Ask Dr James: Why can’t I stop sneezing?

In his regular column, Dr James Le Fanu answers your questions. This week: a reader who can’t stop sneezing

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Almost every evening I have an itchy tickly sensation in my throat culminating in an explosive bout of sneezing. My ears also ache with a sensation as if I am about to develop a head cold. After much persuading my general practitioner eventually referred me to an allergy specialist who unfortunately could neither explain what might account for this or how it could be prevented.
The vigorous expulsion of air when sneezing is not just (self evidently) highly effective in dislodging nasal irritants but an intriguing reflex in other ways instigated by a diverse range of stimuli. The practicalities, that come in two distinct phases, are surprisingly complex. In the first, the lining of the nose becomes engorged secreting a thin watery mucus followed by a series of deep rapid inspirations accumulating a large volume of air within the lungs. When this reaches a critical point, the elastic recoil of the expanded lungs together with contraction of the muscles of the chest wall accelerates air out through the nose and mouth at the phenomenal speed, it has been calculated, of 100 feet per second.
The common precipitants of the reflex are familiar enough colds and other viral illnesses, pollutant particles and odours and, for hay fever sufferers, pollen. But several other factors can, as here, give rise to less obviously explicable recurrent sneezing syndromes.
For some it can be an abrupt change in temperature: “I sneeze profusely on getting into my car after it has been parked on the street on a cold night”, reports one reader. As to exposure to bright lights or glaring sunshine, “the photic-sneeze reflex” (as it is known) may be potentially hazardous when it occurs while driving.
Anger and resentment can predispose to sneezing, the late Prof Linford Rees, a psychiatrist at London’s St Bart’s hospital has observed, whilst conversely it may also resolve emotional tension. Pleasure too, one might infer, from how dogs greet their returning owners with a vigorous bout of sneezing.
As for humans, sexual excitement can have a similar effect first described more than a hundred years ago in “a man of sanguine temperament who whenever he caressed his wife would sneeze several times”. This may be because of the surprising anatomical similarity of the lining of the nose to other better known erectile tissues of the body.
This obscure medical term refers to the phenomenon where the taste (gustatory) of certain foods can cause the nasal lining to become inflammed (rhinitis) resulting in explosive bouts of sneezing. Pickled foods, dark chocolate, sugar and cheap white wine are the main culprits. This form of recurrent sneezing tends to run in families so there is a genetic component but when it develops in later life is clearly age related.
Many nowadays take a small daily dose of aspirin in anticipation its blood thinning properties may reduce the risk of heart attack or stroke. This, along with the widespread use of non-steroidal anti-inflammatory drugs (NSAIDS), such as Nurofen, is probably the major cause of otherwise unexplained sneezing syndromes.
Recurrent sneezing is essentially a benign condition though, if very rarely, the convulsive pressure changes within the chest may rupture a blood vessel with bleeding into the brain or retina. Its frequency and intensity can be mitigated with antihistamines and nasal sprays. Beyond that, squeezing the upper lip or vigorous nose blowing may, it is claimed, terminate a prolonged bout.
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