MadSci Network: Immunology
Query:

Re: Why do I sneeze after swimming?

Date: Sat Apr 10 14:14:47 2004
Posted By: Robin Cooper, Faculty, neurobiology, Univ. of Kentucky
Area of science: Immunology
ID: 1079467138.Im
Message:

" 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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