What Allergies to Expect When You’re Expecting

“They may worsen, they may improve, or they might not change at all, and it really is patient-dependent.” —Dr. Lana Rosenfield

On this episode of The Allergist, Dr. Mariam Hanna welcomes Dr. Lana Rosenfield to unpack the complexities of managing allergic conditions during pregnancy and postpartum. With hormones shifting, the immune system recalibrating, and anxiety about medication safety running high, allergic disease can be especially tricky to manage during this time. Dr. Rosenfield offers practical insights for clinicians supporting pregnant patients with conditions like asthma, rhinitis, chronic urticaria, and food allergy, while navigating a landscape of limited data and heightened patient concerns.

On this episode:

• How the maternal immune system changes during pregnancy—and why it may exacerbate allergic conditions
  
  
• Safe options for managing allergic rhinitis, including which medications to avoid
  
  
• Asthma in pregnancy: monitoring frequency, preferred inhalers, and why under-treatment is riskier than treatment
  
  
• Atopic dermatitis: mimics to watch for, which topicals are safe, and what we know (or don’t) about dupilumab
  
  
• Managing chronic urticaria with second-generation antihistamines and omalizumab
  
  
• Food allergy and anaphylaxis: fetal risks, symptom variations, and why epinephrine remains essential
  
  
• What to do with patients already on immunotherapy, and why it should never be initiated during pregnancy
  
  
• Biologics and breastfeeding: limited evidence, but emerging reassurance
  
  
• Preconception counselling and postpartum care: optimizing control while minimizing risk
  
  

Dr. Rosenfield emphasizes shared decision-making, lowest effective dosing, and the clinical resources she trusts when evidence is limited. It’s a thoughtful and clinically grounded conversation to support allergists managing allergic conditions through pregnancy and beyond.

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Find Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_ca

The Allergist is produced for CSACI by PodCraft Productions