Emesis- Football

Abstract

HISTORY: An 18-year-old NCAA D-I football athlete developed emesis during exercise. During his freshman season, he had recurrent URIs and emesis during practice. The vomiting appeared to be post-tussive during intense exercise. The athlete has not experienced this before but has a history of asthma and allergies. Symptoms improved temporarily with a non-sedating antihistamines and a H2 blocker. But, after one week, the vomiting returned. A PPI, fluticasone nasal spray and albuterol were then added, which appeared to help. Symptoms returned in the spring and montelukast was added to his regimen. He continued to complain of mucus accumulating in his throat that would cause him to gag which would occur with intense exercise and then even while trying to sleep. An EGD was performed which was normal. The athlete was then referred for allergy testing and immunotherapy. PHYSICAL EXAMINATION: Afebrile. Pulse ox 98% on room air. NAD, A&O. Nasal mucosa is pale, boggy and swollen with clear d/c; TM clear bilaterally; OP with posterior cobble stoning; no tonsillar exudate or erythema. No cervical LAN. CV: RRR. Lungs CTAB. Abdomen ND, BS (+), mild epigastric TTP, and no rebound or mass. DIFFERENTIAL DIAGNOSIS: 1. Sinusitis 2. Allergic rhinitis 3. GERD 4. Gastritis 5. asthma TESTS AND RESULTS: Chest radiograph: normal Spirometry Testing: - normal FVC - FEF max was decreased - Increased RV/TLC - diffusion 68% of predicted EGD: normal Allergy testing: (+) ragweed pollen, several weed pollens, tree pollens, several grasses, dust mites, cockroach, animal dander FINAL/WORKING DIAGNOSIS: Allergic rhinitis accompanied by emesis due to hypersensitive gag reflex stimulated by postnasal drip TREATMENT AND OUTCOMES: 1. Continue antihistamines and fluticasone nasal spray 2. Weekly immunotherapy injections 2. Dust mite bed covers to reduce exposure 3. Medication compliance With the above measures, the athlete’s symptoms were controlled and he continues to play football without difficulty.