EXERCISE INDUCED RHINITIS: A PREVALENT BUT ELUSIVE DISEASE

Abstract

Introduction Exercise induced rhinitis is defined as inflammation of the nasal passages leading to rhinorrhea, sneezing, congestion or nasal itching related to physical activity. Although abundant research exists regarding exercise induced asthma, urticaria, and anaphylaxis, as well as allergic rhinitis, little is understood regarding exercise induced rhinitis. Exercise induced rhinitis has been displayed in indoor and outdoor athletes with and without nasal allergy. Similarities exist between the nasal mucosa and the bronchial airways, suggesting similar mechanisms of inflammation between exercise induced asthma and rhinitis. These include airway dehydration, hyperpnoea, fluid hyperosmolarity, neutrophilic inflammation, histamine release and mast cell degranulation. Case Description This case involved a 37-year-old female who presented with rhinitis during exercise. Her symptoms included nasal congestion and discharge, sneezing, and itchy nose, and exam revealed edematous nasal turbinates. Her symptoms were only mildly improved with daily oral Cetirizine and nasal Fluticasone. Allergy testing revealed IgE of 13kU/L (Ref: <=214kU/L), with environmental and food allergens showing no significant elevations in specific IgE levels, suggesting a non-allergic etiology. She was started on a trial of nasal Azelastine to be used prior to exercise, which provided relief of symptoms. Discussion Currently, no standardized method of diagnosis or treatment of exercise induced rhinitis exists. Suggested treatment strategies include intranasal corticosteroids, decongestants, and antihistamines, however, each have side effects that can interfere with exercise. Further research is indicated to explore the mechanism, evaluation, and treatment of exercise induced rhinitis as a distinct entity to ensure the safety and success of affected athletes. Exercise induced rhinitis is defined as inflammation of the nasal passages leading to rhinorrhea, sneezing, congestion or nasal itching related to physical activity. Although abundant research exists regarding exercise induced asthma, urticaria, and anaphylaxis, as well as allergic rhinitis, little is understood regarding exercise induced rhinitis. Exercise induced rhinitis has been displayed in indoor and outdoor athletes with and without nasal allergy. Similarities exist between the nasal mucosa and the bronchial airways, suggesting similar mechanisms of inflammation between exercise induced asthma and rhinitis. These include airway dehydration, hyperpnoea, fluid hyperosmolarity, neutrophilic inflammation, histamine release and mast cell degranulation. This case involved a 37-year-old female who presented with rhinitis during exercise. Her symptoms included nasal congestion and discharge, sneezing, and itchy nose, and exam revealed edematous nasal turbinates. Her symptoms were only mildly improved with daily oral Cetirizine and nasal Fluticasone. Allergy testing revealed IgE of 13kU/L (Ref: <=214kU/L), with environmental and food allergens showing no significant elevations in specific IgE levels, suggesting a non-allergic etiology. She was started on a trial of nasal Azelastine to be used prior to exercise, which provided relief of symptoms. Currently, no standardized method of diagnosis or treatment of exercise induced rhinitis exists. Suggested treatment strategies include intranasal corticosteroids, decongestants, and antihistamines, however, each have side effects that can interfere with exercise. Further research is indicated to explore the mechanism, evaluation, and treatment of exercise induced rhinitis as a distinct entity to ensure the safety and success of affected athletes.