Lifestyle Health & Fitness Sneezing - Beyond Antihistamines, Beyond Antibiotics

Sneezing – Beyond Antihistamines, Beyond Antibiotics

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by Dr Julian Hong, Resident Physician, DTAP Clinic


The body produces a violent non-controllable expulsion of air from the nose. This process starts with viruses infecting the airways, or through the presence of allergens or physical irritants (fragrances, cigarette smoke or polluted air) that irritates the respiratory linings in the nasal cavity.

Chemicals – histamines and leukotrienes then release leukotrienes from inflammatory cells, stimulating the mucous glands causing a runny nose, and then triggering the nerve endings causing an itchy nose. This whole process culminates in the phenomenon known as sneezing.

The sneeze occurs for the body to expel these irritants from our nasal passages. Sneezing is but one of the earliest and most pronounced ways your body tells you something is wrong. It is the evolutionary reflex that ensures we continue to have clear access to our vital building block in life – oxygen. While sneezing is not without reason, it perturbs us if it persists. We may find medical solutions or listen to our families and friends, or even scour the Internet for answers.

As a physician, I have encountered people from all walks of life, encumbered by these symptoms of sneezing, impeding their ability to work or play and ultimately affecting their quality of life. Let us explore some answers.

Beyond Antibiotics
We have had 2 waves of flu during the 2018-2019 season, one peaking at December
and the other almost as recently as April, May.

The influenza virus undergoes a mutation every year allowing it to evade the body’s immune system. This causes the constellation of symptoms which includes sneezing, runny or blocked nose, sore throat, body aches and fever.

The virus spreads predominantly through droplets that emerge from talking, coughing or sneezing. The 2017-2018 flu season had been the most devastating, where nearly 1 million people worldwide were hospitalized for flu, with about 80,000 reported deaths and sadly, of which 600 were children.

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Many people simply down 2 paracetamol tablets and go to sleep. But when the
symptoms persist, people visit doctors demanding for antibiotics.

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Antibiotics can play a huge part in the treatment of bacterial related upper respiratory tract infections only and have no effect on flu. Furthermore, the overuse of antibiotics eventually leads to the public health problem of antibiotic resistance and the proverbial fear of creating the “superbug” because of this multidrug resistance.

So with the knowledge of how nasty the flu infection can get, especially for those who are considered high risk: those with pre-existing chronic conditions, lowered immunity, pregnant, elderly above 65, or heart or lung disease, it is imperative to get to the bottom of this “conflusion”, whether to get a flu vaccination, or survive through the flu with warm honey lemon and warm blankets.

The flu vaccination can be part of the yearly armament to protect yourself from the dreaded virus. Now, you can get a rapid test for flu done in under 15 minutes (in some clinics).

If the results show you have the Flu virus, you can then take flu antivirals for you to recover expediently. The most efficacious treatment window is in the first 48 hours. And rather than suffering from the symptoms of the flu for the entire week or two or develop complications, it is advisable to see your doctor early for testing and treatment.

The advances and benefits of rapid flu testing have not gone unnoticed as a recent study done in a large 1100 tertiary care hospital in Israel during 2016-2017 and the 2017-2018 flu season have proven many benefits to patients, including earlier discharge from hospitals, a 10% drop in hospitalization and the decrease of transmission of flu within the hospital by more than 50%. Not only that, non-judicious antibiotic use was also decreased by more than 50%, which translates to cost savings for patients.

Beyond Antihistamines
Another factor which is triggering the bouts of sneezing is due to allergies from hay fever (allergic rhinitis). This constellation of symptoms brought about by allergies include sneezing, watery eyes, runny or blocked nose and even a skin rash.

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An allergy is a common condition that can happen at any age, where the person’s own immune system overreacts with substances that are usually harmless for most people. These allergens include anything from house dust mites, pollen, moulds (fungi) , pet danders, insect sting/bites, or certain types of medicines, and even foods. The chemical Immunoglobulin E mediates these allergy symptoms and typically manifest within 1 to 2 hours after exposure to the allergen.

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Allergies are more common in people with a genetic disposition towards them, and so it is also common to find relatives having similar allergies. Sometimes, more than just a sneeze, allergic reactions can evolve into a potentially life-threatening condition known as anaphylaxis.

I remember speaking with Sacha just a few days ago who was recently enrolled in a pre-university course. Excited and optimistic, the various exposures to the industry captivated him.

It offered the opportunity to work with many plant types and their pollen. But unfortunately, as the course progressed, so did his once dormant sensitive skin symptoms. Having a background of sensitive nose and skin, his disposition to allergies was heightened.

And all it took was this exposure to pollen to cause an aggravation of his sensitive skin. Redness, irritation, dry, cracking and bleeding skin ensued. These symptoms confined Sacha to recovering at home for an extended period, away from his course, coursework and practical exams.

There are many reasons and benefits to get your allergies treated. One of these reasons is to prevent the progression of the “allergic march”. If an allergy is not diagnosed or treated, it can progress from sensitive skin (eczema), sensitive nose (allergic rhinitis) to food allergies or even sensitive lungs (asthma). In this situation, Sacha had poorly controlled sensitive nose when he was younger, and as he grew up, he started to develop sensitive skin and sensitive eyes.

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This meant that if Sacha had treated his allergies earlier, he could have prevented this “allergic march” from taking place and potentially saved himself the trouble of dealing with this multitude of allergies.

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More often than not, when we think of treatment for allergies, we think of popping antihistamines which are available over the counter. For most people, this would provide some mild and temporary relief, but for those whose allergies are recalcitrant, this does not help at all.

The alternative – SubLingual Immunotherapy (SLIT)
Fortunately there is a way, and it is by identifying the allergen one is allergic to and
subsequently exploring a novel treatment known as SubLingual Immunotherapy (SLIT).

This was what Velda did. Velda kept pets at home. She started to suspect an allergy when she would sneeze non stop whenever she stayed too long in her room. Initially,
simple antihistamines helped, and her family tried to minimize the buildup of dust in her room, thinking it was a dust mite allergy. But after many years, she was finally tested for her allergy with a skin prick test (a blood test is also possible) and was found to be allergic to both cats and dogs!

As you know, the main reason for knowing the allergen that one is triggered by is simply to avoid it. But in this case, as an avid animal lover and training to be a vet, Velda needed a different way. Velda was started on SLIT to Cat and Dog dander and had experienced a significant improvement in her symptoms and quality of life, even allowing her to continue her training as a vet.

Some people are dismissive when it comes to what appears as simple sneezing. But a visit to your doctor may ensure that it gets proper and resolute treatment, whether it be flu, a common cold, or allergies.

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