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Allergy, Asthma, & the Athlete

Mark E. Reiber, MD, FACS, FAAOA

Athletes with asthma and allergies face special challenges. A runny nose or shortness of breath is obviously problematic but watery eyes, headaches, sinusitis, malaise and poor sleep all result from allergies. Unfortunately, over the counter medications may only compound the problem. Decongestants raise the pulse rate and blood pressure, worsen insomnia and produce jitteriness or anxiety. Antihistamines may cause fogginess, sedation, lethargy, slower reflexes, drier airways and thickened secretions. Untreated, severe complications like sudden death may arise from an asthma attack.

The foundation of all allergy treatment is a combination of avoidance, medications and immunotherapy. Avoidance measures include exercising indoors, limiting early morning outdoors exercise when pollen counts are highest, and monitoring air quality and pollen readings daily. Applying saline gel to the nose limits pollen contact with the lining and inflammatory cells triggering allergies. Similarly, gentle saline rinses after exposure reduces inhalants. Bathing and changing clothes is also helpful. Finally, asthmatics should acclimate their lungs slowly during drastic temperature changes such as going from a warm house to cold winter air.

There are a number of special considerations when choosing medications.  For nasal allergy, medications are best used as prevention before symptoms arise.  One of the most effective choices for congestion and drainage are nasal steroid sprays.  They’re used daily throughout the year or seasonally.  They are not anabolic, performance enhancing steroids. They are locally active with minimal absorption throughout the body.

Antihistamine nasal spray is another good choice with minimal side effects.  It can be used immediately before exposures or as a rescue.  There are a few oral antihistamines that don’t cause sedation or effect reflexes, but you must choose carefully. I generally avoid oral (pseudofedrine) or topical (oxymetazolam) decongestants for the reasons stated earlier.

There is a unique type of runny nose, vasomotor rhinitis, brought on by exercise or cold temperatures. It frequenly piggybacks with allergies, but will not respond to antihistamines or nasal steroids. It’s treated with a unique spray known as ipatropium bromide.

Hives or itchy rashes may be brought on by physical exertion and can be very debilitating. The key point is recognizing it for what it is rather than searching for foods or medications as a cause.

Asthma management is identical to that for allergies with prevention being of utmost importance. Medication may be used year round, seasonally, or for exercised induced symptoms only. Steroid inhalers with or without a long acting airway dilator are a main stay of treatment for the severely effected patient. Oral leukotriene inhibitors (montelukast,zileuten) are effective not only for asthma but for nasal allergy as well. Rescue medications are much more effective for asthma than allergic rhinitis. All asthmatic athletes should have a fast acting broncholilator such as albuterol available at all times.

Athletes frequently experience muscle and joint pain and turn to over the counter pain relievers such as ibuprofen or other non-steroidal anti-inflammatories. These can be very problematic for asthmatic or nasal polyp patients and may need to be avoided.

When avoidance and medications are not sufficient, immunotherapy provides a unique opportunity for long lasting relief from allergies. This involves a customized mixture of the specific antigens, identified through testing, that affects the patient. Methods include the traditional injections (allergy shots) or sublingual drops. The specifics of both types are covered in other articles on our website.

There are safety measures that asthmatic and allergic athletes need to follow more diligently than other athletes. First and foremost, never exercise alone. Asthma attacks can come quickly and having someone for aid may be life saving. Keep well hydrated as dehydration thickens secretions and makes breathing more difficult. Learn to monitor warning signs of cough, wheezing and tightness in the chest and adjust exercise accordingly. Unfortunately with asthma, warning signs are not always present until a full attack is underway. Daily monitoring of lung function with peak flow meters however can provide early warning of impending problems. Finally, wear identification with allergy information prominent in case of loss of consciousness.

Asthma and allergies don’t have to impair performance or enjoyment for sports. There have been many Olympic and world class athletes competing with asthma and allergies. With knowledge, planning, preparation, and special precautions, almost anything is possible. The physicians of ENT Carolina are trained in the management of allergies and can customize a program that is best for your needs.