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Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects
  1. Matteo Gelardi1,
  2. Maria Teresa Ventura2,
  3. Raffaele Fiorella1,
  4. Maria Luisa Fiorella1,
  5. Cosimo Russo1,
  6. Teresa Candreva1,
  7. Antonella Carretta2,
  8. Giovanni Passalacqua3
  1. 1Department of Otolaryngology II, University of Bari, Bari, Italy
  2. 2Department of Internal Medicine, Immunology and Infectious Diseases (MIDIM), University of Bari, Bari, Italy
  3. 3Allergy and Respiratory Diseases, DIMI, University of Genoa, Genoa, Italy
  1. Correspondence to Dr Giovanni Passalacqua, Allergy & Respiratory Diseases, Department of Internal Medicine, Padiglione Maragliano, L.go R. Benzi 10, 16132 Genoa, Italy; passalacqua{at}


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.

Conclusion 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.

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the inner Ethical Committee of the Medical School of the University of Bari.

  • Provenance and peer review Not commissioned; externally peer reviewed.