Exercise Induced Rhinitis

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Rhinitis is an infection of the nasal mucosa, or mucous membranes lining the nasal cavity. Generally divided into allergic and nonallergic forms, rhinitis primarily affects both allergic and nonallergic athletes as exercise-induced rhinitis, or EIR. Though the most common symptom is rhinorrhea, or runny nose, other symptoms include postnasal drip, congestion, sneezing, watery eyes, and itchy eyes and nose. EIR can be frustrating for athletes, and can negatively affect their athletic performance.

Affected Populations

Based on a 2008 review headed by Lawrence Schwartz of the Virgina Commonwealth University, rhinitis is nearly equally common among athletes and nonathletes. According to a study by William Silvers and Jill Poole of the Allergy, Asthma, and Immunology Clinic of Englewood, Colorado, EIR affects both athletes with preexisting nasal allergies and those without, though the adverse effects of EIR are more pronounced and common among allergic individuals. EIR is more common among allergic individuals whether exercise is performed indoors or outdoors, though nonallergic individuals are also affected in both environments. In a similar vein, Silvers and Poole found that allergic individuals reported that their athletic performance was more adversely affected by EIR than nonallergic individuals.

Potential Causes

As EIR is relatively unexplored in the scientific literature, many common causes for other types of rhinitis have been suggested for EIR. The most valid association is to vasomotor rhinitis, which is primarily attributed to changes in temperature, humidity, alcohol intake, cigarette smoke and nonspecific odors. Silvers and Poole link both to increased neural activity to brain areas associated with blood flow to the nasal mucosa. According to these researchers, such increased blood flow may result in either passive decongestion, resulting in a runny nose, or increased sensitivity to general irritants, resulting in congestion, watery eyes, and itchy eyes and nose.

Identification

In a 2006 review, David Quillen and David Feller of the University of Florida state that a diagnosis of vasomotor rhinitis should occur only through a process of elimination. Similarly, a diagnosis of EIR often follows the elimination of other potential causes for EIR-related symptoms, such as viral infections, allergies and other forms of rhinitis. According Schwartz and colleagues, only when such symptoms are chronic, worsen with exercise and persist despite varying environmental pressures, should there be a diagnosis of EIR.

Treatment

While bothersome nasal symptoms associated with other forms of rhinitis often improve with increased exercise, Silvers and Poole suggest that this may have the reverse effect on EIR sufferers. Based on the findings of their 2006 review of the literature, Sergio Bonini of the Second University of Naples and his colleagues suggest that the best treatments are common to both allergic and nonallergic individuals with EIR: antihistamines, immunotherapy, and oral, intravenous or intramuscular drugs. As a caveat to their findings, they suggest that you ensure that any drugs or treatments for EIR do not violate the anti-doping regulations of your athletic organization prior to engaging in any such treatment programs.

Prevention

One of the primary concerns related to EIR involves early recognition and a correct diagnosis. As EIR symptoms are common to numerous disorders, viruses, infections and allergies, the risk of misdiagnosis and receiving an unsuitable treatment program is high. Also, numerous other exercise-induced conditions may contribute to or worsen EIR symptoms. Potentially underlying EIR, such conditions, which include EI asthma and EI bronchoconstriction, may be of primary interest in the treatment and prevention of EIR. Bonini and colleagues also suggest that individuals with preexisting nasal allergies present a related concern, with treatment of the underlying allergy a potential prevention and treatment for EIR.

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