Tackling nasal symptoms in athletes: Moving towards personalized medicine

Abstract

For elite athletes, an optimal health state is indispensable in order to deliver their best athletic performances. Athletes who undertake intense aerobic exercise meet metabolic demands by significantly increasing minute ventilation, making the airways one of their most important organ systems. The link between strenuous exercise and asthma has been a long-standing source of research and debate, but

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

“…These include poor quality of life, poor sleep and inadequate recovery from training or competition. Mild symptoms of structural obstruction can worsen when athletes are exposed to trigger from various sports-specific environments that cause additional mucosal swelling (rhinitis) such as cold, pollution, irritants, chlorinated water and allergens 26…”

“…Allergic rhinitis causing nasal obstruction and postnasal drip can disturb sleep and impair quality of life, thereby reducing exercise or sports performance 26 57–62. A decrease in endurance sports performance has been reported in healthy endurance athletes treated with histamine receptor blockers (selective H1 and H2-receptor blocker) 56 63.…”

“…This definition includes a variety of clinical syndromes (phenotypes) that vary according to severity, aetiology and type of inflammation 64. For athletes, exercise itself can be a trigger as well as exposure to environmental irritants in certain sports (eg, chlorine in swimmers, cold air in winter athletes and changes in environmental conditions such as humidity, dry air and ambient air pollution that athletes may be exposed to) 26 65 66…”

“…Second, there may be several pathophysiological mechanisms responsible for a clinical syndrome in an athlete including: various types of inflammation (eg, non-allergic rhinitis with eosinophilia syndrome, with eosinophils and mast cells, neutrophilic rhinitis, neurogenic inflammation) as well as neuronal imbalance or atrophic rhinitis (figure 2). 26 32 36 73 The physiological response to air pollutants and chlorine likely includes stimulation of cell and neurogenic airway inflammation as well as epithelial cell damage through the oxidative stress provoked by the reaction of pollutants with the airway surface lining content 65 74 75…”

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

“…25 A nasal allergen challenge may also be considered if no correlation is observed between the allergic symptoms (i.e., nasal obstruction, rhinorrhoea, nasal itch and sneezing) and the pattern of sensitization. 26 In athletic individuals, the approach to treatment should con- been published which permits a systematic approach to assessment, while considering differential diagnoses (see Hox et al 16 ).…”