What can I do about nasal congestion when I'm running?

Managing Nasal Congestion During Running

For nasal congestion during running, use a second-generation antihistamine before exercise and/or intranasal corticosteroids daily, combined with saline nasal irrigation before running. 1

Understanding Exercise-Induced Nasal Congestion

Exercise initially causes nasal vasoconstriction and decreased nasal resistance, which should improve breathing. However, many runners experience a rebound nasal congestion after about an hour, particularly affecting:

• Long-distance runners
• Cyclists
• Triathletes

This rebound congestion can significantly impair athletic performance, with studies showing that exercise-induced rhinitis adversely affects performance in 53% of athletes with allergies and 28% of those without allergies 1.

Treatment Algorithm

First-Line Options:

1. Saline Nasal Irrigation

   • Use before running to clear mucus and reduce congestion
   • Isotonic saline is as effective as hypertonic solutions 1
   • Can be delivered via squeeze bottle or nasal spray (both equally effective) 1

2. Intranasal Corticosteroids

   • Start daily use for ongoing prevention
   • Safe for long-term use without causing atrophic changes 1
   • Allowed by sports regulatory bodies including USOC/IOC 1

3. Second-Generation Antihistamines

   • Take 1-2 hours before running
   • Choose non-sedating options like fexofenadine, loratadine, or desloratadine 2
   • Avoid first-generation antihistamines which can impair performance due to sedative effects 1

For Breakthrough Symptoms:

• Topical Nasal Decongestants (use sparingly)
  • Oxymetazoline or phenylephrine nasal sprays provide rapid relief 3
  • Limit use to <3-5 days to prevent rebound congestion 3
  • Note: Some decongestants are banned in competitive sports except for phenylephrine and imidazole preparations 1

Special Considerations

For Competitive Athletes:

• Check medication status with WADA (www.wada-ama.org) or USOC hotline (1-800-233-0393) 1
• Allowed medications:
  • All intranasal corticosteroids
  • Most antihistamines (check specific sport regulations)
  • Topical phenylephrine and imidazole preparations
• Banned medications:
  • Most oral decongestants
  • Some antihistamines in certain sports

For Persistent Symptoms:

Consider intranasal cromolyn sodium 30 minutes before running if symptoms persist despite above measures, especially in environments with high allergen exposure 1.

Evidence-Based Effectiveness

• Saline irrigation has been shown to effectively improve nasal congestion with an 87.3% effectiveness rate compared to 59.7% in controls 4
• Intranasal corticosteroids are the most effective for controlling all rhinitis symptoms 2
• Topical decongestants provide the fastest relief but should be used short-term only 5

Common Pitfalls to Avoid

1. Using first-generation antihistamines - these can cause sedation and impair athletic performance 1
2. Overusing topical decongestants - can lead to rhinitis medicamentosa (rebound congestion) if used >3-5 days 3
3. Ignoring underlying allergies - if symptoms persist, consider allergy testing and targeted treatment 1
4. Using oral decongestants before checking sports regulations - many are banned in competitive sports 1

If symptoms persist despite these measures, especially if accompanied by other symptoms like recurrent sinusitis or asthma, referral to an allergist/immunologist is recommended for comprehensive evaluation and consideration of immunotherapy 1.