Pregnancy rhinitis

Nasal congestion is a common companion to pregnancy, with pregnancy rhinitis, i.e., nasal congestion absent an identified cause other than pregnancy, occurring in roughly one in five pregnancies

• common manifestations of pregnancy rhinitis include nasal congestion and rhinorrhea; both of these symptoms are exacerbated by ongoing use of over-the-counter (OTC) nasal decongestant sprays
  
  
• management options:
  • environmental modification can optimize intranasal functioning
    • simple measures such as elevation of the head of the bed, adequate fluid intake, proper room humidity, and avoidance of cigarette smoke and other environmental irritants are essential
  • intranasal saline instillation is a low risk and often effective intervention, as are OTC nasal strips
  • exercise
  • nasal corticosteroids could be effective, but they have not been shown to be effective in isolated pregnancy rhinitis
    • nasal corticosteroids have not been shown to be effective in a trial of fluticasone (1)
    • however nasal corticosteroids are often used in the management of this condition
    • congenital malformations were studied in 2014 infants whose mothers had used inhaled budesonide for asthma in early pregnancy (2)
      • no increase in rate of congenital malformations was observed compared with the general population rate
  • nasal decongestants provide good temporary relief, women tend to overuse them
    • in the last few decades, the awareness of rhinitis medicamentosa has increased
      • resulting rhinitis medicamentosa can produce complete nasal obstruction and a host of subsequent discomforts, including substantial sleep disturbances
      • women with pregnancy rhinitis tend to use nasal decongestants for prolonged periods of time, and are at risk of developing this additional condition
  • systemic corticosteroids and oral decongestants should not be used
  • invasive methods of turbinate reduction may be effective, but are not recommended

Notes:

• rhinitis medicamentosa as a contributing factor
  • rhinitis medicamentosa, a syndrome of rebound nasal congestion following use of intranasal topical decongestants, frequently exacerbates the nasal congestion of pregnancy rhinitis
    • rebound hypercongestion, coupled with the memory of initial relief, thereby initiates a cycle of progressive use and accelerating hypercongestion. Such hypercongestion quickly reaches a level of complete nasal obstruction marked by total unresponsiveness to further applications of topical decongestants
    • any patients using intranasal decongestants for a longer period should be advised to discontinue use immediately.

Reference:

• 1) Ellegård EK et al. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin. Otolaryngol. 2001;26(5); 394-400
• 2) Källén B et al. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet. Gynecol. 199993, 392-395.
• 3) Ellegård EK.Special considerations in the treatment of pregnancy rhinitis.Womens Health (Lond Engl). 2005 Jul;1(1):105-14.