What kind of allergy medicine is safe to take while breastfeeding

What kind of allergy medicine is safe to take while breastfeeding

LactMed Record Number

62

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your specific situation. The U.S.

What helpful of allergy medicine is safe to take while breastfeeding

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Hay fever remedies

When you seek advice from your pharmacist, GP or health visitor they will take into account factors such as:

  1. how mild or severe your symptoms are – if your symptoms are mild, you may be capable to manage without treatment
  2. how effective the medicine is 
  3. how much of the medicine passes to your baby through your breast milk

If you take hay fever medicine while you’re breastfeeding, you should take the lowest possible dose for the shortest possible time, unless your healthcare professional gives you other advice.

Try topical treatments first.

What helpful of allergy medicine is safe to take while breastfeeding

These are medicines that you don’t need to swallow such as nasal sprays and eyedrops.

Corticosteroid nasal sprays assist to unblock your nose and sinuses. They’re unlikely to pass into your breast milk and only in low amounts.

Sodium cromoglicate eyedrops relieve the redness, itchiness and watering of your eyes. It’s unlikely that sodium cromoglicate passes into your breast milk.

Loratadine or cetirizine are the antihistamine tablets recommended if you’re breastfeeding. They can own diverse brand names, so speak to your pharmacist for advice. These are non-drowsy antihistamines – you should avoid using antihistamines that make you drowsy (sedating) as they can affect your baby if used for more than a short time.

Cetirizine use while Breastfeeding

Drugs containing Cetirizine: Zyrtec, Zyrtec-D, Aller-Tec, Wal-Zyr D, Every Day Allergy, Zyrtec-D 12 Hour, Zerviate, KS Aller-Tec D-12, Equate Allergy Relief, Zyrtec Hives, Show every 23 »Children's Zyrtec, Allergy Relief D, 12 Hour Allergy-D, Every Day Allergy-D, Up and Up Every Day Allergy Relief D, Allergy D-12, Alleroff, Aller-Tec Children's, Children's Allergy Relief, Every Day Allergy Children's, PediaCare Children's 24-Hour Allergy, Quzyttir, Cetiri D

Medically reviewed by Drugs.com.

Final updated on Apr 22, 2019.


Cetirizine Identification

Substance Name

Cetirizine

CAS Registry Number

83881-51-0

Drug Class

Breast Feeding

Lactation

Antihistamines


Further information

Always consult your healthcare provider to ensure the information displayed on this sheet applies to your personal circumstances.

Medical Disclaimer


Cetirizine Levels and Effects while Breastfeeding

Summary of Use during Lactation

Small occasional doses of cetirizine are probably acceptable during breastfeeding.

Larger doses or more prolonged use may cause drowsiness and other effects in the baby or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The British Society for Allergy and Clinical Immunology recommends cetirizine at its lowest dose as a preferred choice if an antihistamine is required during breastfeeding.[1] Cetirizine has been used successfully in cases of persistent pain of the breast during breastfeeding.[2]

Ophthalmic use of cetirizine by the mom should pose little risk to the breastfed baby.

To substantially decrease the quantity of drug that reaches the breastmilk after using eye drops, put pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

Effects in Breastfed Infants

In one telephone follow-up study, mothers reported irritability and colicky symptoms 10% of infants exposed to various antihistamines and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.[3]

A lady who was nursing (extent not stated) her newborn baby was treated for pemphigus with oral prednisolone 25 mg daily, with the dosage increased over 2 weeks to 60 mg daily.

She was also taking cetirizine 10 mg daily and topical betamethasone 0.1% twice daily to the lesions. Because of a poor response, the betamethasone was changed to clobetasol propionate ointment 0.05%. She continued breastfeeding throughout treatment and her baby was developing normally at 8 weeks of age and beyond.[4]

A lady with narcolepsy took sodium oxybate 4 grams each night at 10 pm and 2 am as well as fluoxetine 20 mg and cetirizine 5 mg daily throughout pregnancy and postpartum. She breastfed her baby except for 4 hours after the 10 pm oxybate dose and 4 hours after the 2 am dose.

What helpful of allergy medicine is safe to take while breastfeeding

She either pumped breastmilk or breastfed her baby just before each dose of oxybate. The baby was exclusively breastfed or breastmilk fed for 6 months when solids were introduced. The baby was evaluated at 2, 4 and 6 months with the Ages and Stages Questionnaires, which were withing the normal range as were the infant’s growth and pediatrician’s clinical impressions regarding the infant’s growth and development.[5]

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Antihistamines in relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women.[6][7] However, suckling-induced prolactin secretion is not affected by antihistamine pretreatment of postpartum mothers.[6] Whether lower oral doses of cetirizine own the same effect on serum prolactin or whether the effects on prolactin own any consequences on breastfeeding success own not been studied.

The prolactin level in a mom with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider

Desloratadine, Fexofenadine, Loratadine

References

1. Powell RJ, Du Toit GL, Siddique N et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37:631-50. PMID: 17456211

2. Muddana A, Asbill DT, Jerath MR et al. Quantitative sensory testing, antihistamines, and beta-blockers for management of persistent breast pain: A case series.

Breastfeed Med. 2018;13:275-80. PMID: 29630399

3. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418

4. Westermann L, Hugel R, Meier M et al. Glucocorticosteroid-resistant pemphigoid gestationis: successful treatment with adjuvant immunoadsorption. J Dermatol. 2012;39:168-71. PMID: 22379622

5. Gashlin LZ, Sullo D, Lawrence RA et al. Treatment of narcolepsy with sodium oxybate while breastfeeding: A case report. Breastfeed Med. 2016;11:261-3. PMID: 27057786

6.

Messinis IE, Souvatzoglou A, Fais N et al. Histamine H1 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Invest. 1985;8:143-6. PMID: 3928731

7. Pontiroli AE, De Castro e Silva E, Mazzoleni F et al. The effect of histamine and H1 and H2 receptors on prolactin and luteinizing hormone release in humans: sex differences and the role of stress. J Clin Endocrinol Metab. 1981;52:924-8.

PMID: 7228996


More about cetirizine ophthalmic

Related treatment guides

Observational studies

Several observational studies own suggested that early introduction of potentially allergenic foods may be associated with a decreased risk of developing food allergy.

What helpful of allergy medicine is safe to take while breastfeeding

A questionnaire-based survey conducted in 2008 found that the prevalence of peanut allergy was ten-fold higher among Jewish children in the United Kingdom (UK) compared with Jewish children in Israel [12]. This difference in prevalence was attributed to earlier and more frequent peanut exposure in the first year of life in Israel compared with the UK. A population-based, cross-sectional study (HealthNuts) that included over 2500 infants found a lower risk of egg allergy among those that were introduced to egg at 4–6 month of age compared to those introduced at 10–12 months of age or later [13].

Another observational study examining the feeding history of over 13,000 infants found the incidence of IgE-mediated cow’s milk allergy to be significantly lower in infants who were introduced to cow’s milk formula within the first 14 days of life and given it regularly thereafter, compared to those who were introduced to the formula after 3 months of age [14]. Similarly, a case–control study that included approximately 200 children showed that early introduction of cow’s milk formula was associated with a lower incidence of IgE-mediated cow’s milk allergy [15].

Data from a Finnish birth cohort that included 994 children found that delaying the introduction of multiple foods, including oats (> 5 months) and wheat (> 6 months), was significantly associated with an increased risk of allergic sensitization to food and inhalant allergens [16]. Another birth cohort study conducted in the United States (US) showed that introducing solid food or cow’s milk (complementary food) at less than 4 months of age was associated with a reduced risk of peanut allergy by age 2–3 years in children with a parental history of asthma or allergy [17].

A study that included approximately 1600 children observed that delaying initial exposure to cereal grains until 6 months of age may increase the risk of developing IgE-mediated wheat allergy [18].

What helpful of allergy medicine is safe to take while breastfeeding

More recently, data from over 2100 children included in the Canadian Healthy Baby Longitudinal Development (CHILD) birth cohort study showed that delaying the introduction of cow’s milk products, egg, and peanut beyond the first year of life significantly increased the odds of sensitization to these foods [19].

Prospective clinical trials

In recent years, randomized controlled trials own provided further support for the association between early food introduction and the prevention of food allergy.

The most compelling evidence to date comes from the LEAP study, which randomized 640 high-risk infants (defined as those with severe eczema and/or egg allergy) in the UK to either early (age 4–11 months) or delayed (avoidance until age 5 years) peanut introduction. The trial showed that the early and regular (3 times per week) consumption of peanut in these high-risk infants reduced the development of peanut allergy by 86% by 5 years of age [4]. The Persistence of Oral Tolerance to Peanut extension of the LEAP study (LEAP-On) investigated whether participants who had consumed peanut in the primary trial would remain protected from peanut allergy after cessation of peanut consumption for 12 months [20].

This extension study found that the benefits of early peanut introduction persisted after 12 months of cessation of peanut consumption, supporting the concept that early peanut tolerance is not a transient phenomenon.

In the Enquiring About Tolerance (EAT) trial, 1303 exclusively breastfed infants from the general population were randomized to either early (age 3 months) or standard (age 6 months) introduction of six allergenic foods (peanut, cooked egg, cow’s milk, sesame, whitefish, and wheat) [21].

The EAT investigators hypothesized that early introduction of these allergenic foods would reduce the prevalence of food allergy by age 3 years. The intention-to-treat analysis revealed a 20% reduction in the prevalence of food allergy in the early introduction group that was not statistically significant, likely because of the high rate of non-adherence to the dietary protocol. However, in an adjusted per protocol analysis, significant reductions were seen in the rates of peanut and egg allergy in the early introduction group.

Other prospective trials own investigated the effects of early egg introduction.

In the Prevention of Egg Allergy with Tiny Quantity Intake (PETIT) trial, 147 Japanese infants with eczema were randomly assigned to daily consumption of heated egg powder or placebo along with aggressive treatment of eczema [22]. The study found that randomization to heated egg powder at age 6 months significantly reduced the risk of egg allergy by 78% compared with avoidance until age 12 months. The trial was stopped early due to benefit. The Solids Timing for Allergy Research (STAR) randomized 86 high-risk infants with moderate-to-severe eczema to get pasteurized raw whole-egg powder or rice powder (placebo) at 4 months of age [23].

At 8 months, both groups were introduced to whole cooked egg under medical supervision. At 1-year, there was a non-significant trend toward a lower rate of egg allergy in the group who received pasteurized raw egg powder at age 4 months vs. whole cooked egg at age 8 months. However, the trial was terminated early due to the high rate of allergic reactions in the egg-sensitized children randomized to early introduction at age 4 months.

The Starting Time of Egg Protein (STEP) study, which included 820 infants without eczema but with a family history of atopy, found that early introduction of pasteurized raw egg powder at age 4–6 months was associated with a non-significant trend toward a reduced risk of egg allergy compared to introduction at age 10 months [24]. A per-protocol analysis found that significantly fewer children in the early introduction group had IgE-mediated egg allergy at 12 months of age.

In the Beating Egg Allergy Trial (BEAT), 319 infants who were SPT-negative to egg but who had a family history of atopy were randomized to get either pasteurized whole-egg powder or placebo at 4 months of age [25].

Subjects were treated until 8 months of age, at which time egg was introduced into the diet. At 1 year, egg sensitization was significantly lower in the treatment group compared with the placebo group. However, there was only a non-significant trend toward a reduced risk of developing egg allergy in the early introduction group. Findings from the Hen’s Egg Allergy Prevention (HEAP) study also call into question the safety of early pasteurized raw egg introduction [26]. This trial, which included 406 infants from the general population, found no evidence that early introduction of pasteurized raw egg powder at age 4–6 months prevented either egg allergy or egg sensitization. Furthermore, among the children with baseline egg sensitization who were excluded from randomization but then challenged with egg separately (n = 23), two-thirds experienced an anaphylactic reaction upon this initial introduction.

Although the results of egg allergy studies own been conflicting or inconclusive, a recent meta-analysis of randomized controlled trials investigating the timing of allergenic food introduction and the risk of developing food allergy found “moderate certainty” evidence (based on 5 trials, including 1915 children) that introducing egg between 4 and 6 months of age reduced the risk of egg allergy (relative risk [RR], 0.56; p = 0.009) [27], showing much better efficacy with using cooked as opposed to raw egg.

This meta-analysis also found “moderate certainty” evidence (based on 2 trials [LEAP and EAT], 1550 patients) that peanut introduction between age 4–11 months reduced the risk of peanut allergy (RR, 0.29; p = 0.009).

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

The distress of allergies: runny nose, itchy or watery eyes, sneezing, and congestion. You are not alone—allergies affect more than 50 million Americans every year.

Fortunately, there are numerous allergy medications, both prescription and over-the-counter (OTC) to assist relieve those bothersome symptoms.

Two favorite FDA-approved medications are Xyzal (levocetirizine dihydrochloride) and Zyrtec (cetirizine hydrochloride). Both medications are antihistamines, also called H1 blockers. They block the action of histamine, thereby relieving allergy symptoms. Xyzal and Zyrtec are less sedating than the first generation H1 blockers (such as Benadryl, or diphenhydramine).

Xyzal and Zyrtec are classified as non-sedating antihistamines along with other favorite medications such as Claritin (loratadine) and Allegra (fexofenadine) but they still do own the potential to cause some drowsiness.

However, Xyzal may cause less drowsiness than Zyrtec.

Xyzal and Zyrtec both may significantly relieve allergy symptoms, but there are some notable differences between the two drugs.


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