Cold-Induced Rhinitis in Skiers— Clinical Aspects and Treatment with Ipratropium Bromide Nasal Spray: A Randomized Controlled Trial Patrizia Bonadonna, M.D.,* Gianenrico Senna, M.D.,* Piero Zanon, M.D.,# Giulio Cocco, M.D.,§ Romolo Dorizzi, M.D.,¶ Federica Gani, M.D., Massimo Landi, M.D.,** Massimo Restuccia, M.D.,## Amalia Feliciello, M.D.,§ and Giovanni Passalacqua, M.D.§§ (Italy) ABSTRACT Cold-induced rhinitis (CIR) is common among skiers and is perceived as a troublesome disease. We studied the clinical characteristics of CIR in a population of skiers and we evalu- ated the effectiveness of ipratropium bromide nasal spray (IBNS) in relieving symptoms in a double-blind placebo-con- trolled fashion. By means of specific questionnaires, we eval- uated 144 subjects (69% men; mean age, 42.2 years). The prevalence of CIR was 48.6% and the distinctive symptom was rhinorrhea (96%), often severe. The prevalence of atopy was higher in the CIR patients (x 2 ; p 5 0.004). Twenty-eight CIR subjects participated in a double-blind placebo-controlled cross-over trial for evaluating the effectiveness of IBNS (80 mg twice per day [b.i.d.]). The severity of symptoms was assessed by a visual analog scale, and the number of cleaning tissues used also was evaluated. The actively treated group showed a significant improvement of rhinorrhea (p 5 0.0007) and a reduction in the number of cleaning tissues used (p 5 0.0023). Only four mild local side effects were reported. We conclude that IBNS could be regarded as an optimal therapeutic option for treating CIR symptoms in skiers. (American Journal of Rhinology 15, 297–301, 2001) S kiing is one of the most popular sports in Europe and skiers can be affected by several disorders of the upper and lower respiratory airways. For instance, asthma is not infrequent, especially among cross-country skiers. 1 It is sustained by a bronchial inflammation of low or moderate grade, as evidenced by bronchoscopy and bronchoalveolar lavage fluid investigations. 2 Vasomotor syndromes and chronic rhinitis (often consequent to trau- matic lesions of the nose) are frequent events as well. 3 Also, allergic rhinitis, either seasonal or perennial, can impair nasal patency depending on the duration and se- verity of the exposure to allergens. A common but un- derestimated respiratory disease is cold-induced rhinitis (CIR), which affects not only skiers, but also those who From the *Allergy Unit and ¶Laboratorio Analisi Chimico Cliniche, Verona General Hospital, Verona, Italy; #Divisione di Pneumologia, Ospedale Busto Arsizio, Varese, Italy; §Divi- sione di Pneumologia, Ospedale Cardarelli, Napoli, Italy; //Di- visione di Pneumologia, Ospedale S.Luigi, Orbassano, Torino, Italy; **Servizio di Allergologia, Ospedale Kolliker, Torino, Italy; ##Limbiate Allergy Center, Milan, Italy; and §§Allergy and Respiratory Diseases, DiMI, University of Genoa, Genoa, Italy Address correspondence and reprint requests to Giovanni Pas- salacqua, M.D., Allergy and Respiratory Diseases, DIMI, Pad. Maragliano, L.go R. Benzi 10, 16132 Genoa, Italy American Journal of Rhinology 297