when to seek professional advice — in line with NHS, NICE, and UKTIS guidance.

Managing Allergies Safely During Pregnancy

Allergies are common during pregnancy, and many women find that symptoms such as sneezing, nasal congestion, itchy eyes, and skin reactions can significantly affect their quality of life. Hormonal changes during pregnancy — particularly rising oestrogen levels — can worsen nasal congestion independently of allergic triggers, a condition known as rhinitis of pregnancy. This tends to present mainly as nasal obstruction without the itching or sneezing that more typically characterise allergic rhinitis, which can make it difficult to distinguish between the two. If you experience unilateral nasal obstruction, purulent discharge, facial pain, or fever, seek medical advice promptly, as these may indicate a cause other than allergy.

Managing allergies safely during pregnancy requires a careful balance between relieving symptoms and protecting the developing baby. Not all medications that are safe outside of pregnancy are appropriate during gestation, and the risk–benefit assessment changes depending on the trimester. The first trimester is a critical period of foetal organ development, during which exposure to certain medicines carries the greatest potential risk.

Importantly, women with pre-existing conditions such as asthma should not stop essential controller medicines (for example, inhaled corticosteroids) without first seeking clinical advice, as uncontrolled disease may pose a greater risk to the pregnancy than the medication itself.

It is always advisable to speak with a GP, midwife, or pharmacist before starting or continuing any allergy medication during pregnancy. Self-medicating without professional guidance — even with over-the-counter products — is not recommended. Healthcare professionals can help identify the safest options based on individual symptoms, medical history, and stage of pregnancy, in line with NICE antenatal care guidance (NG201) and NHS recommendations.

Which Allergy Medications Are Considered Safe in Pregnancy?

When allergy symptoms are moderate to severe and non-pharmacological measures are insufficient, certain medications are considered relatively safe for use during pregnancy, particularly when used at the lowest effective dose for the shortest necessary duration.

Antihistamines are among the most commonly used allergy medications in pregnancy. Of the oral antihistamines available in the UK, loratadine and cetirizine (both second-generation, non-sedating antihistamines) are considered preferred first-line options during pregnancy. The UK Teratology Information Service (UKTIS), whose evidence summaries inform NHS clinical practice, considers both to have reassuring safety profiles based on available human pregnancy data. Neither should be regarded as superior to the other; the choice may depend on individual response and clinical circumstances. Fexofenadine may be considered if it has previously been effective and other options are unsuitable, though it is not a first-line choice. Acrivastine has more limited pregnancy safety data and is generally not recommended as a first-line option.

Intranasal corticosteroid sprays — including beclometasone, budesonide, fluticasone, and mometasone — are considered appropriate for managing allergic rhinitis during pregnancy. Because these sprays act locally within the nasal passages with minimal systemic absorption, they carry a low risk of affecting the foetus. NICE and NHS guidance supports their use when clinically indicated.

Sodium cromoglicate eye drops are considered safe for allergic conjunctivitis during pregnancy, as systemic absorption is negligible. Sodium cromoglicate is also available as a nasal spray formulation, which may be a useful non-systemic option for nasal symptoms. These preparations can be helpful for women experiencing itchy, watery eyes or nasal symptoms as part of their allergic response.

Antihistamines and Other Treatments: What the Evidence Shows

The evidence surrounding antihistamine use in pregnancy has been studied extensively, though it is important to note that randomised controlled trials in pregnant women are ethically limited. Much of the available data comes from observational studies, pregnancy registries, and post-marketing surveillance.

Loratadine and cetirizine have not been associated with an increased risk of major congenital malformations in the majority of large-scale studies. UKTIS, whose guidance is accessible to both clinicians and patients via the Bumps (Best Use of Medicines in Pregnancy) website, considers the available data for both antihistamines reassuring, whilst noting that no medicine can be declared entirely risk-free in pregnancy.

First-generation (sedating) antihistamines, such as chlorphenamine, have a longer history of use in pregnancy and are sometimes recommended by healthcare professionals for short-term use — for example, when sleep is disrupted by itching. However, if used close to delivery, there is a possibility of neonatal drowsiness; this risk is noted in the Summary of Product Characteristics (SmPC) for chlorphenamine and in UKTIS guidance. Women taking sedating antihistamines should also be aware that these may impair alertness and should avoid driving or operating machinery.

Regarding decongestants: oral agents such as pseudoephedrine and phenylephrine are not recommended during pregnancy, particularly in the first trimester, due to concerns about vasoconstriction and potential effects on placental blood flow. Topical (intranasal) decongestants such as xylometazoline are also generally best avoided; if a clinician or pharmacist advises their use for severe congestion, this should be limited to a very short course (typically no more than three to five days) to avoid rebound congestion. Intranasal saline rinses remain a safer first-line alternative for nasal congestion.

Medications to Avoid and When to Seek Medical Advice

Several allergy-related medications are best avoided during pregnancy due to insufficient safety data or known risks:

• Oral decongestants (e.g., pseudoephedrine, phenylephrine): These are vasoconstrictive agents that may reduce placental blood flow. They are not recommended during pregnancy, particularly in the first trimester, unless specifically advised by a clinician.

• Topical (intranasal) decongestants (e.g., xylometazoline): Generally best avoided; if use is considered necessary on clinician or pharmacist advice, restrict to a very short course to minimise risk of rebound congestion.

• Combination cold and allergy products: Many over-the-counter products contain multiple active ingredients, including decongestants, analgesics, or caffeine. These should be avoided unless each component has been individually assessed as safe by a healthcare professional.

• High-dose or prolonged systemic corticosteroids: While short courses may occasionally be prescribed for severe allergic reactions, routine use is not appropriate without specialist oversight.

• Allergen immunotherapy: Immunotherapy should not be initiated during pregnancy. Women already receiving maintenance immunotherapy should discuss with their specialist whether continuation is appropriate; in some cases, continuation of an established maintenance regimen may be considered under specialist supervision.

• Herbal or 'natural' allergy remedies: Some herbal products hold a Traditional Herbal Registration (THR) in the UK, but robust safety data in pregnancy are generally lacking for most. Avoidance is advised unless a clinician has specifically recommended a product.

Women should seek prompt medical advice if they experience:

• Severe or worsening allergy symptoms that are not controlled by safe first-line measures

• Signs of anaphylaxis — including throat swelling, difficulty breathing, or a sudden drop in blood pressure — which require emergency treatment (call 999 immediately). Adrenaline (epinephrine), including via an auto-injector, remains the first-line treatment for anaphylaxis and is safe to use during pregnancy; call 999 after use

• Uncertainty about any medication they are currently taking or considering

• New or unusual symptoms that may indicate a condition other than allergy

A GP or midwife can provide personalised guidance and, where necessary, refer to an allergy specialist or obstetric physician. If you experience a suspected side effect from any medication during pregnancy, you can report this via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

NHS and NICE Guidance on Allergy Treatment When Pregnant

The NHS advises that pregnant women should consult a healthcare professional before taking any medication, including those available over the counter. The NHS website specifically notes that loratadine and cetirizine are the antihistamines most commonly recommended during pregnancy, and that intranasal corticosteroids are appropriate for allergic rhinitis when symptoms are not adequately controlled by antihistamines alone.

NICE guidance on antenatal care (NG201) emphasises the importance of reviewing all medications — prescribed and over-the-counter — at the earliest opportunity in pregnancy. Women with pre-existing allergic conditions such as asthma, eczema, or allergic rhinitis should have their management plans reviewed by their GP or specialist to ensure ongoing treatments remain appropriate throughout pregnancy.

The UK Teratology Information Service (UKTIS), commissioned by the UK Health Security Agency (UKHSA) and hosted within the NHS, provides detailed evidence summaries on medication use in pregnancy. Their guidance is accessible to both clinicians and patients via the Bumps (Best Use of Medicines in Pregnancy) website (medicinesinpregnancy.org), which is a recommended NHS resource. Women are encouraged to use this resource to access evidence-based information rather than relying on general internet searches. Specific Bumps leaflets are available for loratadine, cetirizine, intranasal corticosteroids, and decongestants, among others.

The Medicines and Healthcare products Regulatory Agency (MHRA) issues safety updates regarding medicines in pregnancy, and the Electronic Medicines Compendium (EMC) provides up-to-date Summary of Product Characteristics (SmPC) documents for all licensed UK medicines, which include specific pregnancy-related prescribing information. Suspected adverse drug reactions can be reported at any time via the MHRA Yellow Card Scheme.

Non-Medication Approaches to Relieving Allergy Symptoms

For many pregnant women, non-pharmacological strategies can significantly reduce the burden of allergy symptoms and may reduce or eliminate the need for medication altogether. These approaches are safe, evidence-supported, and recommended as first-line management wherever possible, in line with NICE CKS guidance on allergic rhinitis.

Allergen avoidance is the most effective strategy. Practical measures include:

• Keeping windows closed during high pollen seasons and checking daily pollen counts

• Washing bedding regularly at 60°C or above to reduce house dust mite exposure, and using allergen-proof mattress and pillow covers

• Avoiding known food allergens and reading ingredient labels carefully; do not restrict major food groups in pregnancy without a confirmed allergy diagnosis and dietitian support

• Keeping pets out of bedrooms if animal dander is a trigger

• Showering and changing clothes after spending time outdoors during high-pollen periods

• Applying a small amount of nasal barrier balm around the nostrils to help trap airborne allergens before they enter the nasal passages

Nasal saline irrigation (using a saline rinse or spray) is a safe and effective method for relieving nasal congestion and flushing allergens from the nasal passages. It can be used as often as needed and carries no risk to the pregnancy.

Cool compresses applied to the eyes can soothe allergic conjunctivitis without the need for medication. Wearing wraparound sunglasses outdoors can also help reduce pollen contact with the eyes.

Air purifiers with HEPA filters can reduce indoor allergen levels, particularly for those sensitive to dust mites, pet dander, or mould spores. Maintaining good indoor ventilation outside peak pollen times and controlling indoor humidity also helps minimise mould growth.

Finally, stress management and adequate rest are important, as physical and emotional stress can exacerbate immune responses. Gentle exercise, mindfulness, and good sleep hygiene all contribute to overall wellbeing during pregnancy and may indirectly help manage allergic symptoms.

Frequently Asked Questions