Rhinitis and asthma in athletes: an ARIA document in collaboration with GA²LEN

Abstract

This consensus document is aimed at reviewing evidence that the rhinits‐asthma links have peculiar features in athletes. Beside a review of epidemological data on the high prevalence of rhinitis and asthma in athletes, the effects on intense physical exercise on the immune system and repiratory functions are discussed, with special reference to the role of allergens and pollutants. In extending the Allergic Rhinitis and its Impact on Asthma (ARIA) recommendations to athletes, the issue is addressed of adapting diagnosis and management to criteria set by the International Olympic Committee (IOC) and regulations adopted by the World Anti‐Doping Agency (WADA).

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

“…In runners, nasal resistance falls to about half of its resting values. Decongestion begins immediately after starting running and persists for around 30 min after (27).…”

“…Several chapters of ARIA were extensively reviewed in an evidence-based model, and papers were published (or submitted) in peerreviewed journals: tertiary prevention of allergy, complementary and alternative medicine, pharmacotherapy and anti-IgE treatment, allergen-specific immunotherapy, links between rhinitis and asthma and mechanisms of rhinitis (24)(25)(26)(27)(28). There was then a need for a global document based on the published papers to highlight the interactions between the upper and the lower airways and to:…”

“…Patients with glaucoma or hyperthyroidism and elderly men with urinary retention due to prostate enlargement are also at risk when using oral sympathomimetic decongestants. Pseudoephedrine was recently banned for Olympic athletes (27).…”

Asthma, allergy, the athlete and the Olympics

“…In Australian Olympic athletes, 29% suffered from allergic rhinoconjunctivitis and 41% had positive skin tests to at least one aeroallergen (24). Allergic athletes experience symptoms of upper and lower airway disease on exposure to both outdoor and indoor aeroallergens, which may significantly decrease their physical performance (25). Furthermore, athletes with hay fever have significantly more exercise-related airway symptoms.…”

Chronic rhinitis in South Africa: Update 2013

“…[24] A number of reasons for this phenomenon have been proposed. [24] Care must be taken with medication because of potential adverse effects and/or 'anti-doping' codes. Permitted and banned medications are listed in Table 3.…”