A 32-year-old pregnant woman from Bangalore landed up in a private hospital ICU due to a severe asthma flareup and low oxygen levels. Myriam (name changed on request) was seven months pregnant and had discontinued her inhalers, exacerbating her asthma. Allergies during pregnancy must be dealt with caution, as they can have far-reaching effects on the health of the mother and the baby.
Myriam had discontinued inhalers on a relative’s advice, fearing that it would harm the baby. “There is a common misconception that inhalers are unsafe during pregnancy,” says Dr Srivatsa Lokeshwaran, lead consultant and HOD, interventional pulmonology and lung transplant, Aster Whitefield Hospital, Bangalore, the doctor who treated her.
Myriam stopping her inhalers had a detrimental effect on the fetus. “A fetal monitoring revealed an elevated fetal heart rate, indicating that the baby was in distress.”
Do allergies flare up during pregnancy?
“When a woman is pregnant, there are several hormonal changes occurring in her body. These hormonal shifts can cause allergies to flare up during pregnancy,” says Dr Lokeshwaran.
According to Dr Lokeshwaran, the estrogen hormone, which increases steadily during pregnancy, causes the airways to swell up, leading to nasal stuffiness and breathlessness. Progesterone, another hormone that rises during pregnancy can cause shortness of breath and stimulate faster breathing.
“Additionally, the growing uterus tends to squeeze the diaphragm, reducing the functional residual capacity, which is the volume remaining in the lungs after a normal, passive exhalation” adds Dr Lokeshwaran.
Common allergies include atopic dermatitis, allergic rhinitis, allergic asthma, and allergic conjunctivitis.
As documented by the Federation of Obstetric and Gynaecological Societies of India (FOGSI), allergic asthma is considered the most common chronic condition in pregnancy, complicating 4% to 8% of pregnancies.
Doctors add that those women vulnerable to certain food allergies must be cautious in their choice of food during pregnancy.
Immune system during pregnancy
“A woman’s immune system undergoes several changes throughout the pregnancy and her immunity tends to decrease. This immunocompromised state makes her susceptible to allergies and infections,” says Dr Barun Chakrabarti, consultant gynecologist and obstetrician, Manipal Hospital, Salt Lake, Kolkata.
Dr Chakrabarti says that both existing as well as new allergies can show up during pregnancy.
The immune system changes to facilitate the growing fetus and prevent the mother’s body from rejecting it.
“There is a shift in maternal immunity from Th1 type to Th2 type during pregnancy. Th2 immunity is associated with an exaggerated allergic response,” points out Dr Lokeshwaran.
Can allergies subside during pregnancy?
Dr Lokeshwaran observes that in some women, existing allergy symptoms are reduced during pregnancy.
While 30% of women experience aggravated allergy symptoms during pregnancy, in 30% of pregnant women, the symptoms remain the same. It has also been observed that 30% experience a decline in symptoms during pregnancy.
Pregnancy rhinitis
Pregnancy rhinitis, commonly seen among pregnant women, is the inflammation and swelling of the mucous membrane — causing symptoms like nasal congestion and runny nose.
“During pregnancy, blood flow increases over 40%, which causes the swelling,” says Dr Chakrabarti.
A common skin allergy is pregnancy-induced pruritis, which causes itching all over the body and it is observed that itching increases after sunset, adds Dr Chakrabarti.
Managing allergies during pregnancy
“Not all allergy medications are fit to use during pregnancy, as some can have harmful effects on the fetus. There are only a certain approved medications to use during pregnancy,” says Dr Chakrabarti.
Dr Lokeshwaran recommends medications that can be administered locally, where the medicine is delivered directly at the site of action.
“Local creams for skin allergies, nasal sprays and inhalers can be used for asthma in consultation with the treating gynecologist,” says Dr Lokeshwaran.
He stresses that contrary to popular belief, inhalers are completely safe during pregnancy and are not to be discontinued without seeking medical advice.
Certain antihistamines are also safe and are to be taken after consulting a pulmonologist.
Myriam was given steroids and other medications to relax her airways. It took three days for her breathing tubes to come back to normalcy.
“Steroids are only used with caution, in severe allergic flare-ups and after weighing the risks and benefits,” says Dr Lokeshwaran.
He adds that the mother should have completed at least 20 weeks of gestation, as this is when the fetus’s lung development is complete and any negative effects in the lung development can be avoided.
Dr Lokeshwaran advises against routine usage of cough syrups during pregnancy because they have sedative effects — causing drowsiness in the mother and reducing the fetus’s respiratory rate.
Takeaways
- Hormonal shifts during pregnancy can trigger allergies in some women.
- A pregnant woman tends to be immunocompromised, making her susceptible to allergies.
- Local medications and antihistamines are usually recommended for allergies during pregnancy.
- Steroids are only used in severe allergy flareups only after 20 weeks of gestation.
