CHAPTER 37 • ALLERGIC DISEASES IN ATHLETES 221MANAGEMENT
- Allergen avoidance is essential in managing allergic
rhinitis.
1.Avoidance of animal dander is always best.
Exclusion of the pet from the bedroom and hepa
filter use may provide some benefit.
2. For dust mite allergy, use occlusive covers on the
pillows, mattress, and box springs. Frequent wash-
ing of bed linens and blankets in hot water is help-
ful. Dehumidifiers and removing carpet may help.
Hepa filters are ineffective because dust mite prod-
ucts are not airborne for an extended period of
time.
3.Mold allergen can be difficult to control, but dehu-
midifiers and scrupulous cleaning can be beneficial.
MEDICAL THERAPY
•Medical therapy is initiated in a stepwise fashion (see
Fig. 37-1). Available medications include: deconges-
tants, oral and topical antihistamines, cromolyn, corti-
costeroids, leukotriene receptor blockers, and topical
ipratropium bromide.
- Oral decongestants relieve congestion in allergic and
nonallergic rhinitis. In allergic rhinitis, they are most
effective combined with an oral antihistamine
(Sussman et al, 1999). Side effects include insomnia,
irritability, tachycardia, and palpations. Because they
decrease heat dissipation via peripheral vasoconstric-
tion, they should be avoided during training or com-
petition in the heat.
•Topical nasal decongestants are for short-term con-
trol of severe congestion. Their use should not exceed
3 days. If used more than 5–7 days they can cause
severe rebound congestion and rhinorrhea. - Antihistamines relieve sneezing, itching, and rhinor-
rhea in allergic rhinitis. Their efficacy is roughly
equivalent to nasal cromolyn but less than nasal
steroids. They provide little relief of nasal obstruction
and are generally ineffective in the treatment of non-
allergic rhinitis. First generation antihistamines can
cause significant sedation, decreased alertness, and
performance impairment—making them undesirable
for most competitive athletes. These effects can exist
without an individual’s awareness and can be present
even with nighttime-only dosing. Second generation
antihistamines are at least as effective as first genera-
tion antihistamines and possess much lower rates of
FIG. 37-1 Suggested Thera-
peutic Strategy for Allergic
Rhinitis in Athletes.