Sports Medicine: Just the Facts

220 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE

Smith BW, MacKnight JM: Pulmonary, in Safran MR, McKeag
DB, VanCamp SP (eds.): Manual of Sports Medicine.
Philadelphia, PA, Lippincott-Raven, 1998, pp 244–254.
Storms WW: Exercise-induced asthma: diagnosis and treatment
for the recreational or elite athlete. Med Sci Sports Exerc
31(suppl 1):S33–S38, 1999.
Storms WW, Joyner DM: Update on exercise-induced asthma:
A reportof the Olympic Exercise Asthma Summit Conference.
Phys Sportsmed25(3):45–55, 1997.
Szentagothai K, Gyene I, Szocska M, et al: Physical exercise pro-
gram for children with bronchial asthma. Pediatr Pulmonol
3(3):166–172, 1987.
Ta n RA, Spector SL: Exercise-induced asthma. Sport Med
25(1):1–6, 1998.
Thole RT, Sallis RE, Rubin AL, et al: Exercise-induced bron-
chospasm prevalence in collegiate cross-country runners. Med
Sci Sports Exerc33(10):1641–1646.
Thomas J, Cook DJ, Brooks D: Chest physical therapy manage-
ment of patients with cystic fibrosis: A meta-analysis. Am J
Respir Crit Care Med151:846, 1995.
Tikkanen HO, Peltonen JE: Asthma-cross-country skiing. Med
Sci Sports Exerc31(5) (suppl): S99, 1999.
Waalkans HJ, van-essen-Zandvliet EEM, Gerritsen J, et al, and
the Dutch CNSLD Study Group: The effect of an inhaled cor-
ticosteroid (budesonide) on exercise-induced asthma in chil-
dren. Eur Resp J6:523–526, 1993.
Wilson BA, Bar-Or O, O’Byrne PM: The effects of indomethacin
on refractoriness following exercise both with and without
bronchoconstriction. Eur Respir J 12:2174–2178, 1994.

37 ALLERGIC DISEASES

IN ATHLETES

David L Brown, MD

David D Haight, MD

Linda L Brown, MD

INTRODUCTION

• Allergic rhinitis alone affects over 40 million
  Americans (American Academy of Allergy, Asthma
  and Immunology, 2003). It is the fifth most common
  chronic disease and the most prevalent in patients
  under 18 years of age (Public Health Service, 1997).


• Urticaria and angioedema affect 20–30% of the popu-
  lation during their lifetime (Kaplan, 2002).


• Approximately 20,000–50,000 patients with anaphy-
  laxis present for medical care in the United States
  each year, resulting in 400–1000 deaths (Neugut,
  Ghalak, and Miller, 2001).

ALLERGIC RHINITIS

• Allergic rhinitis occurs when an individual develops IgE
  sensitization to aeroallergens. Inhalation of the aeroal-
  lergens leads to mast cell activation and release of hista-
  mine and other chemical mediators of inflammation.


• Common symptoms include—rhinorrhea, post-nasal
  drip, congestion, sneezing, cough, and pruritus of the
  nasal and soft palate. Patients may complain of gener-
  alized irritability and fatigue. Eye pruritus, injection,
  irritation, and watery discharge may indicate coexist-
  ing allergic conjunctivitis.


• Symptoms recur on exposure to any aeroallergen to
  which a patient is sensitized.


• Spring and early summer exacerbations occur with
  tree and grass pollination. Late summer and fall
  symptoms are usually because of weeds and mold.
  Indoor flares suggest sensitivity to cockroach, dust
  mites, pet dander, or molds. Perennial symptoms may
  be sensitivity to a combination of these allergens or
  indicate nonallergic rhinitis.

NONALLERGIC RHINITIS

• The etiology of nonallergic rhinitis is unknown.


• The prominent complaint is nasal congestion. Nasal,
  eye, and soft palate pruritus are usually absent.
  Symptoms are often perennial and triggered by strong
  odors or smoke. Seasonal air temperature, humidity,
  and barometric pressure changes may lead to exacer-
  bations, making it difficult to distinguish from allergic
  rhinitis.

EVALUATION

• The history should focus on isolating an allergen
  exposure. A personal or family history of asthma,
  allergies, and eczema leads to a higher suspicion for
  allergic rhinitis.
  •Physical examination will not distinguish allergic and
  nonallergic rhinitis.
  
  
  1. The nasal mucosa in allergic rhinitis is classically
     pale or bluish, but can be red, edematous, or appear
     normal. Postnasal drip of any etiology causes pos-
     terior pharyngeal cobblestoning. “Allergic shiners”
     from infraorbital venous congestion are also non-
     specific.
  
  
  2. Findings suggestive of allergic rhinitis include
     accentuated transverse nasal crease seen in children
     who repeatedly rub their nose because of pruritus
     and atopic stigmata, such as eczema and wheezing
     on auscultation.