The elite athlete: Yes, with allergy we can

摘要

On August 8, 2008, Beijing will welcome the XXIX Olympic Games, and a fourth to a third of the elite athletes from many of the national delegations in the multinational crowd taking part in the Opening Ceremony will have allergic or respiratory disease according to data published for several national delegations at previous Games.Mechanisms for the high prevalence of allergic diseases, including exercise-induced bronchospasm, in elite athletes-even higher than in the general population-still wait for further research. Although moderate physical activity is suggested and appears beneficial in allergic subjects to avoid risks associated with overweight and a sedentary lifestyle, intense and prolonged physical activity has been shown to induce marked changes in several parameters of innate and adaptive immunity. These include a T_H2 shift and a transient immunodeficiency that have been related to the higher prevalence of allergy and upper respiratory diseases in athletes. Certainly, hyperventilation and exposure to allergens and pollutants may cause bronchial hyper-reactivity even in subjects with no clinical asthma and/or allergy. In this issue of the Journal, Anderson and Kippelen have written an outstanding manuscript reviewing exercise-induced asthma and exercise-induced bronchoconstriction and the varied presentations depending on the type of sport and the athlete. Along with the discussion of pathophysiology is an explanation of why and how therapies are successful and why at times the contrary occurs.Surprisingly, however, in spite of the high prevalence of allergic diseases in elite athletes, allergy tests are often not part of the routine medical examination in sports medicine. This is even more questionable when considering that the treatmentof allergic athletes implies several important issues such as environmental control, use of drugs that may affect vigilance and performance, or therapeutic use exemption of antiallergic and antiasthmatic drugs included in the list of substances prohibited by the World Anti-Doping Agency in and out of competition. Therefore, we strongly recommend that standardized practice parameters are set to include allergy assessment among clinical investigations to be performed in athletes and nonprofessional exercisers when indicated.