A 10-year-old boy with no personal or family history of allergic disorders presented with intractable sneezing of 5 days. The sneezing used to be continuous except during sleep and while talking (Fig. 1,Web Video 1). Physical examination and local examination of the nose was normal. Nasal decongestants and oral antihistamines were tried without any benefit. On detailed psychological evaluation, it was found that the child wanted to join an English-medium school as advised by his school teacher, but could not do so because of financial constraint of parents. The child and parents were counseled regarding the nature of symptoms and perpetuating factors. He was prescribed tablet Alprazolam 0.25 mg twice a day for a week. The frequency of sneezing episodes reduced over a week, and the episodes subsided in a month.

Fig.1 Child during sneezing episode (see video link).

Psychogenic sneezing occurs between 9 and 15 years of age, and is characterized by: (i) occurrence in adolescent females, (ii) asymptomatic while asleep, (iii) eyes will be open while sneezing, (iv) no response to a wide variety of medications but subsides with psychotherapy, (v) has an "aborted" or "pseudosneeze" pattern (absence of inspiratory phase with lack of aerosolization of nasal secretions and associated short nasal grunting), (vi) physical examination and investigations are normal, Significant psychiatric history may not be evident. The differential diagnosis are allergic rhinitis, foreign body in the nose and vasomotor rhinitis. It is important to recognize this entity so as to avoid unnecessary investigations and treatment; psycho-therapy remains the treatment of choice.