Ask a doctor on the topic of Allergology

Sneezing and itching after swimming in lakes.

July 12, 2011 | 20,00 EUR | answered by Christian Welsch

I have had the following problem for about 3 years:
Whenever I go swimming in lakes, reservoirs or unchlorinated outdoor pools, I have a strong reaction in my eyes and nose (excessive secretion, tingling, sneezing similar to hay fever) and sometimes also itching in the throat and occasional coughing. The effect occurs nationwide, mainly in Leipzig where I live, except for very cold mountain lakes in the Allgäu. I do not have this problem in chlorinated swimming pools. Unlike other people, I swim very intensively, meaning I have a lot of mucous membrane contact with the water in my eyes, nose, mouth, and ears due to my swimming style. I do not have hay fever and it is also the case that my wife, who swims with me and suffers from hay fever, never has any problems. Unlike with her hay fever, my symptoms do not disappear when the water contact is over, but last for days up to a week. The more frequently and quickly I swim, the stronger the symptoms become, as if something (poison?) were accumulating in my body. The symptoms worsen temporarily every time I shower. We suspected blue-green algae. However, inquiries at the Leipzig water authority revealed that the Leipzig lakes are allegedly not contaminated with blue-green algae or that the limits are well below. In our circle of acquaintances, there is also no one else with similar problems among frequent swimmers.

What other cause could the symptoms have, if not blue-green algae or pollen? And what can I do about it or to prevent it? Taking hay fever medications with cromoglicic acid and Ratioallerg nasal spray has already been recommended to me and brought very little benefit.

Christian Welsch

Dear patient,

I think you may be suffering from hyperreactive mucous membranes. There are people whose mucous membranes react to large temperature or humidity differences as described by you. Treatment can be difficult, so I would recommend using a more modern topical corticosteroid spray before swimming. (e.g. Nasonex or Syntaris) Additionally, a laser treatment of the nasal turbinates could be helpful.

I no longer prescribe cromolyn sodium for allergy relief, as it is too weak and only provides preventive relief. If your symptoms unexpectedly turn out to be allergic, it may be worth trying a modern antihistamine before swimming (e.g. Ebastine). If no reactions occur, this would suggest an allergy.

It is also possible that, due to your described "intense" swimming style, water is entering your sinuses and lingering there for a long time, irritating the mucous membranes. Clarification could also come from a CT scan of the sinuses to determine if a chronic inflammation (polyps?) is maintaining the symptoms.