Sex differences in upper respiratory symptoms prevalence and oral-respiratory mucosal immunity in endurance athletes

Exerc Immunol Rev. 2014;20:8-22.


The purpose of this study was to examine sex differences in oral-respiratory mucosal immunity and the incidence, severity and duration of upper respiratory symptoms (URS) episodes in endurance athletes during a 16-week winter training period. Blood was collected from 210 subjects (147 men and 63 women) at the start and end of the study for determination of differential leukocyte counts. Timed collections of unstimulated saliva were obtained at the start and at 4-week intervals during the study period. Saliva samples were analysed for salivary antimicrobial peptides and proteins (AMPs). Weekly training and daily illness logs were kept using validated questionnaires. Training loads averaged 11 h/week of moderate-vigorous physical activity and were not different for males and females. The salivary concentration of lysozyme and lactoferrin (both P < 0.04) but not salivary immunoglobulin A (SIgA) or amylase were higher in males than females. Saliva flow rates were significantly higher in males than females (P < 0.03) and consequently so were the salivary secretion rates of lysozyme, lactoferrin and amylase (all P < 0.01) but not SIgA (P = 0.097). Total blood leukocyte, monocyte and lymphocyte counts were not different between the sexes but females had higher numbers of circulating neutrophils (P = 0.040). The average number of URS episodes was 0.6 +/- 0.8 (mean +/- SD) in males and 0.8 +/- 1.0 in females (P = 0.103) and the number of URS days was higher in females (4.7 vs 6.8 days, P < 0.02). The duration of URS episodes was longer in females (11.6 vs 15.5 days, P < 0.03). The findings of this study concur with recent reports of illness incidence at major competitive games indicating that female athletes may be more susceptible than their male counterparts to URS and that lower oral-respiratory mucosal immunity may, in part, account for this.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amylases / analysis
  • Anthropometry
  • Athletes*
  • Disease Resistance
  • Exercise / physiology*
  • Female
  • Fever / epidemiology
  • Fever / immunology
  • Humans
  • Immunity, Mucosal*
  • Immunoglobulin A, Secretory / analysis
  • Incidence
  • Lactoferrin / analysis
  • Leukocyte Count
  • Male
  • Medical Records
  • Mouth / immunology*
  • Muramidase / analysis
  • Musculoskeletal Pain / epidemiology
  • Musculoskeletal Pain / immunology
  • Physical Endurance / immunology*
  • Respiratory System / immunology*
  • Respiratory Tract Diseases / epidemiology*
  • Respiratory Tract Diseases / immunology
  • Saliva / chemistry
  • Saliva / metabolism
  • Salivary Proteins and Peptides / analysis
  • Secretory Rate
  • Sex Characteristics*
  • Surveys and Questionnaires
  • Young Adult


  • Immunoglobulin A, Secretory
  • LTF protein, human
  • Salivary Proteins and Peptides
  • Amylases
  • Muramidase
  • Lactoferrin