Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper

Abstract

Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory con- ditions. The recommendations are informed by a multidisciplinary panel of expertsThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Fractional exhaled nitric oxide in the assessment of exercise‐induced bronchoconstriction: A multicenter retrospective analysis of UK‐based athletes

“…42,43 It is therefore often challenging to rule-out EIB in athletes with a mild or borderline response based on a solitary assessment 44 and thus repeat or "in-season" testing is recommended in this scenario. 12 Furthermore, a study by Bougault et al 42 evaluated EIB severity status in swimmers when they were in an intensive phase of training and out of training. The authors reported no changes in FeNO measurements, despite fluctuations in airway caliber in response to EVH and methacholine, which further supports the disconnect between FeNO and EIB in athletes.…”

“…Exercise challenges are typically considered to provide the greatest specificity to detect EIB; however, EVH is thought to offer greater sensitivity 10,11 . Although indirect bronchial provocation challenges provide objective evidence of EIB, 12 they offer limited insight into inflammatory mechanisms or disease subtypes. Airway inflammation is thought to contribute to the development of EIB via release of potent bronchoconstrictive agents, such as mast cell‐derived prostaglandins, 13,14 and mast cell‐ and eosinophilic‐derived leukotrienes 14–16 …”

Activation of epithelial and inflammatory pathways in adolescent elite athletes exposed to intense exercise and air pollution

“…This environmental condition might very well be PM exposure. In addition, the recent position paper of European Academy of Allergy and Clinical Immunology highlights the importance of repeat assessment and requirement of in season testing 50…”

Asthma in elite athletes – do they have Type 2 or non-Type 2 disease? A new insight on the endotypes among elite athletes

“…Elite athletes are more prone to develop asthma and the prevalence of asthma among athletes are higher when compared with the general population (1). Elite training is often considered to be a contributor to the development of asthma in athletes who did not exhibit respiratory symptoms before their sports careers (2).…”