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Klain A, Giovannini M, Pecoraro L, Barni S, Mori F, Liotti L, Mastrorilli C, Saretta F, Castagnoli R, Arasi S, Caminiti L, Gelsomino M, Indolfi C, Del Giudice MM, Novembre E. Exercise-induced bronchoconstriction, allergy and sports in children. Ital J Pediatr 2024; 50:47. [PMID: 38475842 DOI: 10.1186/s13052-024-01594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy.
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126, Verona, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Lucia Liotti
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, 60123, Ancona, Italy
| | - Carla Mastrorilli
- Pediatric and Emergency Department, Pediatric Hospital Giovanni XXIII, AOU Policlinic of Bari, 70126, Bari, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Riccardo Castagnoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98124, Messina, Italy
| | - Mariannita Gelsomino
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, University Foundation Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Elio Novembre
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
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2
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Price OJ, Walsted ES, Bonini M, Brannan JD, Bougault V, Carlsen K, Couto M, Kippelen P, Moreira A, Pite H, Rukhadze M, Hull JH. Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper. Allergy 2022; 77:2909-2923. [PMID: 35809082 PMCID: PMC9796481 DOI: 10.1111/all.15431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.
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Affiliation(s)
- Oliver J. Price
- School of Biomedical SciencesFaculty of Biological Sciences, University of LeedsLeedsUK,Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Emil S. Walsted
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK,Department of Respiratory MedicineBispebjerg HospitalCopenhagenDenmark
| | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly,National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | | | | | - Kai‐Håkon Carlsen
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway,Faculty of Medicine, University of OsloInstitute of Clinical MedicineOsloNorway
| | - Mariana Couto
- Allergy CenterCUF Descobertas HospitalLisbonPortugal
| | - Pascale Kippelen
- Division of Sport, Health and Exercise SciencesCollege of Health, Medicine and Life Sciences, Brunel University LondonUK
| | - André Moreira
- Centro Hospitalar Universitário de São JoãoPortoPortugal,Epidemiology Unit (EPIUnit)Laboratory for Integrative and Translational Research in Population Health (ITR)Basic and Clinical Immunology, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo HospitalCEDOC, NOVA University, Universidade NOVA de LisboaLisbonPortugal
| | | | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK,Institute of Sport, Exercise and Health (ISEH)Division of Surgery and Interventional Science, University College London (UCL)LondonUK
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3
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Maurer DJ, Liu C, Xepapadaki P, Stanic B, Bachert C, Finotto S, Gao Y, Graser A, Jartti T, Kistler W, Kowalski M, Lukkarinen H, Pasioti M, Tan G, Villiger M, Zhang L, Zhang N, Akdis M, Papadopoulos NG, Akdis CA. Physical activity in asthma control and its immune modulatory effect in asthmatic preschoolers. Allergy 2022; 77:1216-1230. [PMID: 34547110 PMCID: PMC9291774 DOI: 10.1111/all.15105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impact of physical activity on immune response is a hot topic in exercise immunology, but studies involving asthmatic children are scarce. Our aims were to examine whether there were any differences in the level of physical activity and daily TV attendance, to assess its role on asthma control and immune responses to various immune stimulants. METHODS Weekly physical activity and daily television attendance were obtained from questionnaires at inclusion of the PreDicta study. PBMC cultures were stimulated with phytohemagglutinin (PHA), R848, poly I:C, and zymosan. A panel of cytokines was measured and quantified in cell culture supernatants using luminometric multiplex immunofluorescence beads-based assay. RESULTS Asthmatic preschoolers showed significantly more TV attendance than their healthy peers (58.6% vs. 41.5% 1-3 h daily and only 25.7% vs. 47.2% ≤1 h daily) and poor asthma control was associated with less frequent physical activity (PA) (75% no or occasional activity in uncontrolled vs. 20% in controlled asthma; 25% ≥3 times weekly vs. 62%). Asthmatics with increased PA exhibited elevated cytokine levels in response to polyclonal stimulants, suggesting a readiness of circulating immune cells for type 1, 2, and 17 cytokine release compared to subjects with low PA and high TV attendance. This may also represent a proinflammatory state in high PA asthmatic children. Low physical activity and high TV attendance were associated with a decrease in proinflammatory cytokines. Proinflammatory cytokines were correlating with each other in in vitro immune responses of asthmatic children, but not healthy controls, this correlation was more pronounced in children with sedentary behavior. CONCLUSION Asthmatic children show more sedentary behavior than healthy subjects, while poor asthma control is associated with a substantial decrease in physical activity. Our results suggest that asthmatic children may profit from regular exercise, as elevated cytokine levels in stimulated conditions indicate an immune system prepared for responding strongly in case of different types of infections. However, it has to be considered that a hyperinflammatory state in high PA may not be beneficial in asthmatic children.
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Affiliation(s)
- Debbie J. Maurer
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Chengyao Liu
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University Beijing China
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Barbara Stanic
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Claus Bachert
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Susetta Finotto
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum Erlangen Erlangen Germany
| | - Ya‐Dong Gao
- Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China
| | - Anna Graser
- Department of Molecular Pneumology Friedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum Erlangen Erlangen Germany
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent Medicine University of Turku and Turku University Hospital Turku Finland
- PEDEGO Research Unit, Medical Research Center University of Oulu Oulu Finland
- Department of Pediatrics and Adolescent Medicine Oulu University Hospital Oulu Finland
| | - Walter Kistler
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Marek Kowalski
- Department of Immunology, Rheumatology and Allergy Central University Hospital Lodz Poland
| | - Heikki Lukkarinen
- Department of Pediatrics and Adolescent Medicine University of Turku and Turku University Hospital Turku Finland
| | - Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Michael Villiger
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Department of Sports Medicine Davos Hospital Davos Switzerland
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital Capital Medical University Beijing China
- Department of Allergy, Beijing TongRen Hospital Capital Medical University Beijing China
| | - Nan Zhang
- Upper Airway Research Laboratory Ghent University Hospital Ghent Belgium
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Swiss Research Institute for Sports Medicine (SRISM) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
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4
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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5
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Evaluation of exercise-induced bronchoconstriction and rhinitis in adolescent elite swimmers. North Clin Istanb 2021; 8:493-499. [PMID: 34909588 PMCID: PMC8630724 DOI: 10.14744/nci.2021.99327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/23/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Exercise-induced bronchoconstriction (EIB) without asthma and non-allergic rhinitis is frequently reported in athletes who are facing high-risk of airway dysfunctions such as elite swimmers. Therefore, we aimed to evaluate the effect of exercise on nasal and pulmonary functions, additionally to determine the prevalence of EIB and rhinitis in adolescent elite swimmers. METHODS The study included 47 adolescent licensed-swimmers (26 males and 21 females) aged between 10 and 17 years old. The prevalence of asthma and allergic disease and the symptom severity scores measured before and after swimming training were assessed through an interview form which includes information related to our study goal. In addition, acoustic rhinometry was utilized to evaluate nasal airway, spirometry was utilized to evaluate EIB in accordance with standard protocols. RESULTS Six swimmers had a history of allergic rhinitis (12.8%), while three (6.4%) had asthma. Post-swim mean forced vital capacity (FVC) was significantly higher than pre-swim FVC (p=0.019) and forced expiratory volume 1 (FEV-l)/FVC ratio was significantly lower than pre-swim FEV-l/FVC ratio (p=0.034). In addition, the prevalence of EIB was 8.5%. Moreover, level of nasal discharge statistically increased in post-swim period (p=0.003). CONCLUSION We have documented that swimming cause's nasal discharge but do not effect nasal passages. In addition, we observed that the overall prevalence of EIB in swimmers was not different from that of the general population, furthermore swimming exercise significantly increased FVC of swimmers. Therefore, we concluded swimming training can be recommended for children diagnosed with asthma or allergic rhinitis.
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Del Giacco S, Couto M, Firinu D, Garcia-Larsen V. Management of Intermittent and Persistent Asthma in Adolescent and High School Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2166-2181. [PMID: 32620431 DOI: 10.1016/j.jaip.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/06/2023]
Abstract
Asthma is the most common chronic condition during childhood and adolescence, affecting an estimated 8% of children and youngsters below 18 years in the United States and the United Kingdom. In adolescent athletes, asthma-like symptoms may represent a common consequence of regular sport practice. Asthma in young athletes poses several challenges, including the ambiguity of definitions and diagnosis of asthma resulting from exercise-induced symptoms, the best pharmacological treatments, and the nonpharmacological options for the management of disease and the challenges inherent to this age group. At a time when the regular practice of sports is increasingly being recommended for a healthy living, the support network around the young athletes is crucial to reduce the impact of asthma on their physical and emotional well-being. In this review, we examine the main issues around the definitions and clinical differentiations of asthma in young sport athletes. We discuss best practice approaches to improve the adherence to the clinical management, including nonpharmacological strategies directed at the family and trainers of athlete adolescents.
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Affiliation(s)
- Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Mariana Couto
- Immunoallergology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vanessa Garcia-Larsen
- Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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7
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Abstract
There are numerous disorders of the skin that occur in athletes. These include infections, mechanical injury, and inflammatory skin diseases such as dermatitis, urticaria, and others. This paper discusses some of the most common athletic skin diseases.
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Affiliation(s)
- Patrick C Carr
- Department of Dermatology, University of Virginia, PO Box 800718, Charlottesville, VA 22908, USA
| | - Thomas G Cropley
- Department of Dermatology, University of Virginia, PO Box 800718, Charlottesville, VA 22908, USA.
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8
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Mustafa S. Heating-induced contraction in airways smooth muscle: A possible causative factor of exercise-induced bronchoconstriction. Respir Physiol Neurobiol 2018; 259:162-165. [PMID: 30412771 DOI: 10.1016/j.resp.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
Asthmatic patients often suffer from bronchoconstriction or asthma following breathing hot air or exposure to exercise due to raises the core body temperature. However, the direct effect of heating airways has not been studied yet. The aim of this study is to investigate the effect of heating on tracheal and bronchiolar smooth muscles. Isolated ovine tracheal strips and bronchiolar segments preparations were suspended in organ baths containing Krebs' solution for isometric tension recording. Tissues responses were examined during decreasing and elevating baths temperature (20 °C, 40 °C-45 °C and 50 °C). Cooling or heating induced rapid and reproducible contractions proportional with decreasing or increasing temperature respectively in tracheal and bronchiolar preparations. On reset to 37 °C the tone returned rapidly to basal level. Changing the bath's temperature from 37 °C to 20 °C or to 40 °C and 45 °C for tracheal strips or to 45 °C and 50 °C for bronchiolar segments induced contractions in both preparations. Changing the temperature below or above the normal body temperature (37 °C), leads to airways contractions. Heating induced contractions in tracheal and bronchiolar smooth muscle proportional to the heating temperature. Therefore, breathing hot air or elevation of body core temperature due to exercise can be considered possible causative factor of heating- or exercise-induced bronchoconstriction.
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Affiliation(s)
- Seham Mustafa
- Department of Biomedical Sciences, College of Nursing, Public Authority for Applied Education & Training, Kuwait.
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9
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Caggiano S, Cutrera R, Di Marco A, Turchetta A. Exercise-Induced Bronchospasm and Allergy. Front Pediatr 2017; 5:131. [PMID: 28642859 PMCID: PMC5462910 DOI: 10.3389/fped.2017.00131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/17/2017] [Indexed: 01/02/2023] Open
Abstract
Sport is an essential part of childhood, with precious and acknowledged positive health effects but the impact of exercise-induced bronchoconstriction (EIB) significantly reduces participation in physical activity. It is important to recognize EIB, differentiating EIB with or without asthma if the transient narrowing of the airways after exercise is associated with asthmatic symptoms or not, in the way to select the most appropriate treatment among the many treatment options available today. Therapy is prescribed based on symptoms severity but diagnosis of EIB is established by changes in lung function provoked by exercise evaluating by direct and indirect tests. Sometimes, in younger children it is difficult to obtain the registration of difference between the preexercise forced expiratory volume in the first second (FEV1) value and the lowest FEV1 value recorded within 30 min after exercise, defined as the gold standard, but interrupter resistance, in association with spirometry, has been showed to be a valid alternative in preschool age. Atopy is the main risk factor, as demonstrated by epidemiologic data showing that among the estimated pediatric population with EIB up to 40% of them have allergic rhinitis and 30% of these patients may develop adult asthma, according with atopic march. Adopting the right treatment and prevention, selecting sports with no marked hyperventilation and excessive cooling of the airways, children with EIB can be able to take part in physical activity like all others.
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Affiliation(s)
- Serena Caggiano
- Respiratory Intermediate Care Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
- Sleep and Long Term Ventilation Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Renato Cutrera
- Respiratory Intermediate Care Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
- Sleep and Long Term Ventilation Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Antonio Di Marco
- Respiratory Intermediate Care Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
- Sleep and Long Term Ventilation Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015. [PMID: 26672959 DOI: 10.3402/ecrj.v2.27984.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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11
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015; 2:27984. [PMID: 26672959 PMCID: PMC4653278 DOI: 10.3402/ecrj.v2.27984] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/04/2015] [Indexed: 01/03/2023] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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12
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Exercise training, lymphocyte subsets and their cytokines production: experience of an Italian professional football team and their impact on allergy. BIOMED RESEARCH INTERNATIONAL 2014. [PMID: 25050349 DOI: 10.1155/2014/429248.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, numerous articles have attempted to shed light on our understanding of the pathophysiological mechanisms of exercise-induced immunologic changes and their impact on allergy and asthma. It is known that lymphocyte subclasses, cytokines, and chemokines show modifications after exercise, but outcomes can be affected by the type of exercise as well as by its intensity and duration. Interesting data have been presented in many recent studies on mouse models, but few studies on humans have been performed to check the long-term effects of exercise over a whole championship season. METHODS This study evaluated lymphocyte subsets and their intracellular IL-2, IL-4, TNF-α, and IFN-γ production in professional football (soccer) players, at three stages of the season, to evaluate if alterations occur, particularly in relation to their allergic status. RESULTS AND CONCLUSION Despite significant mid-season alterations, no significant lymphocyte subclasses count modifications, except for NKs that were significantly higher, were observed at the end. IL-2 and IL-4 producing cells showed a significant decrease (P = 0.018 and P = 0.001, but in a steady fashion for IL-4), confirming the murine data about the potential beneficial effects of aerobic exercise for allergic asthma.
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13
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Exercise training, lymphocyte subsets and their cytokines production: experience of an Italian professional football team and their impact on allergy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:429248. [PMID: 25050349 PMCID: PMC4094862 DOI: 10.1155/2014/429248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, numerous articles have attempted to shed light on our understanding of the pathophysiological mechanisms of exercise-induced immunologic changes and their impact on allergy and asthma. It is known that lymphocyte subclasses, cytokines, and chemokines show modifications after exercise, but outcomes can be affected by the type of exercise as well as by its intensity and duration. Interesting data have been presented in many recent studies on mouse models, but few studies on humans have been performed to check the long-term effects of exercise over a whole championship season. METHODS This study evaluated lymphocyte subsets and their intracellular IL-2, IL-4, TNF-α, and IFN-γ production in professional football (soccer) players, at three stages of the season, to evaluate if alterations occur, particularly in relation to their allergic status. RESULTS AND CONCLUSION Despite significant mid-season alterations, no significant lymphocyte subclasses count modifications, except for NKs that were significantly higher, were observed at the end. IL-2 and IL-4 producing cells showed a significant decrease (P = 0.018 and P = 0.001, but in a steady fashion for IL-4), confirming the murine data about the potential beneficial effects of aerobic exercise for allergic asthma.
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Crisafulli A, Tocco F, Melis F, Milia R, Concu A. Natural killer cells responsiveness to physical exercise: A brief review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/oji.2013.34024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Borges GF, Teixeira AMBM, Rama LMLP, Pedreiro S, Santos AMC, Massart AGM, Alves FB, Paiva A. Diferenças em populações de células exterminadoras naturais (Natural Killers-NK) sanguíneas periféricas entre atletas de caiaque e não atletas. REV BRAS MED ESPORTE 2012. [DOI: 10.1590/s1517-86922012000500004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O exercício estressante prolongado tem sido associado a uma depressão transitória da função imune, com rotinas de treinamento e competição intensas e prolongadas capazes de levar os atletas a uma deficiência imune. OBJETIVO: O objetivo deste estudo foi observar se o treinamento cr ônico foi capaz de produzir diferenças sustentáveis no sangue periférico (SP) subpopulações de leucócitos (LEU, granulócitos, monócitos, linfócitos totais, linfócitos B e T, e células CD4+ e CD8+T e células natural killers) de atletas de caiaque de elite quando comparados com não atletas. MÉTODOS: A amostra incluiu 13 homens atletas de caiaque de elite, 20 ± 3 anos, 75,0kg ± 7,9 peso e 177,3 ± 7,1 cm estatura. O VO2max foi 58,3 ± 7,8mL.kg.min-1. O grupo de não atletas incluiu sete homens saudáveis, idade 18 ± 1 ano de idade, 81,3 ± 13,8Kg de peso corporal e 171,9 ± 4,5cm de estatura. As amostras de sangue dos atletas foram coletadas no início da temporada de treinamento, após um período fora do treinamento de seis semanas. Populações de células sanguíneas periféricas foram identificadas por análise de citometria de fluxo. Para identificar as diferenças entre os grupos de atletas e não atletas, o teste U de Mann-Whitney foi utilizado. RESULTADOS: N ão foram identificadas diferenças entre os atletas de caiaque treinados e não atletas em repouso, exceto para células natural killers (CD3-CD56+) e os valores da subpopulação CD3-CD56+CD8+ os quais foram mais baixos nos atletas. CONCLUSÃO: Nosso estudo encontrou que, após um período prolongado sem treinamento (seis semanas), somente a população de NK CD3-CD56+ e, em especial, a subpopulação de altamente citotóxica CD3-CD56+CD8+ apresentou níveis mais baixos nos atletas de elite quando comparados com os homens destreinados.
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De Luca JF, Adams BB, Yosipovitch G. Skin Manifestations of Athletes Competing in the Summer Olympics. Sports Med 2012; 42:399-413. [DOI: 10.2165/11599050-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Physical activity is beneficial for children with positive outcomes for mental and physical well-being. Allergic conditions unique to the sporting arena may serve as an impediment to participation in physical activity for allergic children. A common example is exercise-induced asthma; less common activity-related allergic conditions include food-dependent exercise-induced anaphylaxis, exercise-induced anaphylaxis, and exercise-induced urticaria. Allergic children may also be at risk of allergic reactions when exposed to allergens that are more commonly found in the sports environment, e.g., latex, sports drinks, and medications such as NSAIDs. Recent advances in our understanding of the patho-physiological and immunologic mechanisms that may account for these conditions have facilitated more effective and safer management strategies. There are also important immunologic lessons to be learnt with respect to specific physical factors that may result in diminished allergen tolerance; indeed, these lessons may facilitate safer allergen desensitisation regimens. The role of the immune system in exercise-induced immunoallergic syndromes, clinical aspects, and diagnostic and therapeutic approaches are discussed in this review.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences M. Aresu, University of Cagliari, Cagliari, Italy.
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Brescianini S, Brunetto B, Iacovacci P, D'Ippolito C, Alberti G, Schirru MA, Stazi MA, Pini C, Di Felice G, Barletta B. Prevalence of self-perceived allergic diseases and risk factors in Italian adolescents. Pediatr Allergy Immunol 2009; 20:578-84. [PMID: 18710432 DOI: 10.1111/j.1399-3038.2008.00793.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of the study was to assess the symptoms prevalence of allergic diseases in a population of 11-15 yr old schoolchildren, to evaluate the associations between asthma and other symptoms and identify risk factors for asthma, rhinitis and eczema syndromes. A sample of 481 students was studied using an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Prevalence of different kind of self-reported symptoms was calculated. Using a logistic regression approach, we tried to identify risk factors for three syndromes - rhinitis, eczema and asthma. The highest and the lowest prevalence rates of self-reported symptoms were recorded for rhinitis (43.6%) and for eczema (8.1%), respectively. The prevalence of asthma was 15.7%. Univariate analysis showed a mutual association between wheeze and rhinitis symptoms. Multivariate logistic regression model for eczema syndrome revealed female gender as a significant risk factor. The polytomic logistic multivariate regression revealed female gender and family history of allergy as significant risk factors for rhinitis syndrome only, and maternal smoking and familial allergy for rhinitis and asthma together. In particular, familial allergy yields a 400% higher chance of developing asthma and rhinitis together. The synergistic effect of familial allergy on rhinitis and asthma syndromes suggests the implementation of preventive measures in children with family history of these diseases.
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Affiliation(s)
- Sonia Brescianini
- National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, I-00161 Rome, Italy
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Influence of physical activity and television-watching time on asthma and allergic rhinitis among young adolescents: preventive or aggravating? Allergol Immunopathol (Madr) 2009; 36:247-53. [PMID: 19080795 DOI: 10.1016/s0301-0546(08)75218-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Related to exercise hypothesis, the aim of the present study was to explore the influence of physical activity on asthma and allergic rhinitis in a developing country where publicity campaigns about the benefits of exercise are scarce. METHODS The analysed data were self-reported and obtained through the standardized International Study of Asthma and Allergies in Childhood Phase Three written questionnaires completed by 3026 adolescents 13/14 year old in Skopje (Republic of Macedonia). Vigorous physical activity and television-watching timeboth unadjusted and adjusted for confounding factorswere used as variables for analysis. Odds ratios (OR, 95 % CI) in binary logistic regression were employed for statistic analysis of the data. RESULTS Vigorous physical activity both > or = 3 times and 1-2 times per week was associated with an increased risk of current wheeze (aOR: 1.66; 1.08-2.55; p = 0.020 and aOR: 1.70; 1.23-2.36; p = 0.001, respectively), speech-limiting wheeze (aOR: 3.15; 1.13-8.77; p = 0.028 and aOR: 4.62; 2.22-9.62; p = 0.000, respectively) and exercise-induced wheeze (aOR: 2.72; 1.93-3.83; p = 0.000 and aOR: 4.01; 3.12-5.14; p = 0.000, respectively). Frequent physical activity was positively associated only with current allergic rhinitis symptoms (aOR: 1.40; 1.04-1.90; p = 0.029). Television watching > or = 3 hours a day increased the risk of current wheeze (aOR: 1.34; 1.01-1.77; p = 0.042) and exercise-induced wheeze (aOR: 1.32; 1.05-1.65; p = 0.016). CONCLUSION The findings support the aggravating role of sedentary regimen and poor physical fitness on asthma symptoms, but not on allergic rhinitis. Physical activity may trigger asthma symptoms when physical fitness is poor and asthma is not controlled.
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Kohlhammer Y, Zutavern A, Rzehak P, Woelke G, Heinrich J. Influence of physical inactivity on the prevalence of hay fever. Allergy 2006; 61:1310-5. [PMID: 17002707 DOI: 10.1111/j.1398-9995.2006.01131.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic diseases constitute a major public health problem, increasing constantly in frequency and severity. While treatments are improving, the main cause for an increasing trend of hay fever and its definite triggers remain unclear. The aim of our study was to assess whether physical inactivity could be a risk factor for hay fever. METHODS We analysed data of a cohort of children aged 5-14 years at baseline (1992-1993) who were followed up until 2003-2005. Parental-reported information on physical activity (being active, doing sports) was obtained for 2429 children participating at the baseline survey (active: n = 1923; semi-active: n = 364; inactive: n = 142). A total of 1703 children (70.1%) were reapproached at least once during follow-up. Logistic regression models were applied to study associations between hay fever, allergic sensitization and physical activity, adjusted for potentially relevant confounders such as age, gender, study site, parental education, breastfeeding, crowding, daycare, dampness or visible moulds, contact to cats, current or prior environmental tobacco smoke exposure and parental atopy. RESULTS Significantly higher rates of hay fever were seen for inactive children [aOR 2.39 (95% CI 1.31-4.36) for baseline survey 1992-1993 and aOR 1.76 (95% CI 1.14-2.71) for the follow-up-period until 2005]. In addition, the relative risk of incident cases of hay fever increased depending on inactivity [aRR 1.50 (95% CI 1.05-2.13)]. No association was found between physical inactivity and allergic sensitization assessed by radioallergosorbent test determinations. CONCLUSIONS Although the underlying biological mechanisms could not be clarified, increasing physical activity in childhood is suggested to prevent hay fever.
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Affiliation(s)
- Y Kohlhammer
- GSF - National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
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Abstract
Allergic diseases are common in athletes. As such, sports medicine practitioners will be involved in the management of allergic diseases on a nearly daily basis. Appreciating the wide array of allergic manifestations in this active population is essential to their accurate and efficient treatment. Although the bulk of allergic disease in athletes is mild, some allergic manifestations are far more serious and even potentially life-threatening. Aggressive and thoughtful allergy management should ensure that all athletes can continue to compete safely and at the highest level possible.
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MESH Headings
- Anaphylaxis/diagnosis
- Anaphylaxis/therapy
- Angioedema/diagnosis
- Angioedema/therapy
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/therapy
- Dermatitis, Allergic Contact/diagnosis
- Dermatitis, Allergic Contact/therapy
- Exercise/physiology
- Food Hypersensitivity/diagnosis
- Food Hypersensitivity/therapy
- Humans
- Hypersensitivity/diagnosis
- Hypersensitivity/immunology
- Hypersensitivity/therapy
- Immunotherapy/methods
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/therapy
- Sports Medicine/methods
- Urticaria/diagnosis
- Urticaria/therapy
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Affiliation(s)
- John M MacKnight
- Department of Clinical Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Saranz R, Del Giacco G, Croce V, Del Giacco S. Exercise-Induced Asthma: An Update. EUR J INFLAMM 2004. [DOI: 10.1177/1721727x0400200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Exercise-induced asthma (E.I.A) affects 12–16% of the general population and most of the patients affected by extrinsic or intrinsic asthma. Surprisingly, also a high percentage of professional and Olympic athletes are affected, showing that E.I.A. does not impair physical activity, whereas endurance sports bear a higher risk than the others. The mast cell role, late asthmatic responses, diagnosis, therapy, theories and data about immunological parameters in sports are taken into consideration in this review.
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Affiliation(s)
| | - G.S. Del Giacco
- Dipartimento di Medicina 2, Policlinico Universitario, Università di Cagliari, Italy
| | | | - S.R. Del Giacco
- Dipartimento di Scienze Mediche Internistiche, Policlinico Universitario, Università di Cagliari, Italy
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