Seasonal allergies during pregnancy

By trimester

Weeks 1–13

1st trimester

Non-drug steps matter most right now: start with allergen avoidance and saline rinses, then add a well-studied antihistamine like chlorpheniramine, cetirizine, or loratadine if symptoms stick around. Set aside '-D' combination products for now, since the decongestant in them has been linked to a small increase in abdominal wall birth defects when used in the first three months.

Weeks 14–27

2nd trimester

Allergy symptoms often continue or change as pregnancy goes on, and a nasal steroid spray can be added on top of an antihistamine if sneezing, congestion, or itchy eyes keep disrupting your sleep or day. Keep avoiding '-D' combination products, and run any new or worsening symptoms by your obstetric provider instead of choosing a stronger option yourself.

Weeks 28–birth

3rd trimester

Nasal congestion is common in the third trimester even without allergies, since pregnancy itself can swell your nasal passages, sometimes called pregnancy rhinitis. That can make it hard to tell how much stuffiness is from allergies. The same approach still applies: avoidance and saline first, then an antihistamine or nasal steroid spray, and mention any regular allergy medication to your care team ahead of delivery.

What does the evidence show for seasonal allergies?

• Chlorpheniramine and dexchlorpheniramine are among the over-the-counter antihistamines studied as safe in pregnancy, and newer options like cetirizine and loratadine may be safe too. 1
• Pseudoephedrine, the decongestant in most '-D' combination allergy products, is linked to a small increased chance of abdominal wall birth defects, so it's best avoided in the first three months of pregnancy. 1
• Fluticasone nasal spray is not expected to raise the chance of birth defects, and available studies haven't found an increased chance of preterm delivery or low birth weight either. 2
• Studies covering more than 1,300 pregnancies exposed to cetirizine didn't show an increased chance of birth defects or miscarriage, and it tends to cause less drowsiness than some older antihistamines. 3
• First-trimester antihistamine use as a class hasn't been linked to increased risk of major malformations, miscarriage, preterm birth, stillbirth, or low birth weight, based on a 2017 review of 37 studies. 4
• Allergic rhinitis commonly causes Eustachian tube dysfunction with ear fullness, otalgia, and ear-popping, and roughly 10 to 40 percent of people with allergic rhinitis also have asthma, since the two conditions share an underlying allergic airway pathology. 5

When should I call my provider about seasonal allergies?

Plain seasonal allergies cause sneezing, itchy or watery eyes, and clear runny congestion, not fever or facial pain. Allergic rhinitis and asthma are closely linked conditions, so new wheezing, chest tightness, or shortness of breath alongside your usual allergy symptoms can mean the allergic reaction has moved into your airways, and that combination deserves a same-day call rather than just adding another allergy medication. Ear fullness, ear pain, or a popping sensation that lingers beyond a week or two can also come from allergies affecting the Eustachian tube and is worth mentioning to your provider. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.