title: Asthma, allergy and the Olympics: a 12-year survey in elite athletes.
abstract: OBJECTIVE
  There are no comprehensive surveys relating the reported high prevalence of asthma and allergic diseases in athletes to comorbidities and immune changes associated with intense chronic exercise. This 12-year survey aims to evaluate several clinical, functional and immunological parameters in order to assess features, trend and burden of asthma, allergy, infections and autoimmune diseases, in a large homogeneous population of Olympic athletes.
  
  
  METHODS
  Six hundred and fifty-nine Italian Olympic athletes were studied through four cross-sectional surveys performed between 2000 and 2012 before the Summer and Winter Olympics. Clinical diagnosis of allergic, autoimmune and infectious diseases was complemented by: skin-prick tests (n = 569); pulmonary function tests (n = 415); total (n = 158) and specific (n = 72) serum IgE; serum autoantibodies (n = 30), cytokines and growth factors (n = 92); flow cytometry (n = 135).
  
  
  RESULTS
  The prevalence of asthma and/or exercise-induced bronchoconstriction was 14.7%, with a significant increase (P = 0.04) from 2000 (11.3%) to 2008 (17.2%). The prevalence of rhinitis, conjunctivitis, skin allergic diseases and anaphylaxis was 26.2%, 20.0%, 14.8% and 1.1%, respectively. Sensitization to inhalant allergens was documented in 49.0% of athletes, being 32.7% in 2000 and 56.5% in 2008 (P < 0.0001). Food, drug and venom allergy was present in 7.1%, 5.0% and 2.1% of athletes, respectively. The high prevalence of asthma and allergy was associated with recurrent upper respiratory tract (10.3%) and herpes (18.2%) infections, an abnormal T cell subset profile and a general down-regulation of serum cytokines with a significantly lower IFN-γ/IL-4 ratio.
  
  
  CONCLUSIONS
  A chronic and intense physical exercise may cause a transient immunodepression with a preferential shift to a Th2 response, associated with abnormalities of the respiratory tract.
authors.affiliation: aDepartment of Public Health and Infectious Diseases, 'Sapienza' University bInstitute of Translational Pharmacology, Italian National Research Council (IFT-CNR) cItalian National Drug Agency (AIFA), Rome, Italy dSwiss Institute of Allergy and Asthma Research (SIAF), Davos, University of Zurich, Switzerland eInstitute of Medicine and Sport Sciences, Rome, Italy fUniversity Hospital Dept of Paediatrics, Norwegian School of Sport Sciences, Oslo, Norway gEuropean Medicine Agency, London, UK hDepartment of Medicine, Second University of Naples, Italy *The AIDA and the Italian Unit of the GA2LEN Olympic Study: A. Amendolea, G. Berlutti, M. Bresciani, G. Colombo, S. Del Giacco, G. Lapucci, C. Masala, P. Matricardi, G. Melioli, T. Pamich, G. Petrelli, C. Rumi, M. Sargentini, V. Sargentini, C. Tranquilli.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bonini
authors.forename: Claudia
authors.initials: C
authors.lastname: Gramiccioni
authors.forename: Daniela
authors.initials: D
authors.lastname: Fioretti
authors.forename: Beate
authors.initials: B
authors.lastname: Ruckert
authors.forename: Monica
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Cezmi
authors.initials: C
authors.lastname: Akdis
authors.forename: Antonio
authors.initials: A
authors.lastname: Todaro
authors.forename: Paolo
authors.initials: P
authors.lastname: Palange
authors.forename: Kai-Hakon
authors.initials: KH
authors.lastname: Carlsen
authors.forename: Antonio
authors.initials: A
authors.lastname: Pelliccia
authors.forename: Guido
authors.initials: G
authors.lastname: Rasi
authors.forename: Sergio
authors.initials: S
authors.lastname: Bonini
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D056352:Athletes; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007371:Interferon-gamma / Q000097:blood / Q000276:immunology; D015847:Interleukin-4 / Q000097:blood / Q000276:immunology; D008297:Male; D015995:Prevalence; D013177:Sports; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism
chemical_list: C573415:IFNG protein, human; C508598:IL4 protein, human; D015847:Interleukin-4; D007371:Interferon-gamma