UNABLE TO SNEEZE? HEALTH EFFECTS, CAUSES, AND SOLUTIONS

Medically Reviewed by Dr. Rae Osborn, Ph.D. and Updated on July 02, 2024

Sneezing has become a topical occurrence since the emergence of COVID-19. It is a natural reflex that helps clear irritants, pathogens, and allergens from the nasal tract, protecting our airways from them. Sneezing is also a leading factor involved in the transmission of respiratory illnesses.

It is interesting to note that some people have lost the ability to sneeze, sometimes called 'Asneezia.' Despite being less likely to spread respiratory diseases, individuals who cannot sneeze may have a higher risk of catching them. Asneezia is also linked to a greater amount of inflammation in the nose. Loss of ability to sneeze is also a cause of several health concerns.

This blog reviews the health effects, causes, and potential remedies for the inability to sneeze.

How the Sneeze Reflex Works

The sneeze reflex helps to expel the irritants from the nasal passages, preventing them from entering the lungs and causing potential harm. According to research, sneezing is one of the only actions that resets the nose and improves the health of the nose cells, called cilia^[1].

Sneezing is a complex process^[2]. It begins with the stimulation of sensory nerve endings in the nasal mucosa when irritants, allergens, or viruses enter the nasal passages.

These sensory nerve endings transmit signals through extensions of the trigeminal nerve to the medulla located in the brainstem, triggering the sneeze reflex. The medulla controls the timing and intensity of the sneeze. It sends signals back to the body, activating the sneeze muscles, including the diaphragm and the airways.

This activation leads to a forceful expulsion of air through the nasal and oral cavities, propelling irritants from the respiratory system. A powerful sneeze can expel up to 40,000 particles, varying in size from 0.5 to 5 mm. Estimates of the speed at which we sneeze fall between 150 km/h and 1045 km/h (almost 85% of the speed of sound).

The sneeze reflex also activates the autonomic nervous system, leading to a slower heart rate and blood vessel constriction.

Sneezing Triggers

There are many unusual sneezing triggers over and above nasal irritants. Nasal irritants can cause the release of histamine, the molecule that brings about allergic responses with symptoms like sneezing. Proteins in viruses can also trigger sneezing by irritating the nerve cells in the nose. These nerves connect to the trigeminal nerve.

The trigeminal nerve has many extensions that connect the ocular nerve of the eyes, the sensory nerves in facial skin, and the nerves in the nose. They can detect multiple sensory signals, including light, touch, chemical changes, and temperature.

These extensions partially explain why triggers of sneezing can include: 

• Nasal irritants
• Chemicals
• Temperature changes
• Bright light (photic sneezing)
• Eyebrow plucking or other sources of facial pain or irritation
• Stress
• Spicy food consumption
• Feeling full
• Eye irritation
• Medications like NSAIDs, antihypertensives, and beta blockers
• Hormonal fluctuations (since hormones influence histamine levels)^[15]

Health Consequences of the Loss of Ability to Sneeze

Not being able to sneeze can have adverse effects on our health.

When we cannot sneeze, irritants and allergens remain in the nasal passages, causing discomfort and potential harm. Nasal contaminants can lead to a dry nose, sinus infections, and other symptoms, such as headaches and anosmia (smell loss)^[3].

As the nose connects to the trigeminal nerve, it may heighten sensitivity to light or facial skin itching.

Some research lists asneezia as a symptom of psychiatric conditions which leads to chronic respiratory infections and light-headedness.^[4]. Asneezia is found in about 2.6% of patients with psychiatric illness.

Additionally, sneezing helps clear nasal passages, allowing us to breathe easily. Without this reflex, we may experience difficulty breathing, especially if we have a cold or allergies. Breathing issues can lead to sleep-disordered breathing and sleep disturbances, which can, in turn, affect dental health, cognition, and daily energy levels.

A study shows that asneezia sometimes causes distress in affected individuals, leading to psychologically-induced illness and depression.^[5]

What causes the inability to sneeze?

Not all causes of Asneezia are known or understood.

The most common cause of Asneezia is chronic nasal irritation leading to prolonged congestion of the nasal passages (also known as rhinitis). When our nasal passages are inflamed or congested, it can disrupt the signals sent to the brainstem, preventing the sneeze reflex from being triggered.^[6] Chronic rhinitis sometimes leads to prolonged Asneezia.

Some other common causes include:

• Nasal surgeries: Septoplasty and rhinoplasty can potentially induce sneeze loss. These surgical procedures can disrupt the normal functioning of the sneeze reflex if they cause damage to the nasal nerves which join with the trigeminal nerve, leading to a decreased ability or complete inability to sneeze.
• Medication Effects: Medications can lead to nasal irritation and congestion, potentially contributing to Asneezia in some people. While reports are scarce, medications that interfere with nerve transmission can theoretically disrupt the sneeze reflex.
• Brainstem Lesion: A brainstem lesion, or damage to the medulla (for example a stroke), can also affect the sneeze reflex^[7]. Damage can occur due to a stroke^[8], tumor, or other neurological conditions. In these cases, the brainstem cannot receive the signals from the trigeminal nerve, resulting in the inability to sneeze.
• Nervous System Disorders: Nervous system disorders, such as Parkinson's disease and Wallenberg syndrome, can also affect the sneezing reflex. These conditions can interfere with the signals sent to the brainstem^[9], resulting in the inability to sneeze.
• Psychiatric Asneezia: Some studies suggest that Asneezia is higher in those with psychiatric conditions, especially depression and schizophrenia.^[10] There is little research on why this is the case, although it may pertain to medications, nervous system imbalances, or chronic infections. This type of Asneezia is the opposite of psychogenic sneezing, in which a psychiatric condition predisposes sneezing attacks in a person.
• Genetics: Genes can also affect our susceptibility to the loss of sneezing. In recent years, researchers found a gene responsible for proteins that detect capsaicin in the noses of mice, leading to sneezing. Mice without this gene sneezed far less when exposed to capsaicin than mice with the gene^[11]. More research is required to pinpoint any genetic mechanisms for the loss of sneezing in people.

Home Remedies

If the inability to sneeze is due to nasal irritation, home remedies may be effective in providing relief.

The first thing to try is to blow your nose. Nose blowing clears the nose and stimulates the nasal receptors at the same time. If you have a dry nose and cannot clear it this way, try steam inhalation, a humidifier, or a saline nasal spray. These can reduce inflammation and congestion, allowing the sneeze reflex to function.

Other possible home remedies include^[12]:

• Look at a bright light
• Pluck a nose or brow hair
• Tickle the inside of your nose with a tissue or swab
• Drink something fizzy or inhale over a fizzy drink to stimulate the nose.
• Gently massage the roof of your mouth with your tongue.
• Sniff aromatic substances, such as intense perfume, essential oils, peppery spices, ammonia, or something you usually sneeze when inhaling.
• A quick shift in temperature, such as entering a cold environment or having a hot bath, may also be helpful

Many of these can be combined, such as steaming with an essential oil in a hot bath.

If you still cannot sneeze after a while of trying home remedies, it is necessary to see a doctor for a proper diagnosis and to get advice for treating any underlying conditions.

When to See a Doctor

If you cannot sneeze for an extended time and it leads to symptoms, it is essential to consult a doctor.

While it may be a temporary issue, it could also signify a more serious underlying condition. Additionally, if you experience any other unusual symptoms, such as a temporary loss of smell or difficulty with breathing, it is crucial to seek medical attention.

Diagnosing Underlying Conditions

When diagnosing underlying causes of Asneezia, a doctor will likely suspect rhinitis (nasal congestion), nasal nerve damage, a neurological condition, or a psychiatric disorder.

Diagnosis of underlying causes of asneezia, like rhinitis or a brain lesion, begins with a detailed medical history, including any recent nasal surgeries, medication use, or symptoms of neurological conditions. A doctor may perform a physical examination focusing on the nasal passages and neurological function.

Imaging studies (MRI, CT scans), nasal endoscopy^[13], nerve conduction studies, or other diagnostic tests can help identify structural or functional abnormalities affecting the sneeze reflex.

The doctor may refer the patient to a psychiatrist if diagnostic tests fail to find any physical causes.

Potential Treatment Options

The treatment for the loss of sneezing will depend on the underlying cause. Most cases pertain to chronic congestion or neurological conditions. Treatment for these concerns can alleviate Asneezia.

Some potential treatment options for chronic rhinitis or neurological conditions leading to Asneezia can include^[14]:

• Medications: In cases where medication causes the inability to sneeze, your doctor may adjust your dosage or prescribe an alternative medicine. It is essential to consult with your doctor before changing your medication regimen.
• Nasal Irrigation: Nasal irrigation, also known as a nasal rinse, can assist in clearing the nasal passages and relieve congestion. Consult with a specialist about nasal irrigation or use a nasal irrigation kit.
• Allergy Treatment:  If allergies are responsible, allergy treatment may alleviate sneeze loss. Treatment for allergies can include over-the-counter or prescription allergy medication, allergy shots, or immunotherapy.
• Surgery: Surgery is necessary in rare cases to correct a brainstem lesion or other underlying condition affecting the sneeze reflex.

Conclusion

While being unable to sneeze may seem like a minor issue, it can have significant health effects and should not be ignored. If you cannot sneeze for an extended period, it is essential to speak to a doctor who can diagnose the underlying cause and offer appropriate treatment. By understanding the importance of sneezing and addressing any potential issues, you can ensure the health and well-being of your nasal passages and respiratory system.

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