title: Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects.
abstract: BACKGROUND
  Rhinitis, either allergic or non-allergic, is frequent in athletes, particularly in swimmers. In this latter case, exposure to chlorine in swimming pools seems to play a relevant role, since it can exacerbate a pre-existing allergic rhinitis (AR) or produce a non-specific irritation. The aim of this study was to detail the clinical and cytological characteristics of rhinitis in swimmers, and to assess the possible role of chlorine-induced symptoms.
  
  
  METHODS
  Elite swimmers with rhinitis symptoms underwent a complete diagnostic work-up, including allergy testing, nasal cytology and anterior rhinomanometry. Those evaluations were repeated after 1 month of use of a nasal clip during swimming. A matched group of asymptomatic swimmers was also studied. A total of 74 swimmers (54 symptomatic and 20 controls), with an age range of 9-21 years, were studied. In the control group, only mild and non-specific findings were observed, and only two had a positive skin test.
  
  
  RESULTS
  In the symptomatic group, 24 (44%) had AR, and 19 (35%) had a predominant neutrophilic inflammation. The use of a nose clip reduced cellular infiltration and nasal resistances only in the subjects with neutrophilic rhinitis, whereas a clinical improvement was seen also in AR.
  
  
  CONCLUSIONS
  A neutrophilic rhinitis occurs in a large proportion of swimmers. This seems to be irritative in its nature and can be prevented by avoiding the direct contact with chlorinated water.
authors.affiliation: Department of Otolaryngology II, University of Bari, Bari, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Gelardi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ventura
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fiorella
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Fiorella
authors.forename: Cosimo
authors.initials: C
authors.lastname: Russo
authors.forename: Teresa
authors.initials: T
authors.lastname: Candreva
authors.forename: Antonella
authors.initials: A
authors.lastname: Carretta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Passalacqua
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002713:Chlorine / Q000633:toxicity; D004202:Disinfectants / Q000633:toxicity; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000453:epidemiology; D008297:Male; D015508:Nasal Obstruction / Q000453:epidemiology; D012220:Rhinitis / Q000139:chemically induced / Q000453:epidemiology*; D012882:Skin Tests / Q000379:methods; D013550:Swimming / Q000502:physiology* / Q000706:statistics & numerical data; D013551:Swimming Pools; D014420:Turbinates / Q000473:pathology; D055815:Young Adult
chemical_list: D004202:Disinfectants; D002713:Chlorine