Allergy Medications and Breastfeeding | Part One
Read Time | 13 minutes
Allergy season is quickly approaching and I am not ready. Even though it happens every year, predictably between March and October, it seems like it arrives with more force & fury than years previous.
If you’re exceptionally lucky, you will get a few extra months of allergy season tacked on- an early start in February with bonus winter allergies due to mold.
Here in Monterey California, we are already experiencing moderately high tree allergen counts and we have 7 days of February remaining. Houston Texas has it really bad, leading today’s ranking of “pollen hot spots” in the United States.
And if you’ve seen my guest post over on Hey Mama Lactation and Perinatal care’s blog on the same topic (containing much of the same information) then you know Philedalpheans and New Jersayans are preparing for a difficult allergy season this year.
These allergies don’t care where you live and they aren’t trying to spare anyone!
I’ve written this post to help you fight back in the best way possible- stopping the suffering by managing your allergy symptoms. By the end of this post, you will have all the information you need to navigate choosing an allergy med that is compatible with breastfeeding.
Do I have to stop breastfeeding if I have allergies?
No. You definitely can breastfeed while you have allergies, including if you have topical symptoms such as a rash or hives.
Sometimes telling the difference between a cold and allergies is a challenge because they share many of the same symptoms.
Rest assured, even if you have a cold or flu, you can still breastfeed while you're symptomatic, and weaning is not necessary.
Will breastfeeding give my baby allergy symptoms?
Allergies CANNOT be transmitted through breast milk, so you don't have to worry about your baby catching allergy symptoms or developing an allergy to something you're allergic to due to breastfeeding.
An allergic reaction is caused by a hyperstimulated (aka overreactive) immune response to something that normally is considered safe.
Regardless of what your body may think, grass and ragweed won't kill you; therefore, it shouldn't create the reaction it does.
But when the substance you're allergic to enters your body, it sends out a whole bunch of allergy- specific antibodies (IgE antibodies for you science nerds), which link up with mast cells to trap and remove the intruder.
Unfortunately, the byproduct of this defense system is histamines, which causes the classic allergy symptoms.
Why is this important?
Because your body is hypersensitive and because the symptoms are a result of its overdramatic response -can you say drama queen much?- there's no concern of passing allergies to your baby.
It's possible that your baby, too, has an overreaction to benign (harmless) substances, but the cause of that is most likely genetic and has nothing to do with breastfeeding.
Of particular interest, breast milk may protect against the development of allergies, so if you needed a reason to continue nursing, there's that.
Do I need to take medication?
No medication can rid you of allergies, but there are many medication options available to help reduce allergy symptoms.
Many people choose to go the medication route to get relief of symptoms; however, it is not necessary. There are homeopathic remedies for allergies, but because of the limited information on homeopathic remedies and breastfeeding AND because homeopathic medicine is so specific to the individual, it's outside the scope of this blog to discuss.
Will taking allergy medicine dry up my milk?
There is a significant concern amongst parents regarding the risk of allergy medication drying up milk. The fears are not unfounded as some antihistamines can, and do, dry up milk.
In fact, some parents use specific allergy medication to speed up the weaning process.
Luckily rarely will small, infrequent doses of allergy medications negatively impact your milk supply. And the medications that post the most significant risk to milk production will be mentioned below. (Spoiler alert, it's Sudafed)
But first...
Various types of medications are used to treat allergies, and there numerous ways to ingest them. The mechanisms by which each allergy medicine works will depend on the kind of medication and the method of ingestion.
Types of allergy medications
Antihistamines: Stops the histamine response by directly blocking your body's histamine receptors.
Decongestants: Contracts blood vessels, thereby decreasing swelling and inflammation in the nasal passages.
Corticosteroids: Similar to decongestants, corticosteroids provide temporary relief, but rather than narrowing blood vessels, the easing of symptoms is due to the steroid's synthetic substance similar to cortisol.
Mast Cell Stabilizers: Prevent the release of histamine by blocking cell degranulation (the sending out additional allergy symptom producing substances) and stabilizing mast cells.
Leukotriene inhibitors: relieves allergy symptoms by stoping the Leukotriene chemical thus blocking 5-lipoxygenase activity
Immunotherapy: Habituatlizes your body to the allergen by gradually increasing the dosage of exposure
Emergency epinephrine: reverses symptoms a life-threatening allergic reaction by constricting blood vessels and raising blood pressure.
Most common Method of Ingestion
Pills/Capsules
Nasal Sprays
Eye drops
Inhalers
Most discussions of allergy medication focus on antihistamines and decongestants.
I wanted to include ALL allergy medication types/options because there's a large population of lactating parents who need more intense allergy medications to get through their seasonal allergies. However, due to time and space, I've decided to break this into two parts; Part one (this post) that focuses on common allergy meds, and Part two, less common medications for allergies.
Which medications are safe for breastfeeding?
Nobody outside of your doctor can tell you which medications are safe for you to take. With that said, generally, most drugs are considered compatible with breastfeeding, meaning they should pose little to no risk of adverse side effects for lactation or your baby.
Overview of compatibility of allergy medication based ingestion method
Pill/capsules: Medication gets released in the stomach and travels through the bloodstream to have a response. Has the most potential for entering breast milk.
Nasal sprays: Usually only has local absorption and poses little risk to breastfeeding babies.
Inhalers: Rarely cause issues with breastfeeding due to the small amount of medication absorbed into the bloodstream.
Eye drops: Absorption of eye drops is minimal, and not enough medication would enter the bloodstream to then transfer into human milk.
In other words, there's little concern when using nasal sprays, inhalers, or eye drops. Should you have symptom relief through those methods alone, there's no need to take oral allergy medication. However, I will cover all of these over the counter options if you'd like more information.
Medication options
Antihistamines
Over The Counter
Loratadine (Alavert, Claritin): Safest (L1). Despite this medication being a long-acting antihistamine, it is THE over-the-counter antihistamine of choice because it does not cross the blood-brain barrier. (I cover this more in a related medication post on my site (Hyperlink this sentence)). According to Hale's Medication & Mothers milk, a baby weighing 8.8 lbs would receive less than 0.46% of the maternal dose.
Cetirizine (Zyrtec): Safer (L2). An excellent medication option for lactating parents to treat seasonal allergies. There are no concerns about adverse side effects for the breastfed baby, and it tends to have less of a sedation effect in those who take it.
Fexofenadine (Allegra): Safer (L2). This medication is highly compatible with breastfeeding; it is a preferred antihistamine due to its nonsedating nature. There have been no reports of side effects in breastfed babies.
Diphenhydramine (Benadryl): Safer (L2). It's thought that small amounts of Diphenhydramine transfer into human milk, though the exact volume is unknown. Non-sedating antihistamines (like Zyrtec, Allegra, Claritin) are preferred, but this is a medication that is compatible with breastfeeding. Observe your baby for sedation when taking this medication.
Diphenhydramine (Benadryl): Safer (L2). It's thought that small amounts of Diphenhydramine transfer into human milk, though the exact volume is unknown. Non-sedating antihistamines (like Zyrtec, Allegra, Claritin) are preferred, but this is a medication that is compatible with breastfeeding. Observe your baby for sedation when taking this medication.
Brompheniramine (Dimetane): Probably safe (L3). However, despite the insignificant amount of drug transfer into breast milk, irritability, excessive crying, and sleep disturbances in breastfed baby's have been reported. Adult side effects also described, though none related to milk supply.
Chlorpheniramine (Chlor-Trimeton): Probably safe (L3). No published data on the secretion amount of this medication into human milk, though no side effects have been reported. Observe for sedation in your baby when taking this medication.
Clemastine (Tavist): Possibly Hazardous (L4). This medication would not be a good first choice in battling seasonal allergies due to it being a long-acting antihistamine, and it's effects on breastfeeding babies. Drowsiness, irritability, breast/bottle refusal, neck stiffness, and increased risk of seizures have been reported.
Prescription
Hydroxyzine (Atarax, Vistaril): Safest (L1). Not much information is available regarding medication transfer into breast milk. Hydroxyzine turns into Cetrizine when it's metabolized (broken down); therefore, the impacts on breastfeeding babies, or the lack thereof, should be similar. No side effects have been reported; however, breastfed babies should be monitored for sedation, rapid heart rate, and dry mouth.
Carbinoxamine (Palgic): Safer (L2). Nonsedating antihistamines are preferred, and unfortunately, Carbinoxamine is not one of them. With that said, it's use is probably safe, but breastfed babies should be observed for sedation.
Desloratadine (Clarinex): Safer (L2). While there's little information on Deloratadine, there is a lot of reassuring information about Loratadine, of which Deloratadine is the active metabolite. In layman's terms - Loratadine is well studied, and when it breaks down in the body, it turns into Deloratadine. Therefore it's safe to say that the compatibility would be similar to Loratadine and that the low drug transfer and no side effect risk would be the same.
Azelastine eye drops (Optivar)/ Azelastine nasal sprays (Astelin, Astepro): Probably Safe (L3). In eyedrop & nasal preparations, there is little risk of milk levels reaching high enough to cause side effects in breastfed babies. It can change the flavor of breast milk, which some babies may refuse.
Cyproheptadine (Periactin): Probably Safe (L3). Currently, there is no published data on the amount of Cyproheptadine that enters breast milk, and breastfed babies should be observed for sedation.
Emedastine eyedrops (Emadine): No information available on this drug, but it may alter the taste of breast milk.
Levocabastine eyedrops (Livostin)/ Levocabastine oral (Xyzal): Probably safe (L3).Most commonly prescribed in the eyedrop form, the volume of medication that transfers into human milk is so low it's not clinically important, and there are no reports of adverse effects in breastfed babies. No information is available on Levocabastine in the oral preparations.
Decongestants (Active ingredient)
Phenylpropanolamine: Safer (L2). There is no information published about its transfer into human milk; however, due to the size of the medication's molocules and how rapidly it enters the blood-brain barrier, secretion into milk is highly likely. This medication is no longer available in the US
Pseudoephedrine: Probably safe (L3). Few reported affects in the breastfed baby; there has been one report of irritability. The biggest concern is regarding its impact on milk supply; therefore, those with low milk production and those in late-stage lactation should be cautious with using.
Phenylephrine: Probably safe (L3). An active ingredient in many cold medicines, nasal sprays, and even some eye drops. In all cases, no adverse side effects from ingesting human milk have been reported.
Propylhexedrine: Hazardous (L5) Breastfeeding parents should avoid Propylhexedrine use.
Corticosteroids
Budesonide: Safest (L1). There have been no reported adverse effects in breastfed babies when their parents have used Budesonide. The amount the baby would ingest via breast milk is 0.3% of the lactating parent's daily dose.
Beclomethasone: Safer (L2). As with most inhaler or intranasal ingestion methods, the amount of transfer into human milk would not be clinically significant.
Triamcinolone: Probably safe (L3). Triamcinolone doesn't transfer into human milk when taking Nasal or inhaler ingestion; therefore, it poses little risk to breastfed babies. Different recommendations apply for intravenous or intramuscular injections of the medication, so please consult with your provider before use.
Fluticasone (Flonase): Probably Safe (L3). No adverse effects have been reported in breastfed babies when ingested both intranasally or oral inhalation.
Mometasone: Probably safe (L3). This medication is unlikely to transfer into human milk at any significant amount, and there have been no reported issues in breastfed babies.
Ciclesonide: Probably Safe (L3). Despite there being little published data regarding the breastfeeding parent, the fact that this medication doesn't absorb well into the bloodstream combined with the fact that nasal steroids, in general, pose little risk, this medication is considered compatible with breastfeeding.
Which Medication is best for me to take?
Now that you know a little bit about all your options of medications that reduce allergy symptoms, you might be feeling a little overwhelmed with your choices.
It may be tempting to stick to the "L1 drugs" as they are rated as the safest options, but many parents need medications with higher lactation ratings to find relief. Or they may be unable to take an L1 or L2 drug due to medical concerns.
It's important to note that L3 medications aren't necessarily more dangerous than L1 or L2 drugs, just that there's not a lot of published information available. Drugs that have been better studied in breastfeeding parents tend to get dropped down in rating.
The only person that can tell you which drug you should take is your care provider, and luckily now you have some information to navigate that conversation better.
The specific details regarding each specific medication were gathered from Dr. Hale’s Medication and Mothers Milk (2012).
Having allergies is not a reason to wean, and breastfeeding is not a reason to suffer.
There are many options available, and hopefully, one will provide you with relief this allergy season.
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