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Posted by on Jul 6, 2011 in Clinical Medicine

Allergic Rhinitis and the Athlete: Part 1

Allergic Rhinitis and the Athlete: Part 1

Now this is a sweet picture…love my gym!

Allergies. Hay Fever. Allergic Rhinitis. By any name, the symptoms are not fun. The last month or so my clinic has been full of patients who are having allergic reactions to the local pollen. And I feel their pain. My allergies flare up for about 2-3 weeks every year when the grass pollen count gets high. 

As most of you can imagine (or experience) it is no fun to do any type of work out with itchy eyes and a runny nose. Not only is this aggravating, the symptoms can also decrease performance. A clogged nasal passage will lead to more mouth breathing, which takes an athlete out of their normal routine. 

The more an athlete is exposed to the allergen then the more severe their symptoms will likely be. In colder climates CrossFit tends to be an inside sport….right up until the spring and the doors fly open and we get outside more. Unfortunately, this is right when the springtime allergies begin. As is obvious, triathletes, cyclists, and runners will generally also have a much higher allergen load than other athletes.

For example, if you are in the Games this year, then you better be ready for some possible outside work. If you only train indoors, then be prepared for a possible increased allergen load.

Now, there are many reports that eating a strict paleo diet will help decrease or eliminate hay fever symptoms. This could be the case for many people. I have not experienced that my 90% paleo diet has helped much at all this year. Simply google paleo and hay fever and you will get several links to some anecdotal evidence that it will help.

If you are still having issues, then this is the following advice that I give my patients, usually with great success. This is a step wise progression of things that can be attempted. These educational tips (not treatment) are based on my experience rather than any in- depth studies.

1. Avoid the allergen

This is key. If you know what you are allergic to, then stay away if you can. Train indoors more often during that time frame etc. I had a patient recently that works in a grass seed factory and was allergic to grass. Obviously, this is not an ideal situation. Most of the time we are unwilling to avoid going outside, so onto #2.

2. Remove the allergen

I think this actually might be the most important thing we can do. Get the pollen etc out of your nasal passages. Do this however you can. I think the easiest and best method is to irrigate your nasal passages with high volume saline. There are commercial products called neti pots that can be purchased to do this or you can simply make your own saline. There are literally hundreds of recipes to make your saline. Use whatever works for you. Also important is to clear the allergen off of your face and body. Shower before sleep. Wash your face. I had my patient in the grass seed factory use a saline rinse after each shift etc.

It would also be great to consider using a saline rinse directly before a competition. Get things cleared up right before you need to perform.

3. Direct nasal steroid use

This is now where I bring in some of Western Medicine. There are several products that are prescription which will deliver a small dose of steroid to the nasal passages. Brand names include Flonase and Nasonex etc. I think these products are great. If you are trying to avoid medication then using this will keep the medication more local rather than an oral medication. The steroid will decrease the inflammatory response due to the allergen. 

I have had great personal success using the generic Flonase to control my own allergies. This medication is designed to be used daily for a few days before the maximum benefit is reached. If you know that you have a performance or race then think about starting this a few days before the performance.

Continue tomorrow…to discuss oral anti-histamines and decongestants.