EpistemisParoxysmal sneezing
Specialty: Otolaryngology.
Why it occurs
- Seasonal allergic rhinitis due to immediate IgE-mediated hypersensitivity to environmental pollens
- Occupational rhinitis due to inhalation of organic dusts, chemical irritants or flours
- Vasomotor rhinitis triggered by sudden changes in temperature, bright light (photic sneezing) or ingestion of spicy foods
- Acute viral infection in the incubation phase or prodromes due to rhinovirus or adenovirus
Initial workup
Skin prick tests with a standard battery of inhalant allergens, determination of total and specific IgE in serum, nasal mucus cytology to look for eosinophils in case of suspected non-allergic eosinophilic rhinitis (NARES), and nasofibroscopy if symptoms are refractory.
red flags
High fever associated with affectation of general condition, intense fronto-orbital headache that does not subside with regular analgesics, appearance of profuse epistaxis coinciding with sneezing, or severe pleuritic chest pain triggered by the repeated effort of sneezing.
Standard management
- Second generation oral antihistamines such as bilastine — 20 mg orally every 24 hours on an empty stomach to minimize drowsiness and ensure rapid effect
- Topical nasal corticosteroids such as budesonide or mometasone — 50 mcg, 2 sprays in each nostril every 24 hours
- Intranasal antihistamines such as azelastine — quick local action
- Montelukast (10 mg orally every 24 hours at night, especially if associated with bronchial asthma or aspirin sensitivity).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4