4. Diagnosis
Diagnosis starts with taking a thorough history about symptoms, sport
environment and a possible link between these two. Questions about
triggering factors or symptom improvement after a resting break or
treatment are useful. Clinical examination should include both
evaluation of the external and internal nose. The general aspect of the
nasal mucosa, the nasal septum and the nasal valve can be appreciated
with anterior rhinoscopy. Nasal endoscopy offers the advantage of a
global evaluation of the nasal cavity and sinus outflow tracts53. Examination of the external nasal pyramid and tip
with valve tests will give information about important structural
abnormalities, nasal valve dysfunction and alar collapse.54.
Technical exams such as anterior rhinomanometry, acoustic rhinometry and
peak nasal inspiratory flow (PNIF) measurements and can be used to
objectify reported nasal blockage and measure nasal resistance55. However, these objective measurements do not
always correspond well with symptoms of nasal obstruction and results
should always be correlated with subjective parameters.
Every athlete with airway symptoms should be screened for allergies as a
causal factor of rhinitis. The validated AQUA questionnaire is often
used as a screening tool to identify athletes with allergic disease
(specificity 97.1%, sensitivity 58.3% when score > 5)56, 57. However, the final diagnosis of AR is based
upon a correlation between the typical history and the systemic
detection of allergen-specific IgE, either by skin prick test (SPT) or
in the serum 58. When a mismatch exists between
symptoms and systemic IgE detection, a specific nasal allergen challenge
can be considered 59. Nasal cold dry air challenge can
objectify the presence of NHR 47. Unlike
exercise-induced bronchoconstriction (EIB), no specific test is
currently available to diagnose exercise-induced rhinitis which is
consequently solely based on self-reporting.
Treatment options
Different types of nasal pathology in athletes should be treated
according to the respective guidelines 20, 21, 60.
However, due to the World Anti-Doping Agency (WADA) regulations61, athletes ought to adhere to strict regulations in
terms of pharmacological treatment. Treatment differs between mucosal
and structural pathology and options are summarized in table 1.