Management of allergic diseases in pregnancy

Abstract

Allergic diseases like asthma, allergic rhinitis, food allergy, hymenoptera allergy, or atopic dermatitis are highly prevalent in women of childbearing age and may affect up to 30% of this age group. This review focuses on the management of allergic diseases during pregnancy. Furthermore, we discuss the challenges of counseling women with allergic diseases in the reproductive age, including considerations relevant to the ongoing SARS-CoV-2 pandemic. To create the optimal milieu for the unborn child, a multitude of immunological changes occur during pregnancy which may favor type 2 responses and aggravate disease phenotypes. In co-occurrence with suboptimal preconception disease control, this elevated Th2 responses may aggravate allergic disease manifestations during pregnancy and pose a risk for mother and child. Due to limitations in conducting clinical trials in pregnant women, safety data on anti-allergic drugs during pregnancy are limited. The lack of information and concerns among pregnant patients demands counseling on the benefits of anti-allergic drugs and the potential and known risks. This includes information on the risk for mother and child of disease aggravation in the absence of treatment. By doing so, informed decisions and shared decision-making can take place.

Pathogenesis of allergic diseases and implications for therapeutic interventions

“…Some reports point out that LTRAs may be considered in second-line treatment of pregnant women if better treatments fail. 462 …”

Exposure to Allergen-Specific Immunotherapy in Pregnancy and Risk of Congenital Malformations and Other Adverse Pregnancy Outcomes

“…27 However, if effective and welltolerated, AIT maintenance therapy in pregnancy may be continued. 27,28 Regrettably, information on epinephrine use to treat systemic allergic reactions complicating AIT was unavailable in the current pregnancy cohort. Thus, it was impossible to perform separate analyses and study adverse pregnancy outcomes in this specific subgroup.…”

Regulatory T cells and immunoglobulin E: A new therapeutic link for autoimmunity?

“…It is also relevant in understanding how to dampen strong immune responses in autoimmune disease, allergic diseases and graft rejection, as well as how feto-maternal tolerance in pregnancy can be increased. [8][9][10][11][12] Numerous triggers and pathways are involved in the immunopathogenesis of autoimmune disease. 2 There are, however, two key stages: the first stage is central tolerance, which takes place within the thymus, while the second stage is mediated outside the thymus, in the periphery.…”

“…Better understanding of the molecular mechanisms involved in immunological self‐tolerance provides knowledge of how weak immune responses, for example those against tumour antigens in malignancy or microbial antigens in chronic infections, can be boosted. It is also relevant in understanding how to dampen strong immune responses in autoimmune disease, allergic diseases and graft rejection, as well as how feto‐maternal tolerance in pregnancy can be increased 8–12 . Numerous triggers and pathways are involved in the immunopathogenesis of autoimmune disease 2 .…”