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sneeze

A sneeze (or sternutation) is a semi-autonomous, convulsive expulsion of air from the lungs, most commonly caused by foreign particles irritating the nasal mucosa. Sneezing can further be triggered through sudden exposure to bright light, a particularly full stomach, or as a result of unexpected, climatic variations in one's environment such as rapid changes in temperature and humidity levels.

Sneezing is widely considered to be an agent of disease dissemination in many cultures.

Biological mechanism

The sneeze reflex is an involuntary, sudden, violent, and audible expulsion of air through the mouth and nose. The afferent (sensory) limb of the reflex is carried by branches of V₂ (maxillary nerve), which is the second branch of the trigeminal nerve (cranial nerve V), and the efferent (motor) limb is carried by the vagus nerve (cranial nerve X).

Sneezing typically occurs when foreign particles or sufficient external stimulants pass through the nasal hairs to reach the nasal mucosa. This triggers the release of histamines, which irritate the nerve cells in the nose, resulting in signals being sent to the brain to initiate the sneeze through the trigeminal nerve network. The brain then relates this initial signal, activates the pharyngeal and tracheal muscles and creates a large opening of the nasal cavity, resulting in a powerful release of air and bioparticles. The reason behind the particularly powerful nature of a sneeze is attributed to its involvement of not simply the nose and mouth, but numerous organs of the upper body – it is a reflectory response that involves the muscles of the face, throat, and chest.

An alternative cause of sternutation is sudden exposure to bright light - a bodily attribute known as the photic sneeze reflex. Up to 37 percent of individuals are believed to have this particular genetic trait, which is most commonly related to exposure to direct sunlight.

A rarer alternative trigger, observed in some individuals, is the fullness of the stomach immediately after a large meal. This is known as snatiation and is regarded a medical disorder passed along genetically as an autosomal dominant trait.

Sneezing cannot occur during sleep due to REM atonia - a bodily state wherein motor neurons are not stimulated and reflectory signals are not relayed to the brain. Sufficient external stimulants, however, may cause a person to wake from their sleep for the purpose of sneezing, although any sneezing that would occur afterwards would take place with at least a partially awake state of mind.

While it is usually thought that the "function" of sneezing is to expel irritating particles, this may not be the case. In many people, a large part or even the whole of the expulsion of breath may be through the mouth rather than the nose, so that little or no expulsory action occurs. The fact that some individuals sneeze in response to the stimulus of cold air on the upper chest, or to bright sunlight, is not easily related to any expulsory function. As in the case of yawning, itching, stretching and hiccups, functional aspects of sneezing have not been definitively identified.

Epidemiology

While generally harmless in healthy individuals, sneezes are capable of spreading disease through the potentially infectious aerosol droplets that they can expel, which commonly range from 0.5 to 5 µm in diameter. About 40,000 such droplets can be produced by a single sneeze.Cole EC, Cook CE. Characterization of infectious aerosols in health care facilities: an aid to effective engineering controls and preventive strategies. Am J Infect Control. 1998 Aug;26(4):453-64. Sneezing can transmit many diseases PMID 9721404

The speed of human sternal release has been the source of much speculation, with the most conservative estimates placing it around 150 kilometers/hour (42 meters/second) or roughly 95 mph (135 feet/second), and the highest estimates -such as the JFK Health World Museum in Barrington, Illinois- which propose a speed as fast as 85% of the speed of sound, corresponding to approximately 1045 kilometers per hour (290 meters/second) or roughly 650 mph (950 feet/second).

Preventative measures

There are numerous suggested ways of countering the act of sneezing, although such proposed remedies are largely anecdotal. Examples of such preventative techniques include the deep exhalation of the air in the lungs that would otherwise be used in the act of sneezing; holding your breath while counting to ten; and crinkling your nose.

However, there is clinical evidence to suggest that the sneezing reflex can be successfully inhibited by applying strong pressure to the region immediately below the nose, using the index finger.

Proven methods to reduce sneezing generally advocate reducing interaction with irritants, such as keeping pets out of the house to avoid animal dander; ensuring the timely and continuous removal of dirt and dust particles through proper housekeeping; replacing filters for furnaces and air-handling units; employing air filtration devices and humidifiers; and staying away from industrial and agricultural zones.

Onomatopoeia

Some common English onomatopoeias for the sneeze sound are achoo, atchoo, achew, and atisshoo, with the first syllable corresponding to the sudden intake of air, and the second to the sound of the sneeze.

A similar linguistic approach has been taken with several other languages; in French, the sound "Atchoum!" is used; in Finnish "Atsiuh!"; in Icelandic "Atsjú!"; in Swedish "Atjo"; in Danish "Atju!"; in Dutch "Hatsjoe!" or "Hatsjie!"; in Hebrew "Apchi!"; in German "Hatschie!"; in Hungarian "Hapci!"; in Polish, "Apsik!"; in Russian , "Apchkhi!"; in Turkish, "Hapşu!"; in Italian, "Etciù!"; in Spanish "¡Achú!"; in Portuguese, "Atchim!"; in Romanian "Hapciu!" ; in Filipino "Hatsing!"; in Japanese, "Hakushon!"; in Tamil, "thummal";in Korean, "Achee!" and in Vietnamese, "Hát-xì!!". In Cypriot Greek, the word is "Apshoo!", incidentally also the name of a village, which is the cause of much mirth locally.

In Howards End, by E.M. Forster, a sneeze in polite society is "a-tissue" - a literary allusion to its respective remedy.

Beliefs and cultural aspects

In the Hellenistic cultures of Classical Antiquity, sneezes were believed to be prophetic signs from the gods. In 410 BC, for instance, the Athenian general Xenophon gave a dramatic oration exhorting his fellow soldiers to follow him to liberty or to death against the Persians. He spoke for an hour motivating his army and assuring them of a safe return to Athens until a soldier underscored his conclusion with a sneeze. Thinking that this sneeze was a favorable sign from the gods, the soldiers bowed before Xenophon and followed his command. Another divine moment of sneezing for the Greeks occurs in the story of Odysseus. When Odysseus returns home disguised as a beggar and talks with his waiting wife Penelope, she says to Odysseus, not knowing to whom she speaks, that "husband will return safely to challenge her suitors"". At that moment, their son sneezes loudly and Penelope laughs with joy, reassured that it is a sign from the gods (Od. 17: 539-551).

In Europe, principally around the early Middle Ages, it was believed that one's life was in fact tied to one's breath - a belief reflected in the word "expire" (originally meaning "to exhale") gaining the additional meaning of "to come to an end" or "to die". This connection, coupled with the significant amount of breath expelled from the body during a sneeze, had likely led people to believe that sneezing could easily be fatal. This theory, if proven conclusively, could in turn explain the reasoning behind the traditional "God bless you" response to a sneeze, the origins of which are currently unclear. (see "Traditional Responses To A Sneeze" below for alternative explanations). Sir Raymond Henry Payne Crawfurd, for instance, the late registrar of the Royal College of Physicians, in his 1909 book "The Last Days of Charles II", states that, when the controversial monarch was on his deathbed, his medical attendants administered a concoction of cowslips and extract of ammonia to promote sneezing. However, it is not known if this promotion of sneezing was done to hasten his death (as coup de grace), or as an ultimate attempt at treatment.

In certain parts of Eastern Asia, particularly in Japanese culture and Vietnamese culture, a sneeze without an obvious cause was generally perceived as a sign that someone was talking about the sneezer at that very moment, this is generally reflected in various manga and anime. In China,Vietnam and Japan, for instance, there is a superstition that if you talk behind someone's back, the person in question will sneeze; as such, the sneezer can tell if something good is being said (one sneeze), something bad is being said (two sneezes in a row), or if this is a sign that they are about to catch a cold (multiple sneezes).

Parallel beliefs are known to exist around the world, particularly in contemporary Greek, Celtic, English, French, and Indian cultures. Similarly, in Nepal, sneezers are believed to be remembered by someone at that particular moment.

In Indian culture, especially in northern parts of India, it has been a common superstition that a sneeze taking place before the start of any work was a sign of impending bad interruption. It was thus customary to pause in order to drink water or break any work rhythm before resuming the job at hand in order to prevent any misfortune from occurring.

The practice among certain Islamic cultures, in turn, has largely been based on various Prophetic traditions and the teachings of Muhammad. An example of this is Al-Bukhaari's narrations from Abu Hurayrah that the Islamic prophet once said:

When one of you sneezes, let him say, "Al-hamdu-Lillah" (Praise be to Allah), and let his brother or companion say to him, "Yarhamuk Allah" (May Allah have mercy on you). If he says, "Yarhamuk-Allah", then let sneezer say, "Yahdeekum Allah wa yuslihu baalakum" (May Allah guide you and rectify your condition).

According to sneezing legend the pressure of a sneeze inside our head is so strong that if you had your eyes open while sneezing your eye balls would pop out of their sockets. Fortunately, this is not the case. Eye sockets (two craters in our skull where the bone sits) are made of bone, and will not crack or open up to release the eye in the event of a sneeze.

Traditional responses to a sneeze

In English-speaking countries, a common response to a sneeze by those around is "God bless you", or "Bless you". The origins and purpose of this tradition are unknown, and several competing explanations have been proposed over time; (1) Preventing the soul from departing one's body, as explained in the "Beliefs and Cultural Aspects" section above; (2) An effort to prevent possible death due to a lethal disease such as the plague pandemics of the fourteenth century; and (3) A method of protection against evil spirits entering the body through the open mouth of a sneezing individual. For each of these explanations, it is considered bad luck to open the mouth again and thank the person who uttered "Bless you" for fear of circumventing the purpose of the blessing.

Today, it is said mostly in the spirit of good manners and not saying thank you is considered rude.

In various other cultures, words referencing good health or a long life are used instead of "Bless you".

In Albanian, one says shëndet (shuhn-det). Typical response is 'Faleminderit', meaning 'Thank you'.

In American Sign Language, it would be appropriate to do the EXCUSE-ME sign.

In Arabic, (Levantine Arabic) the response is صحة (Sahha), which likely evolved from the word صحة (Sihha), meaning "health", or نشوة (Nashweh) which means "ecstasy". The response is either thank you شكراً (Shukran) or تسلم (Tislam/Taslam) which means "may you be kept safe". In Egyptian Arabic, the typical response to a sneeze is يرحمكم الله (yarhamkom Allah) and the answer is يرحمكم و يرحمنا (yarhamkom wa yarhamna) or شكراً (thank you).

In Armenian, one says առողջություն (aroghjootyoon).

In Azeri, sneezing is usually followed by the response Sağlam ol, which means "be healthy"

In Bosnian, one says "Nazdravlje" which when translated to English means "To your good health". The person who sneezed would usually respond with "Hvala" which in English stands for "Thank you".

In Brazil, one says saúde, which means "health"

In Bulgarian, one says Наздраве (Nazdrave), which means "your health" or "cheers". The person who has sneezed can then say Благодаря (Blagodarya), which means "Thank you".

In Chinese, one says 不好意思 (bù hǎo yì si) (Standard Mandarin) or 唔好意思 (Standard Cantonese), meaning "excuse me" or "sorry".

In Czech, one says pozdrav pánbůh, meaning in colloquial Czech "bless God" or "greet God".

In Danish, one says Prosit, which is from the latin meaning "to your benfit" and was used when toasting, but in danish it is used only when someone sneezes.

In Dutch, one usually says Gezondheid (literally translated as "health") or Proost (which means "cheers", see Latin below).

In Estonian, one says Terviseks, which means "your health".

In Finnish, one says Terveydeksi, which means "your health".

In French polite speech, after the first sneeze, one says à vos souhaits which means "to your desires". If the same person sneezes again, the second response is à vos amours, which means "to your loves." Santé (health) is a more casual response.

In German, Gesundheit (your "Health") is occasionally said after a sneeze.

In Greek, γίτσες (jitses) (your "Health") is said after a sneeze.

In Hebrew, one says לבריאות (labri'ut/livri'ut), meaning "to health".

In Hungarian, one says Egészségedre!, which means "your health".

In Icelandic, one says Guð hjálpi þér! ("God help you!"). There is also an old custom to respond three times to three sneezes like so: Guð hjálpi þér ("God help you"), styrki þig ("strengthen you"), og styðji ("and support").Visindavefur.is (Icelandic): http://visindavefur.is/svar.php?id=6044

In Irish, one says , which means "God

with us!"

In Italian, one says Salute, which means "your health".

In Japanese, a sneezer might apologize for the outburst, by saying すみません (Sumimasen) or 失礼しました (Shitsurei shimashita), meaning "excuse me". In formal occasions and less often within the family, after one sneezes, someone else blesses them by saying おだいじに (O-daiji ni), meaning "Take care" in informal contexts and something along the lines of "Get well soon" in a more formal situation.

In Korean, a sneezer might say 누가 내 얘기 했어?(Nuga nae yaegi hatseo), meaning "Did someone talk about me?" after a sneeze.

In Kyrgyz, one says Акчуч!

(which may be based on an onomatopœia of the sound of a sneeze, like English "atchoo" discussed above), to which one may respond Ракмат!, meaning "thank you", if the person who said "акчуч" is liked.

In Lithuanian, one says Į sveikatą, which means "to your health". And person which sneezes answer Ačiū that translates as "Thank you".

In Macedonian, one says На здравје(na zdravje), meaning "your health". The person who sneezes usually says Здравје да имаш(zdravje da imash) which means "have health

", or just says Благодарам(blagodaram) "thank you" or Фала(fala) "thanks".

In Maltese, one says Evviva, which comes from the Latin for "he/she is alive!".

In Norway, Sweden and Denmark, one says Prosit - Latin for "may it advantage (you)".Dictionary.com: prosit http://dictionary.reference.com/browse/prosit

In Persian, if the sneeze is especially dramatic, Afiat bahsheh (عافیت باشه) is said.

In Polish, Na zdrowie (your "Health") is said after a sneeze as is Sto lat (wish you a hundred years health).

In European Portuguese one says Santinho, which means "Little Saint", while in Brazilian Portuguese, one says Saúde, which means "your health".

In Romanian, one says Sănătate ("your health") or Noroc ("your luck"). Also if one sneezes during a conversation, that person is said to agree with or approve of the topic.

In Russian, the appropriate response is будь здоров(а) which means "be healthy." For sneezer it is polite to reply спасибо meaning "thank you."

In Serbian, Na zdravlje (almost always pronounced nazdravlje) (your "Health") is said after a sneeze. For sneezer it is polite to reply Hvala meaning "thank you."

In Slovak, Na zdravie (your "Health") is said after a sneeze. For sneezer it is polite to reply Ďakujem meaning "thank you."

In Somali, one says Jir, which means "Live Long".

In Spanish, one says Salud, which means "your health" and Jesús (in Spain) referring to Christ (similarly to God bless you in english).

In Tamil, one says Nooru aayisu for the first time, which means "(Have a life of) 100 years", for the second time it would be Theerga-aayisu which means "(Have) a Long life" and for the third time it would be Poorna-aayisu which means "(Have) a healthy long life".

In Telugu, particularly around the Indian state of Andhra Pradesh, the phrase is Chiranjeeva, which translates to "(May you be blessed with a) Life without death".

In Turkish, a sneezer is always told to Çok Yaşa, i.e. "Live Long", which in turn receives a response of either Sen De Gör ("I hope that you see it") or Hep Beraber ("all together"). This is to indicate the sneezer's wish that the person wishing them a long life also has a long life so they can "live long" "all together". For more polite circles, one might say Güzel Yaşayın, i.e. "You Live Beautifully", which may be countered with a Siz de Görün ("may You witness it").

In Urdu, the response is traditionally Al-hum-do-lillah, i.e. "Allah (God) Bless You", which is similar to "Bless You".

In Vietnamese, the response is traditionally Sống lâu, i.e. "Live long" which, like "Bless You", is an abbreviation of "Wish you a long life." or "Lạy Mụ" /layh-moo/ from the culture of the Middle of Vietnam means "Mother Nature blesses you."

Notes

References

Ancient Sneezing: A Gift from the Gods - Elaine Fantham, Professor of Classics at Princeton on NPR Radio.

Why do my eyes close every time I sneeze? M.G., Sherborn The Boston Globe

External links

The Origins of Popular Superstitions and Customs - T. Sharper Knowlson (1910), a book that listed many superstitions and customs that are still common today.

Sneezing - Causes, Treatments and good Sneezing Practices

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