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At a glance

Triggering of sneezing reflex upon exposure of the person to bright light.


Autosomal Dominant Compelling Helio-Ophthalmic Outburst Syndrome; Photic Sneeze Reflex; Peroutka Sneeze Reflex.


The incidence is unknown, but this disorder was found in 23% of medical students and 36% of neurologists at John Hopkins University in Boston, USA, and in 25% of a sample of the British population. The syndrome is probably unrecognized as such in many individuals and hence underreported.

Genetic inheritance

ACHOO Syndrome is transmitted as an autosomal dominant trait.

Clinical aspects

Sudden exposure of an affected person to a bright light source (most often sunlight) triggers a burst of uncontrollable sneezing reflexes (often just 2-3, but sometimes dozens), which are even more pronounced when the person was dark-adapted before the light exposure. It has been reported as a “complication” to slit lamp examination and was also found in association with nephropathic cystinosis (in 26% of patients) and thought to be caused by crystal depositions in the cornea.

Precautions before anesthesia

Routine preoperative assessment.

Anesthetic considerations

There are no known specific implications for anesthesia with this condition. However, waking up from general anesthesia or sedation in a bright room could potentially trigger the sneeze reflex in these individuals, which might be undesired after certain types of surgery, where increased intracranial, intraocular, intrathoracic, or intra-abdominal pressure should be avoided.


Beckman  L, Nordenson  I: Individual differences with respect to the sneezing reflex: An inherited physiological trait in man? Hum Hered 33:390–391, 1983.  [PubMed: 6674114]
Collie  WR, Pagon  RA, Hall  JG, Shokeir  MHK: ACHOO syndrome (helio-ophthalmic outburst syndrome). Birth Defects Orig Art Ser 14(6B):361–363, 1978.  [PubMed: 728575]
Everett  HC: Sneezing in response to light. Neurology (Minneap) 14:483–490, 1964.
Forrester  JM: Sneezing on exposure to bright light as an inherited response. Hum Hered 35:113–114, 1985.  [PubMed: 3988295]
Katz  B, Melles  RB, Swenson  MR, Schneider  JA: Photic sneeze reflex in nephropathic cystinosis. Brit J Ophthal 74:706–708, 1990.  [PubMed: 2275931]
Lewkonia  I: An infrequent response to slit lamp examination. Brit J Ophthal 53:493–495, 1969.  [PubMed: 5804036]
Peroutka  SJ, Peroutka  LA: Autosomal dominant transmission of the ‘photic sneeze reflex.’ (Letter) New Eng J Med 310:599–600, 1984.  [PubMed: 6694722]

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