Management of allergic disease exacerbations in pregnancy

INTRODUCTION: Allergic disease exacerbations can affect maternal and fetal conditions in pregnancy. Some of allergic disease exacerbations may trigger pregnancy complications, life-threatening events of the mother and fetus. Eventually, it predisposes both them to the risk of severe damages. We report 4 cases of maternal allergic disease exacerbations (food allergy(FA) and anaphylaxis, bronchial asthma(BA), atopic dermatitis(AD), allergic rhinitis(AR), atopic eruption of pregnancy(AEP)), their management is discussed. CASE REPORT: Case1: a 31-year-old female in 32 weeks of gestation, with a medical history of BA in childhood, AD, AR, FA, was referred by an otolaryngologist because of persistent moderate-to-severe asthma symptoms, severe AR, . We introduced long-acting β2-agonist plus inhaled corticosteroids, short term oral methylprednisolone and nasal corticosteroid. Case2: a 26-year-old female in 25 weeks of gestation, with a medical history of AD, but without a history of any FA or anaphylaxis, was brought to the emergency department because of dyspnea, generalized itchy rash, abdominal pain, and severe uterine contractions after having eaten dinner. She was diagnosed as anaphylaxis and threated abortion. She was immediately treated by epinephrine i.m injection 2 times and obsterician. We disclosed buckwheat allergy as the cause of anaphylaxis. Case3: a 30-year-old female in 27 weeks of gestation, with a medical history of AD, was referred by an obsterician because of her severe AD and AR. She had stopped the medication after her pregnancy, which developed severe AD and AR. We introduced local corticosteroids and nasal corticosteroid. Case4: a 34-year-old female in 31 weeks of gestation, with a medical history of AR and AD during her childhood, came to our hospital because of her severe itchy hives in her both arms and body. She was diagnosed as AEP and was introduced to use local corticosteroids. All mothers and their conditions improved immediately and the baibies of 4 cases were normally delivered without neurological deficiency or congenital malformations. DISCUSSIONS: Allergic disease exacerbations may be common events during pregnancy, that reduce the maternal QOL and can even develop the potential risks of pregnancy complications, life-threatening events of mother and fetus, severe fetal brain damages. To prevent these situations, we should promote the appropriate therapies and educations to allergic diseases, and encourage the mothers to keep allergic medications, not only during pregnancy but prepregnant period. More investigations toward the pharmacologic management in allergic diseases are necessary to keep pregnant women and newborns healthy.