Kerry: 0:29
 Hi everybody. Welcome back to the Get Healthy Tampa Bay Podcast. I’m your host, Dr. Kerry Reller.

Today’s episode is a special one because I had the honor of being a guest on my friend and fellow Notre Dame alum, Dr. Erica Bove’s podcast, Love & Science Fertility. We had an important conversation about allergies and asthma in the preconception phase and during pregnancy — and it’s a topic that creates a lot of fear and confusion.

Women often ask: Are my allergy medications safe? Can I stay on my inhaler if I’m trying to conceive? Should I stop my asthma meds once I’m pregnant? What about allergy shots?

The most important message I share in this episode is: Well-controlled asthma is safer than poorly controlled asthma in pregnancy. Oxygen matters for mom and for baby.

We also talk about safe antihistamines like loratadine and cetirizine, why nasal steroids like budesonide are still first-line, what to avoid (like systemic decongestants), HEPA filters, dust mite strategies, travel tips, allergy shots and when to continue versus start, biologics like Xolair and Dupixent, and even progesterone reactions during fertility treatments.

If you’re trying to conceive, currently pregnant, undergoing fertility treatments, or supporting someone who is, this episode will give you clarity and reassurance grounded in evidence. I’m so grateful to Dr. Bove for hosting this conversation and allowing me to share it with you here. Let’s dive in.

Erica: 1:59
 Hello my loves, and welcome back to the Love & Science Podcast. I am so excited today to have a friend and colleague on the show, Dr. Kerry Reller. We’ve been talking about doing this podcast for so long.

She is the owner of Clearwater Family Medicine and Allergy in Clearwater, Florida. Her practice encompasses family medicine, obesity medicine, allergy, and more — which is amazing because we haven’t yet had anyone come onto the podcast to talk about allergy medicine. I have so many questions.

With the combination of these passions, she helps patients live their healthiest and best lives — to prevent chronic disease, move better, and breathe better.

Another fun fact: Dr. Reller went to Notre Dame just like I did. Go Irish!

Kerry:
 Go Irish.

Erica:
 Can you share a little bit about your story — how you came to do what you do?

Kerry:
 My story is long, but I’ll keep it brief. At Notre Dame, I studied electrical engineering. I went to grad school and worked a little bit in engineering, but I realized I didn’t want to work behind a computer screen all day. I wanted relationships and interaction with people.

I initially thought about doing something biomedical, learned about post-baccalaureate programs, and ultimately went into medicine. I considered different paths — sports medicine, radiology, electrophysiology — but I chose family medicine because I loved every aspect of it.

I also grew up with an allergist father. He wanted me to move home, learn what he did, and gave me the opportunity to become a business owner. My husband and I joined him in practice almost 10 years ago, and I took over a couple years ago. He taught me the allergy and asthma side, and now I get to do a mix — which keeps my days exciting and always evolving.

Erica:
 That’s amazing. I have to admit: I got very little training in allergy medicine, so when my patients ask about allergies, I sometimes feel like I need to phone a friend.

For people trying to get pregnant or who are newly pregnant, what are some basic guidelines you use to counsel them?

Kerry:
 Great question. Allergies are often accompanied by asthma and eczema, and one of the biggest things to remember is that asthma control matters in pregnancy. You want things under control before pregnancy if possible, and you should not stop inhaler medications just because you’re trying to conceive or you’re pregnant.

Oxygen demand is higher in pregnancy, and oxygen delivery is critical for mom and baby — so staying controlled is important.

For allergies, some low-risk first steps include nasal saline irrigation and avoidance strategies. If you have a cat or dog, keep them out of the bedroom, bathe the dog weekly, and consider a HEPA filter. I often prefer a standalone HEPA unit, especially for patients with more symptoms.

Controlling allergies can also help control asthma — because post-nasal drip and chronic inflammation can worsen the airways over time.

Erica:
 What about medications? What’s safe?

Kerry:
 Most antihistamines are generally okay, but the two most studied in pregnancy are loratadine (Claritin) and cetirizine (Zyrtec).

Fexofenadine (Allegra) is also commonly used and is typically non-drowsy.

But nasal steroids are still first-line for allergic rhinitis. The one with the most pregnancy safety data is budesonide (commonly associated with pregnancy data; many clinicians reference it for this reason). If someone prefers fluticasone (Flonase), it’s likely fine too — the distinction is often about how much published safety data we have.

Treating symptoms matters because uncontrolled allergies can worsen sleep, energy, and overall quality of life — and sleep is already a challenge in pregnancy for many people.

Erica:
 Are there other environmental changes people can make — prevention-wise?

Kerry:
 Dust mite precautions can help if someone is dust-mite allergic. These changes can make a modest but meaningful difference:

• Mattress and pillow encasements
• Washing bedding weekly in hot water
• Fluffing pillows in the dryer (heat helps)
• Avoiding added humidity (dust mites thrive in humidity)

A clue is symptoms worse in the morning — because you’re spending so many hours in the bed.

Erica:
 Is allergy testing safe during pregnancy?

Kerry:
 It’s safe to do allergy testing in the preconception phase, but I generally wouldn’t start allergy testing during pregnancy because there is a small risk of a systemic reaction (including anaphylaxis), and we want to avoid that risk in pregnancy whenever possible.

Erica:
 What about travel — hotels, different climates, conferences?

Kerry:
 Travel can be tricky. A few practical tips:

• If you’re not already using a nasal steroid, start it before travel (not just after symptoms flare).
• Many hotels have feather pillows — if you know you’re feather-allergic, request non-feather pillows.
• Hotels often have carpeting, which can hold allergens.
• Avoid humidifiers in hotel rooms if you’re dust mite or mold sensitive.

Erica:
 Can you explain allergy shots — and what happens in pregnancy?

Kerry:
 Allergy shots (subcutaneous immunotherapy) are small doses of allergens you’re allergic to, given in a controlled way to retrain the immune system.

If someone is already on shots and has reached a stable maintenance dose, it’s typically okay to continue during pregnancy.

But we generally do not:

• Start allergy shots during pregnancy
• Increase the dose during pregnancy

Because anaphylaxis is not something we want to risk during pregnancy.

If someone is planning pregnancy and considering shots, it’s ideal to start preconception and reach maintenance before conceiving.

Also, if asthma is uncontrolled, we wouldn’t start immunotherapy.

Erica:
 I want to ask about progesterone reactions. I’ve seen rare cases of true endogenous progesterone allergy, but more commonly I see reactions to progesterone-in-oil injections during fertility treatment — sometimes big welts, sometimes systemic symptoms. What are your thoughts?

Kerry:
 True progesterone allergy is rare. More commonly, people react to the vehicle or ingredients in the formulation rather than the hormone itself.

In theory, an allergist could consider skin testing to components (similar to drug allergy approaches), though it’s not as standardized as something like penicillin testing.

Desensitization is sometimes possible in allergy in general — the concept is giving very small, increasing exposures — but for progesterone formulations, the approach is not as standardized and would require an experienced allergist willing to individualize care.

Also, fever isn’t a classic allergy sign the way hives, wheeze, or anaphylaxis is — but inflammatory reactions can get complicated, especially in fertility protocols.

Erica:
 That makes sense. Anything else you want listeners to know — things to avoid?

Kerry:
 Yes — systemic decongestants are generally recommended to avoid in pregnancy, and they can also reduce milk supply during breastfeeding.

Also avoid topical phenylephrine nasal decongestants in pregnancy.

Oxymetazoline (Afrin) can sometimes be used short-term when needed. And there are approaches where a nasal steroid is the foundation, and then the decongestant is used sparingly if necessary.

For asthma/allergy meds: montelukast (Singulair) is generally considered safe to continue if someone is stable on it, but I typically wouldn’t start it for the first time during pregnancy unless there’s a compelling reason.

Another option that’s very safe is intranasal cromolyn, a mast cell stabilizer — no steroid — and it can help some patients.

Erica:
 I’ve also seen studies about maternal diet and offspring allergies, but a lot of it seems inconclusive. What do you tell patients?

Kerry:
 Unless mom is personally allergic, I don’t recommend avoiding common allergenic foods during pregnancy as a strategy to prevent allergy in the baby.

What we do know from the pediatric data is that early food exposure in infancy (often around 4–6 months depending on readiness and guidance) reduces the risk of developing certain food allergies.

Eczema is a major risk factor because the skin barrier is disrupted — and we often say:
 “Through the skin, allergies begin; through the diet, they stay quiet.”

Erica:
 This is such a resource. Where can people follow you?

Kerry:
 You can find me on the Get Healthy Tampa Bay Podcast. You can also find us at Clearwater Family Medicine & Allergy on social media. Our website is cfma.health. We’re located in Clearwater and Palm Harbor, Florida, and we accept new patients.

Erica:
 If you’re in that region, go see Dr. Reller. And if you’re not, binge her content.

Kerry:
 Thank you so much.

Erica:
 Thank you, Dr. Reller, for being on the podcast. I look forward to more collaborations.

Kerry:
 Thank you so much. Take care.

Erica:
 And to my loves — I love you. Bye.