Rhinitis in Swimmers: A Clinical Issue at the Intersection of Sports Medicine and Otorhinolaryngology
DOI:
https://doi.org/10.12775/QS.2025.47.66927Keywords
Rhinitis, Allergic rhinitis, chlorinated water, non-allergic rhinitis, Water disinfection byproductsAbstract
The development of rhinitis in swimmers is multifactorial. Contact with disinfection byproducts plays a role in the pathogenesis of swimmer's rhinitis, leading to irritation, increased epithelial permeability, and the development of mucosal hyperreactivity, which promotes the dominance of the non-allergic irritant rhinitis phenotype in competitive swimmers. A significant deterioration in quality of life has been demonstrated in swimmers with rhinitis, as assessed using validated scales, in particular the miniRQLQ. The review emphasises the role of chronic exposure to the swimming pool environment as a modifiable risk factor and indicates that limiting contact with irritants – through the use of swimming clips, optimising ventilation, and improving water quality – can lead to reduced symptom severity and partial reversibility of changes in the nasal mucosa. Attention was drawn to the significant heterogeneity in definitions and diagnostic criteria in the literature, which makes it difficult to assess the disease's prevalence and mechanisms clearly.
References
Bernard, A., Nickmilder, M., & Dumont, X. (2015).
Chlorinated pool attendance, airway epithelium defects and the risks of allergic diseases in adolescents: Interrelationships revealed by circulating biomarkers. Environmental research, 140, 119–126. https://doi.org/10.1016/j.envres.2015.03.034
Bousquet, J., Khaltaev, N., Cruz, A. A., Denburg, J., Fokkens, W. J., Togias, A., Zuberbier, T., Baena-Cagnani, C. E., Canonica, G. W., van Weel, C., Agache, I., Aït-Khaled, N., Bachert, C., Blaiss, M. S., Bonini, S., Boulet, L. P., Bousquet, P. J., Camargos, P., Carlsen, K. H., Chen, Y., … AllerGen (2008). Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy, 63 Suppl 86, 8–160. https://doi.org/10.1111/j.1398-9995.2007.01620.x
Bousquet, J., Anto, J.M., Bachert, C. et al. Allergic rhinitis. Nat Rev Dis Primers6, 95 (2020). https://doi.org/10.1038/s41572-020-00227-0.
Bougault, V., Turmel, J., & Boulet, L. P. (2010). Effect of intense swimming training on rhinitis in high-level competitive swimmers. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 40(8), 1238–1246. https://doi.org/10.1111/j.1365-2222.2010.03551.x
Erkul, E., Yaz, A., Cıngı, C., İnançli, H. M., San, T., & Bal, C. (2014). Effects of indoor swimming pools on the nasal cytology of pool workers. The Journal of laryngology and otology, 128(5), 442–446. https://doi.org/10.1017/S0022215114000784
Fornander, L., Ghafouri, B., Lindahl, M., & Graff, P. (2013). Airway irritation among indoor swimming pool personnel: trichloramine exposure, exhaled NO and protein profiling of nasal lavage fluids. International archives of occupational and environmental health, 86(5), 571–580. https://doi.org/10.1007/s00420-012-0790-4
Gelardi, M., Ventura, M. T., Fiorella, R., Fiorella, M. L., Russo, C., Candreva, T., Carretta, A., & Passalacqua, G. (2012). Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects. British journal of sports medicine, 46(1), 54–58. https://doi.org/10.1136/bjsm.2009.066456
Jacobs, J. H., Fuertes, E., Krop, E. J., Spithoven, J., Tromp, P., & Heederik, D. J. (2012). Swimming pool attendance and respiratory symptoms and allergies among Dutch children. Occupational and environmental medicine, 69(11), 823–830. https://doi.org/10.1136/oemed-2011-100621
Kanikowska, A., Napiórkowska-Baran, K., Graczyk, M., & Kucharski, M. A. (2018). Influence of chlorinated water on the development of allergic diseases - An overview. Annals of agricultural and environmental medicine : AAEM, 25(4), 651–655. https://doi.org/10.26444/aaem/79810
Kaliner, M. A., Baraniuk, J. N., Benninger, M., Bernstein, J. A., Lieberman, P., Meltzer, E. O., Naclerio, R. M., Settipane, R. A., & Farrar, J. R. (2009). Consensus Definition of Nonallergic Rhinopathy, Previously Referred to as Vasomotor Rhinitis, Nonallergic Rhinitis, and/or Idiopathic Rhinitis. The World Allergy Organization journal, 2(6), 119–120. https://doi.org/10.1097/WOX.0b013e3181a8e15a
Kurowski, M., Jurczyk, J., Krysztofiak, H., & Kowalski, M. L. (2016). Exercise-induced respiratory symptoms and allergy in elite athletes: Allergy and Asthma in Polish Olympic Athletes (A(2)POLO) project within GA(2)LEN initiative. The clinical respiratory journal, 10(2), 231–238. https://doi.org/10.1111/crj.12210
Papadopoulos NG, Guibas GV. Rhinitis Subtypes, Endotypes, and Definitions. Immunol Allergy Clin North Am. 2016 May;36(2):215-33. doi: 10.1016/j.iac.2015.12.001. Epub 2016 Feb 28. PMID: 27083098; PMCID: PMC7127043.
Wise, S. K., Damask, C., Roland, L. T., et al. (2023). International consensus statement on allergy and rhinology: Allergic rhinitis – 2023. International Forum of Allergy & Rhinology, 13, 293–859.
Savouré, M., Bousquet, J., Jaakkola, J. J. K., Jaakkola, M. S., Jacquemin, B., & Nadif, R. (2022). Worldwide prevalence of rhinitis in adults: A review of definitions and temporal evolution. Clinical and translational allergy, 12(3), e12130. https://doi.org/10.1002/clt2.12130
Surda, P., Walker, A., Putala, M., & Siarnik, P. (2017). Prevalence of Rhinitis in Athletes: Systematic Review. International journal of otolaryngology, 2017, 8098426. https://doi.org/10.1155/2017/8098426.
Surda, P., Putala, M., Siarnik, P., Walker, A., Bernic, A., & Fokkens, W. (2018). Rhinitis and its impact on quality of life in swimmers. Allergy, 73(5), 1022–1031. https://doi.org/10.1111/all.13359
Villanueva, C. M., Cordier, S., Font-Ribera, L., Salas, L. A., & Levallois, P. (2015). Overview of Disinfection By-products and Associated Health Effects. Current environmental health reports, 2(1), 107–115. https://doi.org/10.1007/s40572-014-0032-x
Font-Ribera, L., Villanueva, C. M., Nieuwenhuijsen, M. J., Zock, J. P., Kogevinas, M., & Henderson, J. (2011). Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort. American journal of respiratory and critical care medicine, 183(5), 582–588. https://doi.org/10.1164/rccm.201005-0761OC
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Copyright (c) 2025 Mateusz Matyja, Marta Kowalska, Anna Mazur, Julia Brodziak, Katarzyna Fojcik, Wiktoria Ciszewska, Zofia Kosztyła-Czech, Tomasz Wiśniewski, Michał Dworak
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