Salve dottor Giordano,

Sono mamma di una bimba di 1 mese e mezzo...soffro di allergia al polline molto forte che mi causa rinite, prurito e bruciore agli occhi insopportabile...leggendo il foglietto illustrativo del mio antistaminico ho letto che non si può assumere in allattamento; esiste qualche altro antistaminico che si può prendere allattando?

Grazie in anticipo

Gentile mamma,

ahimè ! i foglietti illustrativi NON possono essere considerati fonte di informazioni scientificamente fondate.

Gli antistaminici sono molecole generalmente considerate compatibili con l'allattamento, in quanto passano nel latte in quantità talmente esigue da essere inverosimile un effetto sul bambino allattato.

Soprattutto per le molecole di seconda generazione come la cetirizina (lo zirtec del commercio).

Solo pochi vecchi testi mettono in guardia da possibile sonnolenza nel bambino, ma i più, ripeto, danno il via libera alle mamme che allattano e che soffrono di allergie.

A seguire, a sostegno di quanto scrivo, ho fatto copia ed incolla di un articolo scientifico tratto dal portale dell'agenzia governativa per la salute degli USA

Quindi si curi pure in tutta tranquillità

Cordiali saluti

Dott GG

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868610/

Language: English | French

Safety of antihistamines during pregnancy and lactation

Miranda So, RPh, Pina Bozzo, Miho Inoue, MD, and Adrienne Einarson, RN

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Antihistamines and breastfeeding

Although the data regarding the use of first-generation antihistamines and breastfeeding is limited, only minimal amounts of these drugs have been reported to be secreted in breast milk.16,17 In a telephone follow-up study conducted by Motherisk, 10% of mothers reported irritability and colicky symptoms in their infants exposed to various antihistamines, and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.18 Therefore, short-term or occasional use of the older generation antihistamines would not be expected to be a concern during breastfeeding.

Among the second-generation H1 blockers, data on drug concentration in breast milk are available for loratadine, desloratadine, and fexofenadine. The pharmacokinetics of loratadine and its metabolite desloratadine in breast milk were studied in 6 lactating women after a single oral dose of 40 mg of loratadine,19 which is 4 times the current standard therapeutic dose. Assuming the breast milk intake by an infant is 150 mL/kg daily, the maximum infant loratadine-equivalent dose based on the highest concentration of loratadine and desloratadine in breast milk was estimated to be 7.3 μg/kg daily (ie, 1.1% of the daily dose given to the mother in mg/kg). The pharmacokinetics of fexofenadine in breast milk were studied in 4 lactating women taking 60 mg of terfenadine every 12 hours.20 The maximum infant dose of fexofenadine based on the highest concentration of fexofenadine in breast milk would be 9 μg/kg daily (ie, 0.45% of the daily dose given to the mother in mg/kg). Considering the minimal exposure of a nursing infant to the drugs through breast milk, maternal use of loratadine, desloratadine, or fexofenadine in a standard therapeutic dose is unlikely to result in adverse effects in nursing infants and is considered to be compatible with breastfeeding.

Conclusion

Although seasonal allergy is not a life-threatening medical condition, it can be extremely troublesome for pregnant women and breastfeeding mothers. Based on the current body of evidence, which is large, first-generation H1blockers are not associated with an increased risk of major malformations or any other adverse fetal effects. Although there is less evidence on second-generation H1 blockers, they have also not been associated with an increased risk of adverse pregnancy outcomes. In addition, none of the antihistamines is excreted in the breast milk in an appreciable amount so as to have any adverse effects on the breastfeeding infant. Therefore, pregnant and breastfeeding women can be reassured that they can alleviate their symptoms without posing an increased risk to their fetuses or infants.