Respiratory tract symptoms in endurance athletes - a review of causes and consequences

Current Allergy and Clinical Immunology

Volumn 23, Issue 2, 2010, Pages 52-57

  Schwellnus, M P ^a   Lichaba, M ^a   Derman, E W ^a  

^a UNIVERSITY OF CAPE TOWN   (South Africa)

Author keywords

[No Author keywords available]

Indexed keywords

ALLERGIC RHINITIS; ALTERNATIVE HYPOTHESIS; ARTICLE; ATHLETE; ENDURANCE SPORT; EXERCISE INTENSITY; HUMAN; IMMUNE RESPONSE; IMMUNOLOGICAL PARAMETERS; PATHOPHYSIOLOGY; PHYSICAL ACTIVITY; PRACTICE GUIDELINE; RESPIRATORY TRACT DISEASE; SYMPTOMATOLOGY; UPPER RESPIRATORY TRACT INFECTION;

EID: 79955811269     PISSN: 16093607     EISSN: 16093607     Source Type: Journal    
DOI: None     Document Type: Article

References (109)

1. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ 2006; 174: 801-809.
2. Karacabey K. Effect of regular exercise on health and disease. Neuro Endocrinol Lett 2005; 26: 617-623.
3. Kohl HW, III. Physical activity and cardiovascular disease: evidence for a dose response. Med Sci Sports Exerc 2001; 33(6 Suppl): S472-S483.
4. Brenner IK, Shek PN, Shephard RJ. Infection in athletes. Sports Med 1994; 17: 86-107.
5. Nieman DC. Special feature for the Olympics: effects of exercise on the immune system: exercise effects on systemic immunity. Immunol Cell Biol 2000; 78: 496-501.
6. Schumacher YO, Pottgiesser T, Koenig D. The risk of upper respiratory tract infections (URTI) in athletes. International Sportmed Journal 2003; 4: 1-12.
7. Friman G, Wesslen L. Special feature for the Olympics: effects of exercise on the immune system: infections and exercise in highperformance athletes. Immunol Cell Biol 2000; 78: 510-522.
8. Lakier SL. Overtraining, excessive exercise, and altered immunity: is this a T helper-1 versus T helper-2 lymphocyte response? Sports Med 2003; 33: 347-364.
9. Nieman DC. Is infection risk linked to exercise workload? Med Sci Sports Exerc 2000; 32(7 Suppl):S406-S411.
10. Calabrese LH, Nieman DC. Exercise, immunity, and infection. J Am Osteopath Assoc 1996; 96: 166-176.
11. Konig D, Grathwohl D, Weinstock C, Northoff H, Berg A. Upper respiratory tract infection in athletes: influence of lifestyle, type of sport, training effort, and immunostimulant intake. Exerc Immunol Rev 2000; 6: 102-120.
12. Bougault V, Turmel J, Levesque B, Boulet LP. The respiratory health of swimmers. Sports Med 2009; 39: 295-312.
13. Moreira A, Delgado L, Moreira P, Haahtela T. Does exercise increase the risk of upper respiratory tract infections? Br Med Bull 2009; 90: 111-131.
14. Spence L, Brown WJ, Pyne DB, et al. Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes. Med Sci Sports Exerc 2007; 39: 577-586.
15. Shephard RJ. Special feature for the Olympics: effects of exercise on the immune system: overview of the epidemiology of exercise immunology. Immunol Cell Biol 2000; 78: 485-495.
16. Schwellnus MP, Kiessig M, Derman W, Noakes TD. Fusafungine reduces symptoms of upper respiratory tract infections (URTI) in runners after a 56km race. Med Sci Sports Exerc 1997; 29(5 (Suppl)):S296.
17. Cox AJ, Gleeson M, Pyne DB, Callister R, Hopkins WG, Fricker PA. Clinical and laboratory evaluation of upper respiratory symptoms in elite athletes. Clin J Sport Med 2008; 18: 438-445.
18. Bermon S. Airway inflammation and upper respiratory tract infection in athletes: is there a link? Exerc Immunol Rev 2007; 13: 6-14.
19. Nieman DC. Current perspective on exercise immunology. Curr Sports Med Rep 2003; 2: 239-242.
20. Metz JP. Upper respiratory tract infections: who plays, who sits? Curr Sports Med Rep 2003; 2: 84-90.
21. Eichner ER. Infection, immunity, and exercise: what to tell patients. Phys Sports Med 1993; 21: 125-135.
22. Hosey RG, Rodenberg RE. Training room management of medical conditions: infectious diseases. Clin Sports Med 2005; 24: 477-506, 7.
23. Kostka T, Berthouze SE, Lacour J, Bonnefoy M. The symptomatology of upper respiratory tract infections and exercise in elderly people. Med Sci Sports Exerc 2000; 32: 46-51.
24. Ray CG. Influenza. Respiratory syncytial virus, adenovirus, and other respiratory viruses. In: Ryan KJ, ed. Sherris Medical Microbiology An Introduction to Infectious Diseases. 3rd ed. Upper Saddle River: Prentice Hall, 1994: 451-466.
25. Peters EM, Bateman ED. Ultramarathon running and upper respiratory tract infections. An epidemiological survey. S Afr Med J 1983; 64: 582-584.
26. Heath GW, Ford ES, Craven TE, Macera CA, Jackson KL, Pate RR. Exercise and the incidence of upper respiratory tract infections. Med Sci Sports Exerc 1991; 23: 152-157.
27. Peters EM, Goetzsche JM, Grobbelaar B, Noakes TD. Vitamin C supplementation reduces the incidence of postrace symptoms of upper-respiratory-tract infection in ultramarathon runners. Am J Clin Nutr 1993; 57: 170-174.
28. Peters EM, Anderson R, Nieman DC, Fickl H, Jogessar V. Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running. Int J Sports Med 2001; 22: 537-543.
29. Peters EM, Anderson R, Theron AJ. Attenuation of increase in circulating cortisol and enhancement of the acute phase protein response in vitamin C-supplemented ultramarathoners. Int J Sports Med 2001; 22: 120-126.
30. Berglund B, Hemmingsson P. Infectious disease in the elite crosscountry skiers: a one-year incidence study. Clinical Sports Medicine 1990; 2: 19-23.
31. Gleeson M, McDonald WA, Pyne DB, et al. Immune status and respiratory illness for elite swimmers during a 12- week training cycle. Int J Sports Med 2000; 21: 302-307.
32. Gleeson M, Pyne DB, Austin JP, et al. Epstein-Barr virus reactivation and upper-respiratory illness in elite swimmers. Med Sci Sports Exerc 2002; 34: 411-417.
33. Nieman DC, Nehlsen-Cannarella SL, Fagoaga OR, et al. Immune function in female elite rowers and non-athletes. Br J Sports Med 2000; 34: 181-187.
34. Novas AM, Rowbottom DG, Jenkins DG. Tennis, incidence of URTI and salivary IgA. Int J Sports Med 2003; 24: 223-229.
35. Filaire E, Bonis J, Lac G. Relationships between physiological and psychological stress and salivary immunoglobulin A among young female gymnasts. Percept Mot Skills 2004; 99: 605-617.
36. Furusawa K, Tajima F, Okawa H, Takahashi M, Ogata H. The incidence of post-race symptoms of upper respiratory tract infection in wheelchair marathon racers. Spinal Cord 2007; 45: 513-517.
37. Tiollier E, Gomez-Merino D, Burnat P, et al. Intense training: mucosal immunity and incidence of respiratory infections. Eur J Appl Physiol 2005; 93: 421-428.
38. Page CL, Diehl JJ. Upper respiratory tract infections in athletes. Clinical Sports Medicine 2007; 26: 345-359.
39. Nieman DC, Johanssen L M, Lee J W. Infectious episodes in runners before and after a roadrace. J Sports Med Phys Fitness 1989; 29: 289-296.
40. Fricker PA, Gleeson M, Flanagan A, et al. Do elite swimmers experience more upper respiratory tract illness than nonathletes? Clin Exerc Physiol 2000; 2: 155-158.
41. Linde F. Running and upper respiratory tract infections. Scan J Sports Sci 1987; 9: 21-23
42. Nieman DC, Nehlsen-Cannarella SL, Markoff PA, et al. The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 1990; 11: 467-473.
43. Nieman DC, Henson DA, Gusewitch G, et al. Physical activity and immune function in elderly women. Med Sci Sports Exerc 1993; 25: 823-831.
44. Baum M, Liesen H. [Sports and the immune system]. Orthopade 1997; 26: 976-980.
45. Nieman DC. Exercise, infection, and immunity. Int J Sports Med 1994; 15 Suppl 3: S131-S141.
46. Jedrychowski W, Maugeri U, Flak E, Mroz E, Bianchi I. Cohort study on low physical activity level and recurrent acute respiratory infections in schoolchildren. Cent Eur J Public Health 2001; 9: 126-129.
47. Klentrou P, Cieslak T, MacNeil M, Vintinner A, Plyley M. Effect of moderate exercise on salivary immunoglobulin A and infection risk in humans. Eur J Appl Physiol 2002; 87: 153-158.
48. Klentrou P, Hay J, Plyley M. Habitual physical activity levels and health outcomes of Ontario youth. Eur J Appl Physiol 2003; 89: 460-465.
49. Kotaniemi-Syrjanen A, Reijonen TM, Korhonen K, Korppi M. Wheezing requiring hospitalization in early childhood: predictive factors for asthma in a six-year follow-up. Pediatr Allergy Immunol 2002; 13: 418-425.
50. Matthews CE, Ockene IS, Freedson PS, Rosal MC, Merriam PA, Hebert JR. Moderate to vigorous physical activity and risk of upperrespiratory tract infection. Med Sci Sports Exerc 2002; 34: 1242-1248.
51. Hemila H, Virtamo J, Albanes D, Kaprio J. Physical activity and the common cold in men administered vitamin E and beta-carotene. Med Sci Sports Exerc 2003; 35: 1815-1820.
52. Schouten WJ, Verschuur R, Kemper HC. Physical activity and upper respiratory tract infections in a normal population of young men and women: the Amsterdam Growth and Health Study. Int J Sports Med 1988; 9: 451-455.
53. Nieman DC. Upper respiratory tract infections and exercise. Thorax 1995; 50: 1229-1231.
54. Alaranta A, Alaranta H, Heliovaara M, Alha P, Palmu P, Helenius I. Allergic rhinitis and pharmacological management in elite athletes. Med Sci Sports Exerc 2005; 37: 707-711.
55. Nieman DC, Pedersen BK. Exercise and immune function. Recent developments. Sports Med 1999; 27: 73-80.
56. Krause R, Patruta S, Daxbock F, Fladerer P, Biegelmayer C, Wenisch C. Effect of vitamin C on neutrophil function after high-intensity exercise. Eur J Clin Invest 2001; 31: 258-263.
57. Nieman DC, Peters EM, Henson DA, Nevines EI, Thompson MM. Influence of vitamin C supplementation on cytokine changes following an ultramarathon. J Interferon Cytokine Res 2000; 20: 1029-1035.
58. Peters-Futre EM. Vitamin C, neutrophil function, and upper respiratory tract infection risk in distance runners: the missing link. Exerc Immunol Rev 1997; 3: 32-52.
59. Pyne DB, Gleeson M. Effects of intensive exercise training on immunity in athletes. Int J Sports Med 1998; 19 Suppl 3: S183-S191.
60. Malm C. Exercise immunology: the current state of man and mouse. Sports Med 2004; 34: 555-566.
61. MacKinnon LT. Special feature for the Olympics: effects of exercise on the immune system: overtraining effects on immunity and performance in athletes. Immunol Cell Biol 2000; 78: 502-509.
62. Pedersen BK. Special feature for the Olympics: effects of exercise on the immune system: exercise and cytokines. Immunol Cell Biol 2000; 78: 532-535.
63. Gleeson M, Pyne DB, Callister R. The missing links in exercise effects on mucosal immunity. Exerc Immunol Rev 2004; 10: 107-128.
64. Jeurissen A, Bossuyt X, Ceuppens JL, Hespel P. [The effects of physical exercise on the immune system]. Ned Tijdschr Geneeskd 2003; 147: 1347-1351.
65. MacKinnon LT. Chronic exercise training effects on immune function. Med Sci Sports Exerc 2000; 32(7 Suppl): S369-S376.
66. Gleeson M. Immune function in sport and exercise. J Appl Physiol 2007; 103: 693-699.
67. Green KJ. Improving understanding of exercise effects on in vitro T-lymphocyte function - the role of fluorescent cell division tracking. Exerc Immunol Rev 2002; 8: 101-115.
68. McKune AJ, Smith LL, Semple SJ, Wadee AA. Influence of ultraendurance exercise on immunoglobulin isotypes and subclasses. Br J Sports Med 2005; 39: 665-670.
69. Muns G. Effect of long-distance running on polymorphonuclear neutrophil phagocytic function of the upper airways. Int J Sports Med 1994; 15: 96-99.
70. Pedersen BK, Toft AD. Effects of exercise on lymphocytes and cytokines. Br J Sports Med 2000; 34: 246-251.
71. Shephard RJ. Cytokine responses to physical activity, with particular reference to IL-6: sources, actions, and clinical implications. Crit Rev Immunol 2002; 22: 165-182.
72. Shinkai S, Kurokawa Y, Hino S, et al. Triathlon competition induced a transient immunosuppressive change in the peripheral blood of athletes. J Sports Med Phys Fitness 1993; 33: 70-78.
73. Akimoto T, Kumai Y, Akama T, et al. Effects of 12 months of exercise training on salivary secretory IgA levels in elderly subjects. Br J Sports Med 2003; 37: 76-79.
74. Ciloglu F. The effect of exercise on salivary IgA levels and the incidence of upper respiratory tract infections in postmenopausal women. Kulak Burun Bogaz Ihtis Derg 2005; 15(5-6): 112-116.
75. Fahlman MM, Engels HJ, Morgan AL, Kolokouri I. Mucosal IgA response to repeated wingate tests in females. Int J Sports Med 2001; 22: 127-131.
76. Gleeson M. Mucosal immune responses and risk of respiratory illness in elite athletes. Exerc Immunol Rev 2000; 6: 5-42.
77. Libicz S, Mercier B, Bigou N, Le Gallais D, Castex F. Salivary IgA response of triathletes participating in the French Iron Tour. Int J Sports Med 2006; 27: 389-394.
78. Muns G, Singer P, Wolf F, Rubinstein I. Impaired nasal mucociliary clearance in long-distance runners. Int J Sports Med 1995; 16: 209-213.
79. Nehlsen-Cannarella SL, Nieman DC, Fagoaga OR, et al. Saliva immunoglobulins in elite women rowers. Eur J Appl Physiol 2000; 81: 222-228.
80. Reid MR, Drummond PD, MacKinnon LT. The effect of moderate aerobic exercise and relaxation on secretory immunoglobulin A. Int J Sports Med 2001; 22: 132-137.
81. Sari-Sarraf V, Reilly T, Doran DA. Salivary IgA Response to Intermittent and Continuous Exercise. Int J Sports Med 2006; 27:849-855.
82. Dressendorfer RH, Petersen SR, Moss Lovshin SE, Hannon JL, Lee SF, Bell GJ. Performance enhancement with maintenance of resting immune status after intensified cycle training. Clin J Sport Med 2002; 12: 301-307.
83. Moreira A, Kekkonen RA, Delgado L, Fonseca J, Korpela R, Haahtela T. Nutritional modulation of exercise-induced immunodepression in athletes: a systematic review and meta-analysis. Eur J Clin Nutr 2007; 61: 443-460.
84. Nieman DC. Immunonutrition support for athletes. Nutr Rev 2008; 66: 310-320.
85. Krieger JW, Crowe M, Blank SE. Chronic glutamine supplementation increases nasal but not salivary IgA during 9 days of interval training. J Appl Physiol 2004; 97: 585-591.
86. Nieman DC. Exercise immunology: nutritional countermeasures. Can J Appl Physiol 2001; 26 Suppl: S45-S55.
87. Nieman DC, Bishop NC. Nutritional strategies to counter stress to the immune system in athletes, with special reference to football. J Sports Sci 2006; 24: 763-772.
88. Peters EM. Nutritional aspects in ultra-endurance exercise. Curr Opin Clin Nutr Metab Care 2003; 6: 427-434.
89. Venkatraman JT, Pendergast DR. Effect of dietary intake on immune function in athletes. Sports Med 2002; 32: 323-337.
90. Cox AJ, Pyne DB, Saunders PU, Fricker PA. Oral administration of the probiotic Lactobacillus fermentum VRI-003 and mucosal immunity in endurance athletes. Br J Sports Med 2010; 44: 222-226.
91. West NP, Pyne DB, Peake JM, Cripps AW. Probiotics, immunity and exercise: a review. Exerc Immunol Rev 2009; 15: 107-126.
92. Komarow HD, Postolache TT. Seasonal allergy and seasonal decrements in athletic performance. Clin Sports Med 2005; 24(2): e35-e50, xiii.
93. MacKnight JM, Mistry DJ. Allergic disorders in the athlete. Clin Sports Med 2005; 24(3):507-viii.
94. Katelaris CH. Atmospheric emissions and the allergic athlete. International Sportmed Journal 2000; 1(2):1-7.
95. Terrell TT, Hough DO, Alexander R. Identifying exercise allergies, exercise-induced anaphylaxis and cholinergic urticaria. Phys Sports Med 1996; 24: 76-89.
96. Helenius IJ, Tikkanen HO, Sarna S, Haahtela T. Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors. J Allergy Clin Immunol 1998; 101: 646-652.
97. Helenius IJ, Tikkanen HO, Haahtela T. Occurrence of exercise induced bronchospasm in elite runners: dependence on atopy and exposure to cold air and pollen. Br J Sports Med 1998; 32: 125-129.
98. Katelaris CH, Carrozzi FM, Burke TV. Allergic rhinoconjunctivitis in elite athletes: optimal management for quality of life and performance. Sports Med 2003; 33: 401-406.
99. Schwartz LB, Delgado L, Craig T, et al. Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). Allergy 2008; 63: 953-961.
100. Katelaris CH. Allergic rhinoconjunctivitis - an overview. Acta Ophthalmol Scand Suppl 2000; 230: 66-68.
101. Katelaris CH, Carrozzi FM, Burke TV, Byth K. A springtime olympics demands special consideration for allergic athletes. J Allergy Clin Immunol 2000; 106: 260-266.
102. Bonsignore MR, Morici G, Vignola AM, et al. Increased airway inflammatory cells in endurance athletes: what do they mean? Clin Exp Allergy 2003; 33: 14-21.
103. Karjalainen EM, Laitinen A, Sue-Chu M, Altraja A, Bjermer L, Laitinen LA. Evidence of airway inflammation and remodeling in ski athletes with and without bronchial hyperresponsiveness to methacholine. Am J Respir Crit Care Med 2000; 161: 2086-2091.
104. Leonard EG. Viral myocarditis. Pediatr Infect Dis J 2004; 23: 665-666.
105. Shephard RJ, Shek PN. Infectious diseases in athletes: new interest for an old problem. J Sports Med Phys Fitness 1994; 34: 11-22.
106. Roberts JA. Viral illnesses and sports performance. Sports Med 1986; 3: 298-303.
107. Friman G, Wright JE, Ilback NG, et al. Does fever or myalgia indicate reduced physical performance capacity in viral infections? Acta Med Scand 1985; 217: 353-361.
108. Friman G. Effect of acute infectious disease on isometric muscle strength. Scand J Clin Lab Invest 1977; 37: 303-308.
109. Friman G. Effects of acute infectious disease on circulatory function. Acta Med Scand Suppl 1976; 592: 1-62.