Health & Safety Resources

ALLERGIES AND ASTHMA IN THE ATHLETE

Happily, we’re entering spring, expecting warmer weather, sunnier skies and getting outdoors.  The indoor gyms start to empty as more athletes and fitness enthusiasts take their activities into the fresh air.  Exercising outdoors is great for most, but it can be problematic for athletes who have seasonal allergies or asthma.  At the very least, allergies and asthma can limit the athlete’s performance.  At its worst, it can be life-threatening.

Allergy symptoms can be mild and include nasal stuffiness, clear runny nose, sneezing, cough, tearing, eye redness, itchiness of the roof of the mouth.  These symptoms occur after exposure to specific allergens.  In the spring, the most common allergens are tree and grass pollen.  Exposure to the allergens causes a reaction in the body which releases a chemical called histamine.  The histamine is what causes the symptoms noted above.  Symptoms can occur immediately after exposure or up to several hours after exposure.

There are several types of medications used for seasonal allergies:  anti-histamine tablets (sedating and non-sedating), and nasal sprays.  Benadryl, Zyrtec, Contac are common antihistamines.  These minimize the body’s reactions to the released histamines.  They can be used prior to the expected exposure or afterward.  These medications are effective and have been used for a number of years, but can cause sedating side effects (drowsiness).  If athletes are using these medications, they should use them cautiously because of the sedating effects, especially if the athlete is trying them for the first time.  The non-sedating antihistamines include Claritin, Alavert, and Allegra.  These are dosed either once or twice daily and offer moderate-to-good relief of symptoms with minimal-to-no sedation.

Nasal sprays have shown to be very helpful with allergy symptoms and are preferred by many clinicians.  There are two types of nasal sprays:  corticosteroid nasal sprays (Flonase, Rhinocort, Nasacort), and mast-cell stabilizers (Nasacrom).  The nasal sprays are most effective if used daily and if started prior to the allergy season.  It takes 3-10 days of regular use to achieve maximum benefit.  So, initially, a combination therapy of a nasal spray and an antihistamine tablet are commonly recommended.  As the effect of the nasal spray takes hold, the use of the antihistamine is weaned. 

Athletes who have allergies should be monitored for proper hydration (sufficient fluid intake).  Increased body fluid loss occurs, and some of the medications may alter fluid losses and natural body cooling mechanisms.

These seasonal allergy symptoms are more of a nuisance to the athletes, and rarely cause severe problems.  In contrast, athletes who have allergies to more sinister objects (i.e. bees, wasps, certain foods) can have life-threatening anaphylactic reactions.  Anaphylactic symptoms can include lip swelling, sensations the throat closing, and inability to breath.  They can also include severe eye swelling, hives and earlobe swelling.  This is a medical emergency.  Immediate medical attention is warranted.  If available, low-flow oxygen is helpful.  Epipens are also used in this instance.  An Epipen is an auto-injector that administers epinephrine—and epinephrine is the definitive emergency treatment for severe allergic reactions.   If athletes have a history of such reactions or a history of severe allergic reactions to items, it is imperative that they are prepared.  Athletes should alert their coach or trainer to their allergies and be sure they are prepared for this type of emergency. 

ASTHMA

Approximately 17 million adults and 5 million children in the United States have asthma.  Asthma is a pulmonary disorder characterized by chronic inflammation of the airways leading to bronchial hyper-reactivity.  Episodic symptoms of airflow obstruction:  cough, wheeze, chest tightness, or shortness of breath are hallmarks for asthma.  Sometimes the athlete presents with “windedness” greater than expected or greater than teammates.  Symptoms can be very subtle.  Formal pulmonary testing is available to assess severity of asthma and to diagnose subtle cases of asthma.

There are several possible triggers for asthma.  These triggers include allergens (pollen, mold, ozone), exercise and cold air.  The athlete may have occasional asthma symptoms that occur only while they’re ill with a cold or bronchitis.  Athletes who have asthma should either practice indoors on bad weather days or use a mask.  Athletes who have exercise-induced asthma may benefit from a longer warm-up, longer cool-down, and aggressive hydration.

Athletes who have asthma absolutely should be monitoring their lung capacity regularly.  This is done with peak flow meters usually given by their physicians.  Decreases in lung capacity can be subtle.  Peak flow meters help to identify when the athlete’s capacity is waning.  Changes in their medication regime can be made to allow them to breathe easier.

Medications commonly used in asthmatic athletes are inhaled B2-agonists (albuterol, Ventolin, Proventil, Serevent), inhaled corticosteroids (Pulmicort, Azmacort), combination inhalers (Advair), and anti-leukotrienes (Singulair, Accolate).  The only inhaler that is helpful in the acute setting is the short-acting B2-agonists:  i.e. albuterol, Ventolin, Proventil.  The others types are not “rescue inhalers.”

Ongoing discussions with their clinician are imperative.  “rescue inhalers” are too often overused.  If the athlete requires them more than twice a week, it’s time to consider a different regime.   We used to worry about kids becoming addicted to the inhalers.  However, keeping asthma under excellent control is necessary to limit permanent changes that can develop in the lungs.  Over a lifetime, asthma flare-ups take its toll on the lungs’ architecture and their ability to function properly.

Certainly, asthma can be life-threatening.  If you have an athlete who is in respiratory distress, get them immediate medical attention.

For further information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313-972-4216. 

Written by: Nancy White, M.D., Henry Ford Center for Athletic Medicine

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.