Hay fever affects up to 40% of the UK population, athletes and people who regularly exercise in the outdoor urban environment are a specific population at risk for allergic rhinitis1.
For the general populus allergic rhinitis can have a significant detrimental impact on quality of life, various studies have documented the impact on sleep, work and learning ability. For sporting professionals this condition can potentially affect performance and recovery2.
The first step in treating any allergic condition is avoidance of the allergen, however avoidance of outdoor pollen exposure is impractical and therefore some form of pharmacological intervention is usually required. ARIA (Allergic Rhinitis and it’s Impact on Asthma (ARIA, a WHO backed organisation) and the World Anti-Doping Agency produce similar guidelines on hay fever treatment.
Older, first generation antihistamines such as chlorphenamine should be avoided as they cause a significant sedative effect that has been shown to reduce academic performance, reaction times and impair judgement.
Second generation antihistamines such as cetirizine, loraditine, fexofenadine or rupatidine are efficacious for 24 hours, cause minimal sedation and have a good safety profile. Topical nasal antihistamines such as azelastine have a rapid onset of action as do olopatidine eye drops.
Nasal decongestants may cause absorption of significant amounts of ephedrine or methylephedrine and urine concentrations may fall foul of WADA limits so they are best avoided in athletes.
Topical nasal steroids decrease all the main symptoms of allergic rhinitis including congestion and are not normally absorbed into the systemic circulation. Patient education is required with regards to technique as incorrect administration can take the drug straight to the back of the throat where it is swallowed.
In severe cases systemic steroids can only be used with an exemption by WADA but if symptoms have not been controlled by antihistamines, nasal sprays and eye drops, immunotherapy could be considered.