[25M] With chronic sneezing, facial sweating, and chest pressure

Patient Description

A 25-year-old male has been experiencing constant sneezing and a runny nose every morning and night for the past three years. The sneezing episodes are particularly bothersome during cold mornings and after taking a morning bath. At night, sneezing is accompanied by facial sweating, which makes the face feel damp but not excessively wet. Recently, the patient started experiencing a dull pressure in the chest when sneezing, rated as 4 out of 10 in pain severity, which is relieved by stretching the body. The patient also reports itching in the nose and ears, and occasional episodes of wheezing or shortness of breath, but no nasal congestion or coughing. There is no known family history of allergies, asthma, or other respiratory conditions. The patient has not been tested for allergies and has not found previous medications effective. The patient has traveled recently but did not specify the location.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Allergic Rhinitis

Rationale: Constant sneezing, runny nose, and itching in the nose and ears are classic symptoms of allergic rhinitis. This condition is often triggered by allergens such as pollen, dust mites, or pet dander, even if you haven't identified a specific trigger.
Typical Treatments: Antihistamines, nasal corticosteroids, and decongestants are commonly used to manage symptoms. Allergy testing can help identify specific triggers, and immunotherapy (allergy shots) may be recommended for long-term relief.

Non-Allergic Rhinitis

Rationale: If allergy tests come back negative, you might have non-allergic rhinitis, which can be triggered by environmental factors like changes in weather, strong odors, or irritants.
Typical Treatments: Similar to allergic rhinitis, treatments include nasal sprays and antihistamines, but identifying and avoiding triggers is also crucial.

Asthma

Rationale: The episodes of wheezing and shortness of breath could indicate asthma, especially if these symptoms are triggered by the same factors causing your sneezing.
Typical Treatments: Inhalers (both rescue and maintenance types), corticosteroids, and bronchodilators are commonly used. A pulmonary function test can help confirm the diagnosis.

Gastroesophageal Reflux Disease (GERD)

Rationale: The dull chest pain and pressure you feel when sneezing could be related to GERD, where stomach acid irritates the esophagus.
Typical Treatments: Lifestyle changes, antacids, and proton pump inhibitors are commonly used. Avoiding large meals and not lying down immediately after eating can also help.

What you can do

For Sneezing and Runny Nose

Consult a Doctor: See an allergist or an ENT specialist for a thorough evaluation and possible allergy testing.
Over-the-Counter Medications: Try antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) to manage symptoms.
Nasal Irrigation: Use a saline nasal spray or a neti pot to flush out irritants from your nasal passages.
Environment Control: Use air purifiers and keep windows closed during high pollen seasons. Regularly clean your living space to reduce dust mites.

For Chest Pain and Pressure

Consult a Doctor: Given the new onset of chest pain, it's important to rule out any serious conditions. A healthcare provider may recommend an ECG or other tests.
Stretching and Posture: Continue stretching exercises that relieve your chest pain. Maintaining good posture can also help.
Avoid Triggers: If you suspect GERD, avoid spicy foods, caffeine, and large meals before bedtime.

For Wheezing and Shortness of Breath

Consult a Doctor: A pulmonary function test can help diagnose asthma or other respiratory conditions.
Avoid Irritants: Stay away from smoke, strong odors, and other potential irritants.
Use MDandMe: Journal your symptoms, track progress, and share your notes with your healthcare provider for better management.

What you should look out for

Given the chronic nature of your symptoms and the new onset of chest pain, it's important to seek medical care. Reasons to seek care more urgently include:

Severe Chest Pain: If the chest pain becomes severe or is accompanied by shortness of breath, seek immediate medical attention.
Persistent Wheezing: If wheezing becomes more frequent or severe, consult a healthcare provider.
Uncontrolled Symptoms: If over-the-counter medications do not provide relief, a healthcare provider can offer more targeted treatments.

Remember, while I can provide information and suggestions, it's crucial to consult a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.