5.1.8. Allergen Immunotherapy
Allergen immunotherapy (AIT) is the only disease-modifying treatment option for athletes suffering from AR, because of its capability to induce immune tolerance leading to long term disease control76. Multiple studies have proven that AIT is effective in reducing symptoms and rescue medication, as well as in improving QOL in AR patients 76. AIT is administered either subcutaneously (SCIT) or in a sublingual way (SLIT) with SCIT being slightly more effective but SLIT showing a better safety profile. Both types are permitted by the WADA regulations 61. SCIT usually precludes performing exercise on the administration day, which should be a factor to be considered in athletes.
A recent questionnaire-based study in athletes with AR, has indicated that AIT had the most beneficial effect on AR symptoms with better outcomes than classical pharmacological treatments 16. Despite these positive AIT results, a post-hoc analysis showed that the majority of athletes were not aware or had misbeliefs about this treatment option.
Practically, it is recommended to start AIT a few months before the competitive season because the initial phase can be accompanied with local or systemic side effects, more so for SCIT than fore SLIT.