Akut Quinkes ödem hos 25-årig kvinna. Ej känd allergi. Gravid vecka 7. Hydrocortison, adrenalin res

Fråga: Akut Quinkes ödem hos 25-årig kvinna. Ej känd allergi. Gravid vecka 7. Hydrocortison, adrenalin resp antihistamin - teratogenicitet.

Sammanfattning: These agents are safe to use in the context of an acute allergic reaction in pregnancy and the risks of withholding adequate treatment, greatly outweigh any possible risks associated with their use. Chronic use of antihistamines (except brompheniramine) also seems to be safe if they are clinically required. Chronic corticosteroid (prednisolone) treatment during pregnancy causes reduced birthweight with POSSIBLE attendant risks in the neonatal period but these also should not be withheld if clinically required.

Svar: The question relates to acute use of agents for allergic conditions during early pregnancy and possible continued use after the acute phase.

1 CORTICOSTEROIDS. One early study of corticosteroids in pregnancy suggested an increased incidence of stillbirth and placental insufficiency in women who took prednisolone throughout pregnancy. However two larger and more recent studies failed to confirm these results and found no evidence of increased incidence of spontaneous abortion or congenital abnormalities following corticosteroid (mainly prednisone/prednisolone) treatment during pregnancy. (For discussion of these studies see (1) and (2)). A carefully controlled study (3) has however shown that prednisone at a daily dose of 10 mg (for infertility) during conception and throughout pregnancy causes a statistically significant retardation of intrauterine growth although most infants would have been regarded as within the normal weight range. Reduced birth weight was not seen if prednisone was discontinued when conception was confirmed (4).

2 ANTIHISTAMINES. Epidemiological studies (discussed in (1)) have not shown antihistamines as a group to cause an increased incidence of malformations. However an increased risk was seen with brompheniramine and data on diphenhydramine are conflicting. Overall the data suggests that antihistamines apart from brompheniramine are safe in pregnancy if required.

3 ADRENALINE. Adrenaline has been found to be associated with a slight but statistically significant increase in congenital malformations (see (1)) but it could not be excluded that this was due to hypoxia and/or infection associated with acute asthmatic episodes rather than adrenaline itself. 1 Greenberger P, Patterson R: Safety of therapy for allergic symptoms during pregnancy. Ann Intern Med 1978; 89: 234-237 2 Pratt WR: Allergic diseases in pregnancy and breast feeding. Ann Allergy 1981; 47: 355-360 3 Reinisch JM, Simon NG, Karow WG, Gandelman R: Prenatal exposure to prednisone in humans and animals retards intrauterine growth. Science 1978; 202: 436-438 4 Smith KD, Steinberger E, Rodriguez-Rigau LJ: Prednisone therapy and birth weight. Science 1979; 206: 96-97