What allergy medicine is ok to take while breastfeeding

CAS Registry Number

Substance Name

Cetirizine

Drug Class

Breast Feeding

Lactation

Antihistamines


Cetirizine Levels and Effects while Breastfeeding

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.

What allergy medicine is ok to take while breastfeeding

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

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.

What allergy medicine is ok to take while breastfeeding

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.

Alternate Drugs to Consider

Desloratadine, Fexofenadine, Loratadine

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 % 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 % twice daily to the lesions. Because of a poor response, the betamethasone was changed to clobetasol propionate ointment %. 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.

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]

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. ; PMID:

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.

What allergy medicine is ok to take while breastfeeding

Breastfeed Med. ; PMID:

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. ; PMID:

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

5. Gashlin LZ, Sullo D, Lawrence RA et al. Treatment of narcolepsy with sodium oxybate while breastfeeding: A case report.

Breastfeed Med. ; PMID:

6. Messinis IE, Souvatzoglou A, Fais N et al. Histamine H1 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Invest.

What allergy medicine is ok to take while breastfeeding

; PMID:

7. Pontiroli AE, De Castro e Silva E, Mazzoleni F et al.

What allergy medicine is ok to take while breastfeeding

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. ; PMID:


Further information

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

Medical Disclaimer


istrative Information

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.

What allergy medicine is ok to take while breastfeeding

The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.



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, Equate Allergy Relief, Zyrtec Hives, Show every 23 »Childrens Zyrtec, Allergy Relief D, 12 Hour Allergy-D, Every Day Allergy-D, Up and Up Every Day Allergy Relief D, Allergy D, Alleroff, Aller-Tec Childrens, Childrens Allergy Relief, Every Day Allergy Childrens, PediaCare Childrens Hour Allergy, Quzyttir, Cetiri D

Medically reviewed by Final updated on Apr 22,


Hay fever remedies

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

  1. how effective the medicine is 
  2. how mild or severe your symptoms are – if your symptoms are mild, you may be capable to manage without treatment
  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.

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.

Faced with an baby with CMA, the pediatrician must dictate an avoidance regimen. This will include a substitute; the best is – of course – breastfeeding with a mother’s diet free of milk products [1].

What allergy medicine is ok to take while breastfeeding

Breastfeeding is strongly recommended as the preferred way of baby feeding [14]. Compared to formula-fed infants, the breastfed show:

  1. Better immunologic system development & immune responses

  2. Better brain development

  3. Different growth patterns

  4. Different gut microflora

  5. Different nutritional status

  6. Fewer infections, of shorter duration.

Despite the fact that formulae are modeled after breastmilk, the human milk composition maintains its unique characteristics.

It contains a series of inimitable molecules with potential immune modulating activities. Examples comprise:

  1. hormones and growth factors, influencing the maturation of the baby gut and of the associated lymphoid tissues;

  2. maternal antibodies, including anti-idiotypic antibodies, capable to sustain and regulate immune cell populations through a priming of fetal and neonatal cells;

  3. cytokines (TGF-β2, IL, thymic stromal lymphopoietin) and chemokines, influencing the development of allergy and atopic diseases;

  4. PUFAs, nucleotides, glycoproteins, oligosaccharides and microRNA, capable in turn to exert immune functions.

Probably also for these reasons breastfeeding has been shown to influence a series of outcomes, including the establishment of gut microbiota, the prevention of overweight and obesity, the development of immunoallergic parameters and the neural development.

This final aspect is being actively investigated, and in the final few years offers us some new acquisitions that can be of interest in the general management of CMA.

Breastfed babies display significant structural differences in the brain anatomy compared with those that received baby formula: for instance, they present a longer corpus callosum, a higher ganglyothalamic ovoid diameter [15], a higher cortical thickness in parietal lobules [16]. Probably related to these effects, breastfeeding positively influences cognitive development and general intelligence [14].

From studies in cohorts of non-allergic infants it is known that the neural programming displays some ‘windows of plasticity’, during which environmental, nutritional, and microbiological factors may influence the brain function, generating diverse behavioral competence trajectories [17].

Numerous animal studies own focused on the effects of nutrition on brain development demonstrating that changes in dietary nutrients can alter brain morphology as well as its biochemical functions. Before the year , however, much of the evidence from human studies was retrospective. Then epidemiological birth cohort studies indicated that folate, n-3 fatty acids, iodine and iron istered in pregnancy may influence the brain development in healthy children [18]. In specific, from the ALSPAC cohort we know that:

  1. Low maternal seafood intake was also associated with increased risk of suboptimum outcomes for prosocial behaviour, fine motor skills, communication, and social development scores.

    For each outcome measured, the lower the intake of seafood during pregnancy, the higher the risk of suboptimum developmental outcome [19]

  2. Maternal seafood intake during pregnancy of less than  g per week is associated with increased risk of their children being in the lowest quartile for verbal intelligence quotient (IQ), compared with mothers who consumed more than  g per week [19]

  3. Iodine deficiency during pregnancy is associated with negative cognitive outcomes [19, 20].

After birth, the more implicated nutrients in the global development of infants are protein supply, PUFAs, Vitamins B12, C, A and D, iron, iodine, choline, zinc, selenium, and copper.

Independently or in combination, their nutritional availability may influence cognitive performance behavior [21]. Other studies failed to identify positive effects of breastfeeding on early life intelligence and cognitive growth from toddlerhood through adolescence [22], while an improved performance in intelligence of breastfed children was found at age 30 [23]. Taken together, the recent human studies indicate that the association among breastfeeding and improved performance in intelligence tests is not casual [24].

As a case in point, essential fatty acids frolic a central role in brain development of infants: humans can synthesize saturated and monounsaturated fatty acids but cannot synthesize the n-3 and the n-6 families of PUFA.

The parent fatty acids of these families, alpha linolenic acid (18 carbons, three double bonds with the first double bond in the n-3 position, Cn-3, ALA) and linoleic acid (Cn-6, LA) are essential fatty acids and must be present in the diet. ALA is converted to eicosapentaenoic acid (C n-3, EPA) then to docosahexaenoic acid (Cn-3, DHA), while LA is converted to arachidonic acid (Cn-6, AA). DHA is a critical component of cell membranes, especially in the brain and retina.

AA is both a membrane component and a precursor to potent signaling molecules, the prostaglandins and leukotrienes. The human milk always contains both AA and DHA, while in the past baby formulae had neither. Interventional studies failed to discover evidence that prenatal fish-oil (and folic acid) supplementation may influence the cognitive development of children at y of age, but a high DHA in maternal erythrocytes at delivery was associated with a Mental Processing Composite Score higher than the 50th percentile in the offspring [25].

Also, associations of maternal LC-PUFA status with kid emotional and behavioral problems were found in an epidemiologic study [26]. Nowadays, special formulae for the treatment of CMA are not in line with these characteristics of HM (Table 1).

Another significant component of breast milk is folic acid; its appropriate availability at the onset of pregnancy is associated with brain volume (Fig. 1). In children with low maternal folate levels, the head grows  mm per week less than in the controls [27]. This may translate in million neurons and billion synapses less per week.

Low maternal folate status during early pregnancy was also found associated with a higher risk of emotional and behavioral problems in the offspring [28]. The use of prenatal folic acid supplements around the time of conception has been associated with a lower risk of autistic disorder [29]. Human milk provides sufficient folate intake, essential for normal growth and brain development; heat treatment in the breastmilk banks may critically reduce its quantity [30].

Breastfeeding also influences the gut microbiota. Its establishment soon after birth is conditioned by factors as the type of delivery (passage through the birth canal vs.

caesarean section), socioeconomic and climatic environment (born in developed vs. developing countries), and immune system development during pregnancy, antibiotic treatments, and contacts with parents, siblings and hospital staff [31]. Dietary factors (breast vs. formula feeding) are of prominent importance in this context.

The gut microbiota as a major topic of research interest in biology has increased in recent years . Studies are assessing the influence of variations in the composition of the gut microbiota on diseases, ranging from inflammation to obesity. Accumulating data now indicate that the gut microbiota also communicates with the CNS — possibly through neural, endocrine and immune pathways — and thereby influences brain function and behavior.

Studies in germ-free animals and in animals exposed to pathogenic bacterial infections, probiotic bacteria or antibiotic drugs propose a role for the gut microbiota in the regulation of anxiety, mood, cognition and pain [32]. It is now generally accepted that a stable gut microbiota is essential for normal gut physiology and contributes to appropriate signaling along the gut–brain axis and, thereby, to the healthy status of the individual, as shown on the left-hand side of Fig. 2. The right-hand side of the figure indicates how intestinal dysbiosis can adversely influence gut physiology, leading to inappropriate gut–brain axis signaling and associated consequences for CNS functions and resulting in disease states.

Conversely, stress at the level of the CNS can affect gut function and lead to perturbations of the microbiota [33]. Thus, the emerging concept of a microbiota–gut–brain axis suggests that modulation of the gut microbiota may be a tractable strategy for developing novel therapeutics for complicated CNS disorders.

Of course, every these activities of breastfeeding are mediated through epigenetic activities of the diet, especially during prenatal and early postnatal life. Diets high in choline, methionine, folate, vitamin B6 and vitamin B12 increase DNA and histone methylation altering gene expression and generating permanent changes in development [34].

Early-life nutritional exposures, therefore, can act on the development of asthma, allergy, and obesity through epigenetic mechanisms [35].

Not to be confused with Lactose intolerance.

Milk allergy is an adverse immune reaction to one or more proteins in cow’s milk. When allergy symptoms happen, they can happen rapidly or own a gradual onset. The previous may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine among other measures. The latter can take hours to days to appear, with symptoms including atopic dermatitis, inflammation of the esophagus, enteropathy involving the little intestine and proctocolitis involving the rectum and colon.[2]

In the United States, 90% of allergic responses to foods are caused by eight foods, with cow’s milk being the most common.[3] Recognition that a little number of foods are responsible for the majority of food allergies has led to requirements to prominently list these common allergens, including dairy, on food labels.[4][5][6][7] One function of the immune system is to defend against infections by recognizing foreign proteins, but it should not over-react to food proteins.

Heating milk proteins can cause them to become denatured, meaning to lose their 3-dimensional configuration, and thus lose allergenicity; for this reason dairy-containing baked goods may be tolerated while unused milk triggers an allergic reaction.

Management is by avoiding eating any dairy foods or foods that contain dairy ingredients.[8] In people with rapid reactions (IgE-mediated milk allergy), the dose capable of provoking an allergic response can be as low as a few milligrams, so recommendations are to avoid dairy strictly.[9][10] The declaration of the presence of trace amounts of milk or dairy in foods is not mandatory in any country, with the exception of Brazil.[5][11][12]

Milk allergy affects between 2% and 3% of babies and young children.[8][13] To reduce risk, recommendations are that babies should be exclusively breastfed for at least four months, preferably six months, before introducing cow’s milk.

If there is a family history of dairy allergy, then soy baby formula can be considered, but about 10 to 15% of babies allergic to cow’s milk will also react to soy.[14] The majority of children outgrow milk allergy, but for about % the condition persists into adulthood.[15]Oral immunotherapy is being researched, but it is of unclear benefit.[16][17]


More about cetirizine ophthalmic

Related treatment guides

There are some hay fever medicines that you can generally take while you’re breastfeeding without risk to your baby.

Nasal sprays and eyedrops should be tried first, and the antihistamines loratadine and cetirizine are generally considered safe when taken at low doses.

However, it’s safest if you get advice from your pharmacist, GP or health visitor first.

This advice applies to mothers of full-term, healthy babies. Always get advice from your GP before taking any medicine if you’re breastfeeding and your baby:

  1. had a low birth weight
  2. was born early (prematurely)
  3. has a medical condition


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What allergy medicine is ok to take while breastfeeding