Psychogenic intractable sneezing: case reports and a review of treatment options.
OBJECTIVE
To report 2 cases of the uncommonly seen diagnosis of psychogenic intractable sneezing, to review the clinical presentation, workup, and various previous treatment modalities, and to present a unique method of treatment.


METHODS
The literature was reviewed using a MEDLINE search of the following keywords: psychogenic intractable sneezing, paroxysmal sneezing, factitious sneezing, respiratory disorders, conversion disorders, habit cough, and psychogenic cough. The search was restricted to articles published from 1966 onward, although older references were cross-referenced from more recent articles.


RESULTS
Sneezing alone can be caused by foreign substances, odors, chemical irritants, allergies, and other less common factors. Psychogenic intractable sneezing, although not a particularly common disease, occurs mainly in adolescent girls for which a cause may not be found. Patients are usually refractory to various medications and have an otherwise unremarkable extensive workup. Treatments have included corticosteroids, antihistamines, hydroxyzine hydrochloride, and decongestants among other pharmacologic agents, as well as psychotherapy. Based on the presented case reports, a trial of isotonic sodium chloride solution with suggestion therapy was able to rid the patients of their intractable sneezing.


CONCLUSIONS
Psychogenic intractable sneezing is a real disease. Although other diseases may be considered, the workup may merely include an extensive history and physical examination. Many treatments have been tried with varying success, including those that incorporate psychotherapy. A variation of suggestiontherapy is offered as a unique treatment modality.
Lin
Timothy J
TJ
Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA. linti@umdnj.edu
Maccia
Clement A
CA
Turnier
Charles G
CG
D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D011613:Psychotherapy; D012120:Respiration Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D012912:Sneezing
D006634:Histamine H1 Antagonists; D006919:Hydroxyzine