Exercise-induced rhinitis: a common disorder that adversely affects allergic and nonallergic athletes

The diagnosis and management of rhinitis: An updated practice parameter

“…66 Patients with predominant nasal congestion may have nociceptive neurons that have heightened sensitivity to stimuli such as temperature change, airborne irritants, foods (especially hot and spicy foods), alcoholic beverages, cold dry air, and exercise. [67][68][69][70] Temperature change has also been noted to increase symptoms and the inflammatory nasal response in patients with allergic rhinitis. 71 Acute infectious rhinitis [Summary Statements 23,24] Acute viral upper respiratory infections are the most common predisposing factor for bacterial sinusitis, accounting for 90% to 98% of all episodes of sinusitis in children and adults.…”

“…They are also effective and have been associated with a clinically significant effect on nasal congestion for nonallergic rhinitis 336-338 but Antihistamine, oral with decongestant, oral (SS 63) More effective relief of nasal congestion than antihistamines alone Antihistamine, oral with LTRA, oral (SS 85) May be more effective than monotherapy with antihistamine or LTRA Less effective than INS An alternative treatment for patients unresponsive to or not compliant with INS Antihistamine, oral with intranasal antihistamine (SS [65][66][67][68][69] Combination may be considered, although controlled studies of additive benefit lacking Antihistamine, oral with intranasal corticosteroids (SS [74][75][76][77] Combination may be considered, although supporting studies limited and many studies unsupportive of additive benefit of adding an antihistamine to an intranasal steroid Intranasal anticholinergic with intranasal corticosteroid (SS 84) Concomitant use of ipratropium bromide nasal spray and an intranasal corticosteroid is more effective for rhinorrhea than administration of either drug alone Intranasal antihistamine with intranasal corticosteroid (SS 65-69) Combination may be considered based on limited data Inadequate data about optimal interval between administration of the 2 sprays For mixed rhinitis, there may be significant added benefit to the combination of an intranasal antihistamine with an intranasal corticosteroid LTRA, oral with intranasal corticosteroid (SS 85) Subjective additive relief in limited studies, data inadequate are generally less effective than intranasal corticosteroid for treatment of allergic rhinitis. 46 Combination therapy with intranasal corticosteroids may provide added benefit.…”

“…67 Cold dry air and exercise may also trigger symptoms. 68,69,757 The symptoms are variable, consisting mainly of nasal obstruction and increased secretion. Sneezing and pruritus are less common.…”

“…In fact, the majority of all individuals, allergic and nonallergic, report nasal symptoms, especially rhinorrhea, with both outdoor (56%) and indoor (61%) exercise, but this rate is higher in patients with allergic rhinitis (72% and 70%, respectively). 69 Furthermore this exercise-induced rhinitis adversely affects athletic performance in athletes with allergy (53%) and without allergy (28%). 69 Among elite athletes, endurance athletes report a higher frequency of physician-diagnosed allergic rhinitis and use of antiallergic medications.…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…This is the case of the skierÕs nose, a model of cold-induced rhinitis (176,(182)(183)(184), or rhinitis in competitive swimmers who inhale large quantities of chlorine gas or hypochlorite liquid (185)(186)(187). In runners, nasal resistance falls to about half of its resting values.…”