Treatment/intervention Disease WADA rules Notes
Trigger avoidance AR, NAR, CRS Allowed Not always feasible to achieve.
Saline douchings
AR, NAR, ARS, CRS
Allowed
Very safe and cheap treatment option recommended as an adjunct for all mucosal pathology. Might be considered specifically for symptomatic swimmers after leaving a chlorinated pool.
Decongestants
Infectious rhinitis, ARS
Allowed: phenylephrine, phenylpropanolamine, adrenaline, xylometazoline and synephrine Allowed in limited concentrations: cathine, ephedrine and methylephedrine, pseudoephedrine Not allowed: sympathomimetic amines
Overuse can lead to rhinitis medicamentosa with paradoxal chronic nasal obstruction.
Intranasal corticosteroids
AR, NAR, ARS, CRS
Allowed, TUE is not required
Transient side effects: minor epistaxis, nasal dryness and irritation of nose and throat. Golden standard for chronic mucosal sinonasal pathology.
Oral corticosteroids Severe therapy-resistant AR Allowed with TUE. Indications are rare for AR. Gastro-intestinal, cardiovascular, ocular, psychiatric side-effects. Avascular necrosis, suppression of HPA-axis, osteopenia, diabetes mellitus, increased infection rate.
Antihistamines AR Allowed Side effect: first-generation antihistamines can have a sedative effect. Second-generation and later antihistamines are less sedative.
Cromoglycates AR Allowed Less effective in suppressing nasal symptoms than antihistamines.
Antileukotrienes AR Allowed Comparable efficacy to antihistamines, but no sedation.
Allergen Immunotherapy
AR
SLIT: Allowed SCIT: Allowed Immunotherapy should be started before competition. Local and systemic side effects are reported, more in SCIT than in SLIT. Exercise is prohibited on day of injection for SCIT.
Nasal dilators Structural pathology Allowed No clear effect on physiological parameters, however, beneficial effect on subjective breathing.
Surgery
Structural pathology, AR, NAR, CRS
Permitted
(Rhino)septoplasty is an option for medically resistant nasal obstruction in the presence of structural abnormalities. Turbinoplasty can be considered in medically resistant, reversible nasal obstruction due to turbinate hypertrophy. Endoscopic sinus surgery is an option in CRS patients in whom maximal medical therapy has failed.