Nosfer-Achoo! Trivia Quiz

Answer: rhinitis

Rhinitis is a general term for inflammation of the lining of the nose ("rhino" from the Greek word for nose, and "-itis" meaning inflammation). There are several broad types, such as allergic rhinitis (hay fever), non-allergic rhinitis (possible causes include chemicals and temperature change), infectious rhinitis (caused by colds, flu, etc), and medication-induced rhinitis. Sneezing is one of the many symptoms of rhinitis.

Of the incorrect answers: a rhinoceros is a large, horned, thick skinned herbivore; a rhinolith is a nasal stone, forming around a nucleus such as a bead or seed or a fragment of retained nasal packing material; a rhinestone is manufactured gem, often foil-backed, that imitates naturally occurring sparkly gemstones such as diamonds.

Answer: anastomosis

When a surgeon removes diseased or damaged tubular structures in the body, such as sections of blood vessel or intestine, the two "loose ends" need to be reconnected to restore function to the organ, and this connection is called an anastomosis. It is a surgical procedure, not a disease.

The other choices are all diseases of the upper respiratory tract whose symptoms may include sneezing: nasopharyngitis is a fancy name for a cold and sore throat; laryngotracheitis describes the condition known as croup, where infection causes a typical hoarse, barking coughing; strep throat is a highly contagious bacterial infection which is usually treated successfully with antibiotics.

Dr Stein quickly establishes that there is no sign of inflammation or infection in Nosfer-Achoo's throat and swiftly moves away from his fangs and on to the next question...

Answer: nasal decongestant

Nasal decongestant sprays are frequently used when inflammation of the nasal passages (rhinitis), whatever the root cause, results in that "bunged-up" feeling of a very blocked nose. While sparing use can help to relieve these symptoms, overuse can actually make the problem worse and increase sneezing.

This is called rhinitis medicamentosa, or rebound congestion. The active ingredients in the decongestant constrict blood vessels in the nose, thus reducing the swelling and irritation that may be producing a sneezing reaction. With prolonged use, the blood vessels become dependant on the presence of the active ingredient to maintain constriction, and when the effect wears off the vessels rapidly swell up again - causing increased sneezing.

Answer: garlic

Sneezing can have sensory triggers, such as inhaling the aromas of strong-smelling or spicy foods. Dr Frankie-Ann Stein knows that, as a vampire, Nosfer-Achoo does not eat food like a normal human being, but she has to ask the question just in case any of the vampire's servants are being a little careless about clearing things up in Castle Gesundheit's kitchens.

Any nasal irritant can trigger a sneeze - perfumes, smoke and dust are three very common examples.

Of course, garlic is one of the things that vampires can't abide, so Dr Stein can cross that off the list.

Answer: snatiation

Has Nosfer-Achoo been overindulging in gore? If so, he may have a condition known as "snatiation" - a portmanteau of the words "sneeze" and "satiation". Also known as gustatory rhinitis, this is caused when an overfull stomach exerts pressure on the nearby vagus nerve, stimulating a sneezing fit.

Snatiation is a harmless condition which is thought to be genetic, and can be treated by eating and drinking more slowly and taking smaller meals.

Fortunately, Nosfer-Achoo drinks sparingly at mealtimes, so Dr Stein can probably eliminate this condition as a cause of his sneezing.

Answer: acute sinusitis

Severe tooth decay can lead to acute sinusitis - infection seated in the spaces (sinuses) of the upper jaw or maxilla. This can result in swelling, facial pain, runny nose and sneezing. This differs from chronic sinusitis, which is more usually caused by allergies or other irritants.

Fortunately for Nosfer-Achoo his teeth are in tiptop condition, something his future "dinner guests" may have cause to regret!

Answer: exercise-induced rhinitis

In exercise-induced rhinitis the nasal lining swells due to the increased volume of cold air passing through the nose during exertion, and the increased blood flow - conditions likely to trigger the sneezing reaction. Rapid changes in body temperature can also contribute to this phenomenon.

Nosfer-Achoo assures Dr Frankie-Ann Stein that, although he is a frequent flyer, in his bat form he is well-adapted to the environment and has no problems with sneezing in this situation.

Answer: Yes

A phenomenon known as psychogenic sneezing can be triggered by strong emotion or psychological stress. Under stress, the body releases cortisol, as well as other chemicals such as histamine: the histamine can cause the nasal membranes to swell and shrink, resulting in sudden or prolonged bouts of sneezing.

It has been suggested that this is a nervous system reflex rather than being caused by allergy or direct irritation.

Answer: Vampires would not go out in strong sunlight

Autosomal Dominant Compelling Helio-Ophthalmic Outburst (or ACHOO syndrome) is a genetic condition known more commonly as photic sneezing. It causes those who have this trait to sneeze, often violently, when suddenly exposed to bright light - especially sunlight. Photic sneezing affects between a quarter and a third of the general population, and seems to be more common in females and Caucasians.

The mechanism is poorly understood, but one possible explanation is that the strong light stimulus of the optic nerve somehow causes interference/stimulation in the trigeminal nerve, which governs sensation in the nose - resulting in sneezing.

Photic sneezing has been observed for a long time: in 350 BCE Aristotle considered the question "Why does the heat of the sun provoke sneezing?" and concluded that the sun's heat made the inside of the nose sweat, and that sneezing dispersed the excess moisture. In the 17th century Francis Bacon, the English philosoper and scientist, disproved this by facing the sun with his eyes closed - no sneezing was provoked - and concluded that open eyes must therefore play some part in the phenomenon.

ACHOO syndrome does not generally need any treatment or medication, although common-sense precautions should be taken when driving, piloting a plane, or operating any potentially dangerous equipment in bright sunlight - such as shielding the eyes with good sunglasses and/or a hat - as a sudden sneeze, with the attendant eye-closing reflex, could result in loss of control of vehicle or equipment.

Bright sunlight is, of course, fatal to vampires, so Dr Frankie-Ann Stein can discount this cause immediately!

Answer: Reaction to the cat's saliva

Finally! The timely entrance of ex-cat Hedra has lead Dr Frankie-Ann Stein to the seat of Nosfer-Achoo's problem. Our sickly vampire friend has a cat allergy.

Although it is popularly believed that it is cat hair that causes allergies, the actual stimulus is a protein (Fel d 1) found in cat saliva, which is transferred to hair and skin when the cat grooms itself; cat dander (tiny dead skin flakes) will be found anywhere a cat has been and also adds to the allergen burden. Up to 20% of adults have an allergic reaction to cats, and symptoms can range from mild to severe: sneezing and eye irritation are common, and some people may develop a skin rash where the cat has licked or scratched them; in some cases the allergy can trigger an asthma attack.

Management of cat allergy varies: the obvious course of action is to avoid cats and things that may have been in contact with them, but this may not be a practical solution. Nosfer-Achoo may wish to make Castle Gesundheit a cat-free zone, check his servants for pet ownership, and get them to deep clean the vaults and furnishings to remove all possible trace of pesky feline protein, followed by regular thorough vacuuming, even if doing so destroys the spooky ambience of dust and cobwebs.

Medication with antihistamines may be considered, although there has been very little research on their effectiveness in vampires; similarly, the use of allergy shots to desensitise the immune system is a tried-and-tested treatment in living humans, but not well-documented in the undead - like many humans with allergies, Nosfer-Achoo will just have to try different things and see what works best for him!