Anti-Allergy Agents in Patients Practicing Sports
Pp. 50-117 (68)
Mariana Couto, Diana Silva, Luís Delgado and André Moreira
Regular physical activity is recommended for all individuals, but allergic
athletes face special challenges managing their diseases while practicing sports.
Exercise-induced hypersensitivity disorders are significant problems for both
recreational and competitive athletes, occurring with higher prevalence than in the
general population. Asthma is the most common chronic condition among athletes.
Athlete’s allergic diseases often perplex, frustrate and distress both patients and their
physicians. Their treatment frequently poses several issues. In the specific case of
asthma, multiple phenotypes exhibiting differences in response to treatment exist, which
creates additional difficulties when managing these patients.
Optimal allergic diseases management aims to control both symptoms and
inflammation, but when choosing treatment for a specific athletic population compared
with the common allergic patient, some additional factors should be taken into account.
For the top athlete it is important not only to control symptoms of allergy and prevent
its progression, but it becomes equally imperative to reduce the impact upon sports
performance, often practiced under extraordinary circumstances. Therefore, the
possibility of side effects of the prescribed treatments should also be carefully
considered, in a way to allow full participation in physical activity and sports.
Commonly used drugs include antihistamines, corticosteroids or β2-agonists. Oral H1-
antihistamines are one of the first-line therapeutic options for allergic rhinitis, however
they might affect vigilance and reaction time in athletes. Antileukotrienes efficacy has
been questioned in athletes and inhaled corticosteroids are only partially effective. Also,
some potential adverse events with the use of inhaled β2-agonists agents have been
pointed out, and health care providers should be aware of these concerns. Moreover, as
mechanisms and triggers of hypersensitivity disorders can be different in athletes
compared to general population, and even vary between athletes practicing different
sports, these patients should be managed sometimes in a singular and different way. On
the other hand, a careful consideration of available therapies is required in order to
comply with World Anti-Doping Agency regulations. Certain medications for athletes
with asthma and rhinitis who participate in regulated competitions are not allowed, and
as these guidelines often change, sometimes annually, the physician caring for subjects
who are active in sports needs regular update.
The aim of this chapter is to increase physicians’ awareness of special treatment needs
for such a prevalent heath problem among athletes, to demystify this issue and improve
doctor’s confidence on prescribing anti-allergy agents to sports practicing patients.
Anaphylaxis, antihistamines, antileukotrienes, asthma, allergy, beta-2
agonists, corticosteroids, exercise, immunotherapy, rhinitis, sports, urticaria, antiallergy
agents, doping, drugs, athletes.
Immunology Lab, Faculty of Medicine, University of Porto – Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.