Allergies in Youth Athletics

Danny Nguyen, MD, is a primary care physician board certified in family medicine. He practices at Inova Medical Group’s primary care practice at the Inova HealthPlex in Ashburn, VA. He has special interests in pediatric and adolescent health, athletic injuries, diabetes management, and preventive medicine.

With the springtime and outdoor athletic season in full swing, you may be wondering how to best keep your athletes performing at their peak capacity while battling seasonal allergies. Appropriate management of seasonal allergy symptoms can keep your player comfortable – both on and off the field. Here’s what you need to know:

What are seasonal allergies?

Allergies are caused by any substance that comes into contact with an individual (particularly those substances that are inhaled) and yields an immune response. Examples of common substances that can yield an immune response include plant or grass pollen, tree pollen, animal hair, dust and dander.

Who can be affected?

All players may be susceptible to allergies. Because asthma, eczema, and allergies are all associated with a hyperactive immune system, those who have a personal or family history of these three conditions may be at an increased risk.

What are the symptoms to look out for?

Players may notice the following symptoms:

• Itchy and watery eyes, with increased irritation and redness
• Nasal congestion
• Clogged ears
• Difficulty breathing, coughing and itching of the throat

Players who have a history of asthma may notice increased coughing and/or exacerbation of their asthma.

Allergies left unmanaged can lead to poor performance – including poor visual acuity, difficulty breathing, and decreased hearing. In severe cases, they may lead to infections of the ears and sinuses.

How can I manage symptoms?

If you have a history of seasonal allergies, the best way to manage symptoms would be to avoid the triggering/offending agent. However, this is usually not possible – especially for athletes who cannot avoid outdoor allergies with outdoor sports and activities. The following may help with relief:

• Players may consider nasal saline rinses for alleviation of symptoms. This may be performed before participation, during breaks and at the end of the game.
• In order to continue management off the field, players are recommended to change out of their clothes once returning home to avoid spreading the outdoor allergens around the home.
• Use caution when going to bed as allergens may be transferred and imbedded into the sheets and linens. Before going to bed, a shower is recommended to wash the pollen and other allergies off the body and out of the hair.
• Maintenance of a clean household also prevents additional unwanted allergies to household dust mites. This includes frequently cleaning, vacuuming, mopping and changing the sheets and linens.

What pharmacological interventions are available?

Pharmacological interventions are available for treatment of symptoms and include:

• Artificial tears are available to increase lubrication in the eyes.
• Ophthalmic antihistamine may reduce redness, itching and watery eyes if artificial tears alone are not sufficient.
• Nasal symptoms may be managed with saline rinses as mentioned above. Additionally, nasal corticosteroid spray may decrease nasal inflammation and congestion – allowing adequate flow of mucus out of the sinuses and ears.
• Oral antihistamine therapy may be effective to manage symptoms of seasonal allergies – especially if a player exhibits multiple symptoms.

Lastly, players with a history of asthma are encouraged to remain complaint to their inhaled therapy. Keep an albuterol inhaler handy to treat exacerbations. Some may consider using their albuterol 30 minutes before engaging in physical activity to prevent exacerbations.

A child with seasonal allergies and asthma may also benefit from the addition of montelukast to their regimen. Please speak to your primary care provider if you may be a candidate.

What are the side effects of therapy that may affect performance?

Because of the need for reapplication, ophthalmic drops may take some time away from the sport, but otherwise poses little interference.

• With usage of nasal saline irrigation and nasal corticosteroid, there is a risk of a bloody nose. This could be inconvenient if it occurs during a game, but may be prevented with adequate hydration and by using the therapy as directed – avoiding local trauma to the nasal mucosa.
• Antihistamines are classically known to cause drowsiness and sedation. Newer antihistamines available are now less sedating. Speak to your provider to tailor treatment to your needs.

Seasonal allergies can be a pain and a burden. In extreme cases, parents may consider taking their child out of sports and athletics altogether. However, with proper education and management, the player can be offered a chance to enjoy their sports with minimal interference. Please see your primary care provider if you have further questions regarding this topic.