Exercise-induced rhinitis: a common disorder that adversely affects allergic and nonallergic athletes

Background: Exercise is a well-established trigger for allergic disorders such as asthma, urticaria, and anaphylaxis, but the effect of exercise on rhinitis has not been well described. Objective: To survey individuals with and without nasal allergy who exercise regularly to determine the prevalence and nature of nasal symptoms induced by indoor exercise. Methods: An original, self-administered questionnaire to evaluate exercise-induced rhinitis (EIR) was distributed to adults who were receiving allergy immunotherapy at a community allergy practice and to members of a community athletic club. Nasal symptoms that occur indoors (runny nose, nasal congestion, postnasal drip) were primarily evaluated. Comparisons with outdoor EIR were determined. The perception of adverse effects of rhinitis on exercise was evaluated. Results: Sixty-six (40%) of the 164 patients indicated that their indoor EIR adversely affected athletic performance, and this finding occurred more frequently in patients with nasal allergy vs unaffected individuals (53.1% vs 27.7%; P =.009). Of the 61.0% who reported increased rhinitis with indoor exercise, rhinorrhea was the most common symptom experienced (48.8%). Indoor EIR occurred more frequently in patients with nasal allergy vs unaffected individuals (69.1% vs 53.0%; P =.04). Outdoor EIR occurred in 56.1% of the total population, and patients with nasal allergy reported significantly more rhinitis with outdoor exercise compared with unaffected individuals (71.6% vs 41.0%; P <.001). Conclusions: Exercise-induced rhinitis, predominantly rhinorrhea, commonly occurs in athletes regardless of underlying nasal allergy. A history specific to indoor and outdoor exercise triggers needs to be part of the complete rhinitis history so that specific treatment can be directed.