Allergy Medications for Breastfeeding Moms

Medications are the mainstay of therapy in the treatment of classic allergy symptoms.  These include nasal congestion, watery rhinorrhea, repetitive sneezing, and nasal or ocular itching.  Medications used to treat allergy symptoms include antihistamines, topical and oral decongestants, mast-cell stabilizers, oral or topical corticosteroids, and lastly immunotherapy. 

Antihistamines: It is advised for a breastfeeding mom to use the newer non-sedating antihistamines instead of the older antihistamines.  These include Cetirizine (Zyrtec), Loratidine (Claritin), and Fexofenadine (Allegra). The older sedating antihistamines include Diphenhydramine (Benadryl), Chlorpheneramine (Aller Chlor), and Brompheneramine (Dimetapp).  Sedation in a newborn or young infant can lead to apnea or temporary breathing cessation and therefore is something to be concerned about.

Decongestants:  Pseudoephedrine (Sudafed) and Phenylephrine (Vicks Sinex Nasal) are two of the most commonly used decongestants on the market.  Pseudoephedrine is secreted into milk in low levels, however, it has been shown to decrease milk production and should be used with extreme caution in late-stage lactation (>8 months).  Although levels of phenylephrine in milk have not been documented, they are thought to be low and theoretically can decrease milk supply.  Antihistamines such as Zyrtec-D or Claritin-D contain these decongestants and should be used with caution by a breastfeeding mother.  Oxymetazoline (Afrin) is a nasal spray decongestant that can be used to treat acute congestion.  It should not be used for more than three days as it can cause rebound congestion.

Mast-Cell Stabilizers: Mast Cell Stabilizers such as Cromolyn Sodium (Nasalcrom) suppress mast cell degranulation thereby reducing allergy symptoms.  There is no data on its transfer into milk, but because it has a low pKa minimal levels would be expected in milk.  This drug is used frequently in pediatric patients and poses little risk to an infant.

Corticosteroids: Corticosteroids can be administered orally, inhaled, or intranasally.  Inhaled corticosteroids include Beclomethasone (Beclovent) while intranasal ones include Fluticasone (Flonase, Flovent), Budesonide (Rhinocort), and Mometasone (Nasonex).  Intranasal and inhaled corticosteroids may be safely used by a breastfeeding mother as the maternal plasma levels are low and therefore milk levels are low to undetectable.  If oral steroids are used (i.e Prednisone), it is preferred for the dose to be kept low (<40mg/day).  Also, prolonged use of oral steroids increases the risk of abnormal growth in the infant.  If a mother is on high dose steroids for a prolonged period of time (more than a month), the infant should be monitored closely by the pediatrician to make sure he or she is growing adequately.  For a more complete list of steroids see Tables below.

Immunotherapy: Allergy Immunotherapy or allergy injections are composed of protein substances that are unlikely to enter into milk.  Allergy injections are safe to use in breastfeeding.  Although adverse effects are unlikely, the infant should be observed for allergic reaction.

Table 1.  Inhaled Corticosteroids

Table 2. Combination Inhaled Corticosteroids and Long-Acting Beta2-Agonist

Table 3. Intranasal Steroids

Table 4. Oral Steroids

References

Hale TW. Berens P. Clinical Therapy in Breastfeeding Patients. Amarillo: Hale, 2010