| Drug Class | Examples | Safety | Evidence | |------------|----------|--------|----------| | | Budesonide (Pregnancy Cat B), Fluticasone (Cat C, but widely used) | Preferred pharmacologic – minimal systemic absorption | RCTs show safety; budesonide has most pregnancy data. | | Intranasal antihistamines | Azelastine (Cat C) | Second-line | Limited data; systemic absorption low. | | Oral antihistamines (non-sedating) | Loratadine, Cetirizine (Cat B) | Reasonable for rhinorrhea/sneezing | No increased malformations in large cohort studies. | | Intranasal cromolyn sodium | Cromolyn (Cat B) | Safe but less effective | Very low absorption. | | Oral decongestants | Pseudoephedrine (Cat C) | Caution – Avoid in first trimester. Contraindicated with hypertension/pre-eclampsia. | Possible small risk of gastroschisis (first trimester). Use only short-term after 1st tri. | | Topical decongestants | Oxymetazoline (Cat C) | Avoid prolonged use (>3 days) due to rhinitis medicamentosa. | Minimal systemic absorption, but safety data sparse. |