MadSci Network: Immunology |
" I swim in a pool twice a week. A couple of hours later I'll start sneezing periodically and it will continue throughout the day. This will also be accompanied with a stuffed up head, not unlike a head cold. By evening I'm fine." Dear John, What an interesting question you posed. There are many possibilities for your physical response that mimics a head cold after going to a different environment and swimming at a public pool. Some possibilities are really far out but there are some weird links occur all the time. Some factors one might overlook at a first but once you think about some of them they might make sense. Some of these possibilities you could test experimentally to determine the cause to your symptoms. For example, if you went to the pool but did not swim but spent about the same time in the pool area reading a book would you have the same response? Also, if you shower at the pool facilities and use their towels, without swimming do you have the same response? You might be wondering how weird these ideas. Many people have very server reactions to mold. People that are sensitive will have the same responses as you mentioned. This happened to people that stay in a hotel or motel room that is full of mold also for people that visit or stay for some time in a basement that is moldy. Maybe the swimming facilities are not as clean as they may appear. But if the place uses bleach to clean the pool/shower area that would likely kill out the mold, however that brings us to another point below about bleach and chlorine which some people are sensitive to. So what about the towels and the shower at the facilities? The shower and the damp dressing room are great places to grow mold. We just covered that factor above in relation to mold. The towels however might be washed with a particular soap that you show a heightened sensitivity to. If the towels are not thoroughly rinsed the fine soap particles might be a factor. But lets think about some other possibilities besides the postulations around mold and soap allergies. I found this nice article on Medline (a resource that is free to anyone) that deals directly with swimmers and respiratory symptoms. It is copied below for you. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi " Allergy. 1998 Apr;53(4):346-52. Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers. Helenius IJ, Rytila P, Metso T, Haahtela T, Venge P, Tikkanen HO. Department of Allergology, Helsinki University Central Hospital, Finland. To investigate respiratory symptoms, increased bronchial responsiveness, and signs of airway inflammation in elite swimmers, we examined 29 swimmers from the Finnish national team and 19 healthy control subjects (nonasthmatic, symptom-free). They answered a questionnaire and were interviewed for respiratory symptoms. Lung volumes were measured and bronchial responsiveness assessed by a histamine challenge test. Induced sputum samples were also collected. Fourteen (48%) of the swimmers and three (16%) of the control subjects showed increased bronchial responsiveness (P<0.05). The sputum cell differential counts of eosinophils (mean 2.7% vs 0.2%) and neutrophils (54.7% vs 29.9%) from swimmers were significantly higher than those from controls (P<0.01). Eosinophilia (sputum differential eosinophil count of >4%) was observed in six (21%) of the swimmers and in none of the controls (P<0.05). Symptomatic swimmers had significantly more sputum eosinophils than did the symptom-free. The concentrations of sputum eosinophil peroxidase (EPO) and human neutrophil lipocalin (HNL) were significantly higher in swimmers than control subjects (P<0.001 and P=0.05). We conclude that elite swimmers had significantly more often increased bronchial responsiveness than control subjects. Sputum from swimmers contained a higher percentage of eosinophils and neutrophils, and higher concentrations of EPO and HNL than sputum from controls. Long-term and repeated exposure to chlorine compounds in swimming pools during training and competition may contribute to the increased occurrence of bronchial hyperresponsiveness and airway inflammation in swimmers. " Also you might consider the sneezing effects a bit independent of the cold like symptoms you have after swimming. If you are in a swimming pool like some that I have been in the room is usually very well illuminated with lights. Maybe the walls and floor are white in color making the room even brighter. Bright intense lights can induce a sneezing reflex. Perhaps even after you're done swimming with your eyes closed part of the time and then open wide after your done will provide a greater response to the bright lights. You may have experienced such a phenomenon when you outside and you look at the sun and all the sudden sneeze. This is a very interesting response. Of course you can test this yourself to know if your very sensitive to such a light induced response with out having to swim at the pool. In case you are interested I found another article from Medline related to the sneezing response induce by light. " Anaesthesia Volume 58 Issue 9 Page 925 - September 2003 Correspondence General anaesthesia and the photosternutatory reflex by S. Yarrow Sneezing in response to bright light is a poorly-understood phenomenon - and is known by a variety of synonyms - photic sneezing, solar sneezing or the photosternutatory reflex. Although it is usually only an annoyance, its occurrence during surgery could be a cause of morbidity. A 79-year-old man presented for cataract surgery at his local hospital. He had a history of mild chronic obstructive airway disease but physical examination was unremarkable. General anaesthesia was requested by the patient because of a history of photic sneezing. He reported a tendency to sneeze violently in response to bright lights, and was concerned about the consequences of this occurring if the operation was in progress under local anaesthesia. It was judged that there was no absolute contraindication to general anaesthesia, and he was prepared accordingly. Surgery and anaesthesia were entirely uneventful, apart from violent sneezing in response to the lights in the anaesthetic room, and he was discharged the following day. The photosternutatory reflex was described as long ago as the nineteenth century. Classically, a susceptible dark-adapted subject will sneeze in response to a sudden sunlight stimulus, but the reflex can also be stimulated by artificial light, ultraviolet light [1], photographic flash light, ophthalmic slit lamp examination [2] and EEG photic stimulation [3]. Sneezes can be single or multiple, and there is typically a refractory period afterwards during which no further sneezing can be induced. The reflex may prove hazardous to individuals in certain occupations - baseball outfielders, pilots, acrobats and sky divers [4]- or situations such as driving out of tunnels on sunny days [5]. The incidence of photic sneezing varies from 11% to 36% in a variety of highly selected populations [6]. The observation that the incidence is higher in those with a family history was borne out in a study of four families [7] who demonstrated a distribution consistent with an autosomal dominant inheritance. This led the authors to postulate a specific syndrome, which they termed 'ACHOO'- the autosomal dominant compelling helio-ophthalmic outburst syndrome. The physiology underlying the photosternutatory reflex remains unclear and several mechanisms have been proposed. The theory of optic-trigeminal summation holds that the optic and trigeminal nerves are intimately linked in the mid-brain. Bright light stimulates the optic nerve, causing photophobia and pain via the ophthalmic branch of the trigeminal nerve. Conversely, nasal irritation can lead to blinking and lacrimation. It is suggested that intense stimulation of the optic nerve could cause sneezing if the maxillary branch of the trigeminal nerve was stimulated as well as the ophthalmic branch. The theory of parasympathetic generalisation invokes co-activation by one stimulus of neighbouring parasympathetic branches. Light falling on the retina stimulates pupillary constriction (via the third cranial nerve) and lacrimation (via the seventh). A stimulus of sufficient intensity could generate enough parasympathetic activity to cause nasal congestion and secretions, and stimulate sneezing by an effect on the maxillary branch of the trigeminal nerve. The theory of parasympathetic hypersensitivity suggests that individuals with photic sneezing may have a more active or sensitive parasympathetic system, leading to hypersensitive nasal mucosa. In an experimental model [8], rats exposed to bright artificial light demonstrated altered central parasympathetic function. The role of intra-orbital trigeminal nerve stimulation was proposed by Katz et al.[9], who found a high incidence of photic sneezing in patients with corneal crystals secondary to nephropathic cystinosis. They suggested that cystine crystal deposition results in dysfunction of the peripheral branches of the trigeminal nerve, leading to supersensitivity and hence photophobia and photic sneezing. Despite the frequency with which the photosternutatory reflex occurs, it has received little attention in the anaesthetic literature. However, sneezing is a well-recognised complication of local anaesthesia for eye surgery. Abramson [10] reports a patient with a corneal burn who sneezed in response to peribulbar block insertion with propofol sedation. Two other patients responded similarly to local anaesthetic injection after sedation with thiopental [11]. The authors suggest that these represent photic sneezes, although the response occurred after local anaesthetic injection, not necessarily in response to light. In a prospective study, Wessels et al.[12] demonstrated a 5.2% incidence of sneezing after local anaesthetic injection under thiopental sedation, with no relationship between this and a history of photic sneezing. This suggests that sneezing after local anaesthetic injection is a different entity to photic sneezing, although the underlying physiology may be similar. A patient who sneezes involuntarily during ophthalmic surgery could easily sustain ocular damage. The patient described here was aware of this possibility, and requested general anaesthesia for his procedure. Given the ease with which the reflex could be provoked in him, this was judged to be preferable; if damage had occurred as a result of sneezing, it would have been difficult to mount a medico-legal defence. I propose that a pronounced photosternutatory reflex be added to the list of indications for general anaesthesia for cataract surgery. " So I hope this discussion provides some insights to the potential factors that could explain your responses. Maybe it is something else that triggers your physiological reactions. Can you think of anything else related to the swimming environment that might be a possibility ? If so, design and experiment to test one variable at a time. I bet you will find an answer. This looks like the beginnings of a great science fair project for your science class in school!! All the best, Robin L. Cooper
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