Which Allergy Nasal Sprays Are Safe To Use During Pregnancy?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Nasal allergy sprays treat stuffy noses and itchy eyes related to allergies. If you’re pregnant though, you may wonder if they’re safe to use. Recent studies have shown us that nasal steroid sprays are safe to use during pregnancy for mild to moderate allergy symptoms. However, not all nasal sprays are safe during pregnancy. Here’s what you need to know.

How do we know nasal steroid sprays are safe during pregnancy?

Commonly used steroid nasal sprays (also called intranasal glucocorticoid sprays) include Flonase (fluticasone propionate), Nasacort AQ (triamcinolone), Nasonex (mometasone), Omnaris (ciclesonide), Rhinocort Aqua (budesonide) and Veramyst (fluticasone furoate). Many have over the counter versions, including Flonase Allergy Relief, Nasacort Allergy, and Rhinocort Allergy.

A study of 140,000 pregnant women, of whom 2502 were exposed to steroid nasal sprays during their pregnancy, found no increased rates of miscarriage or major birth defects compared to those not using nasal steroid sprays.

Which steroid nasal sprays should I use if I’m pregnant?

Rhinocort Aqua (budesonide) has been the best studied during pregnancy, so it’s recommended as a first-line treatment. Budesonide nasal spray is available with a prescription, or as over-the-counter Rhinocort Allergy. Other options that are safe to use during pregnancy include Nasonex (mometasone) or Flonase (fluticasone propionate).

Nasacort AQ (triamcinolone) nasal spray, which is also available over the counter, was the only steroid nasal spray of potential concern. It was associated with a slightly increased risk of abnormalities of the respiratory system and of choanal atresia (narrowing or blockage of the nasal airway by tissue).

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What about antihistamine nasal sprays?

Astelin and Astepro (azelastine) are also allergy spray medications, but they have not been well studied and should be avoided until we know more. They are antihistamines, rather than steroids, and work in a different way.

What about over-the-counter decongestant nasal sprays?

Decongestant nasal sprays can be used very briefly during pregnancy (three days or less) for temporary relief of nasal congestion, but they also have not been well studied and are not for prolonged use. Examples of over-the-counter nasal decongestants are AfrinMucinex, Vicks and Neo-synephrine. I’d say avoid these; you have better options.

I hate using nasal sprays. Do I have other options for allergies during pregnancy?

Antihistamine tablets like Claritin (loratadine) and Zyrtec (cetirizine) are less effective compared to the nasal steroid sprays, but they are safe for use during pregnancy.

Dr. O.

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