Management

• when managing women with pregnancy rhinitis, the selflimited nature of the condition underscores the critical aspects of management: safety to the fetus and short-term symptomatic relief for the mother
• 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
  • nasal strips can enhance nasal patency, particularly in the nasal valve area - a structurally narrow part of the anterior nose that often cannot withstand even minor nasal oedema without the resulting subjective experience of nasal obstruction.
  • nasal saline and the nasal strips are excellent first line interventions for women who are reluctant to take medications during pregnancy
• exercise
  • mild to moderate exercise is another valuable first line intervention, provided the pregnant woman has no other contraindications precluding exercise
  • likely mechanism of relief following exercise is the role of moderate exercise as a vasoconstrictor
    • typical exercise sessions are associated with nasal vasoconstriction for roughly one hour following the session
• medication
  • nasal decongestants should be avoided for prolonged periods of time, as their use induces rhinitis medicamentosa
  • if the patient has difficulty discontinuing use of nasal decongestants, nasal corticosteroids could be effective, but they have not been shown to be effective in isolated pregnancy rhinitis
  • systemic corticosteroids and oral decongestants should not be used

Notes:

• as well as rhinitis medicamentosa, sinusitis is a differential diagnosis, which needs to be borne in mind.

Reference:

• 1) Ellegård EK.Special considerations in the treatment of pregnancy rhinitis.Womens Health (Lond Engl). 2005 Jul;1(1):105-14.