low platelets and sneezing

This may sound barmy.. but does anyone else notice sneezing and an itchy nose when their platelets go very low?

I'd always suspected this co-occurrence, but couldn't be sure until being put on Romiplostim, and having counts go from <10 to >100, and the reverse, in a matter of days, and so being able to track what's happening each time. I get this sneezing (and some dizziness) each time the count drops below 20.

I know sneezing can be triggered by a whole range of things that are not direct irritants of the nose (e.g. sunlight), so maybe this isn;t as crazy as it sounds....

Am I the only one???

Could your sneezing and itchy nose be cause by an allergy. If so allergies cause an immune response and that could trigger a drop.

Yes, I've thought of that. But if that's the case then I should still be sneezing when the Romiplostim kicks in and raises my counts, since Romiplostim just increases platelet production and doesn't address the immunological issue that's causing the destruction of platelets. But when the counts go up, I don't get these symptoms. It seems odd.

That is odd. I can think of no logical reason that low counts would cause sneezing. First time I ever heard that. I'd think that Julia's theory is more credible, not the other way around.

I can imagine how a blood blister or even a small petechia might form in the nasal passages irritating the mucosa and causing sneezing. Are you prone to nosebleeds with low platelets?

It would be interesting to note whether the sneezing precedes, follows, or coincides with the drop in platelets. Do you ever have a drop in platelets FOLLOWED by sneezing?

Yes, that would make more sense. But then treating the count shouldn't help at all. Once off the Pred, and when the Romiplostim was working nicely, I never felt better - no fatigue, dizziness or nose itchiness/sneezing. I observed this alteration 2 or 3 times over the space of 3 months.

It doesn't make sense, but then again, I've just been reading about the growing evidence for platelets having some role in modulating inflammatory reactions and immune responses.

circres.ahajournals.org/content/100/1/27.full

In other words, it's just possible that there is some allergen that is causing my platelets to crash, and that a fall in platelets aggravates my immune reaction to that allergen even further. Hence I can get into either a vicious circle (by not treating the count) or - maybe - a virtuous circle (by treating the count).

Does that sound crazy, or possible?

This is also interesting... Would suggest we are more susceptible to infections with low platelet counts (so maybe this sneezing isn't due to an allergy but to easy infections at low counts)

n.b. hasn't been shown in humans yet, just mice.

www.the-scientist.com/?articles.view/articleNo/36040/title/Platelets-Help-Tackle-Bacteria/

and one more, then I'll stop! Haven't looked at this article in full yet, but should be able to get it later, if anyone is interested.


Arch Immunol Ther Exp (Warsz). 2012 Dec;60(6):443-51. doi: 10.1007/s00005-012-0193-y. Epub 2012 Sep 1.
Platelets in inflammation and immune modulations: functions beyond hemostasis.
Huang HS, Chang HH.
Source

Department of Molecular Biology and Human Genetics, Tzu Chi University, 701 Sec. 3, Chung Yang Rd, Hualien, 970, Taiwan, ROC.
Abstract

Platelets play central roles for maintaining the homeostasis of the blood coagulation. As they are also involved in immune responses and host defenses, increasing evidences have suggested that platelets exert other roles beyond their well-recognized function in preventing bleeding. This review is focused on inflammation, allergy and immune modulations of platelets. Platelets conduct immunoregulation through secretion of functional mediators, interaction with various immune cells, endothelial cells and beneficial for the leukocyte infiltration to inflamed/allergic tissues. In these regulations, the leukocytes are influenced by and receiving the signals from platelets. In contrast, rare attentions were focused on platelet regulations by immune system. An intriguingly example in the intravenous immunoglobulin (IVIg) treatment is discussed, in which dendritic cells exert anti-inflammatory effect through platelets. This further suggests that coagulant and immune systems are tightly associated rather than separate entities. The cross-talks between these two systems implicate that platelet therapy may have application beyond thrombosis, and immune interventions may have potentials to treat thrombosis diseases.

Norita:

The article about platelets and infection is interesting. I'd never heard that before.

Maybe the medications are causing an allergic reaction? Some people are allergic to Prednisone. I don't know....this is odd. If you had an infection that was causing sneezing (like a cold, etc.), you'd probably know it. Also, it would be strange to pick up an infection every single time your counts are down. Maybe you get sick and that drops your counts? Everything that you are saying seems to be in reverse.

Sandi:

yes, it could be a side effect of the Romiplostim, but I think I got the same thing on Pred., it was just more difficult to track because the effect of the medication on platelets was very slow.

I don't know. It's really odd. I doubt it's an on-off infection - that would be a bit absurd. But I suppose it could be related to regulation of the inflammatory response to an allergen. Or it might just be a huge coincidence.

But I know one thing (as of course do many others): having low platelets is not just a question of susceptibility to bleeding. I don't get many symptoms of bleeding, but I don't feel right generally. It's only when I managed to get reasonable counts, in a short space of time, with Romiplostim (alas, not uniformly so, yet...) that I realised just how 'off' low platelets had been making me feel.

I felt that way too when counts were under 20k. Very weak, dizzy and tired. Others have said they felt fine though, so it's not true for everyone and probably involves more than just platelets.

Yes, thanks Sandi. I take your point and know some people get these symptoms and some don't. My point was that I only get the symptoms when my platelets are low, and that the Romiplostim is only (supposedly) targetting the platelet count and not (I presume) addressing any other possible issues. I got the same relief from tiredness, dizzinees, etc. when my count went up on Prednisolone, but then Prednisolone has wide-ranging effects on our body, and most importantly is immunosuppressive, so I just thought something general was going on. Romisplostim, as far as I know, just raises counts. Well, I know there are some who think it may also have some immuno-regulatory properties too, but it's not very clear. Platelets are also known to do more than just clot blood.

As for people getting different symptoms at low counts, that could be because there are different illnesses involved under the umbrella of ITP. But it's also interesting to note that people have different degrees of bleeding symptoms too. Some bruise at relatively high counts (high for me is 20+ !), some have regular nose bleeds, others don't. In other words, the body reacts to and copes with haemostatic imbalances in different ways in different people.

Since I am an odd person (I got hives from pred and it is used to treat hives). I suggested it was an allergy because of the sneezing.

That said if you get these sneezing attacks with no other allergy symptoms and every time this happens your counts drop. I say run with it at least you have a warning system.

Do you use Prednisone every time counts drop? One more possibility - maybe you have allergies and Prednisone helps that. So every time your counts drop and you are put on Prednisone, the allergies improve, not because of counts but because of steroids.

I used to have horrible allergies, but since being on Prednisone for the past 7 years, it has not been as bad.

Just grasping here.

I was on low dose Prednisolone constantly for a long while, then came off when I started the Romiplostim 3 months ago. My counts have been yo-yoing on Romiplostim, but unless I'm flying somewhere my consultant doesn't want me back on the steroids. So I've been increasing the dose of Romiplostim when my counts crash, which works for a bit and I get really good counts, and none of the other symptoms!

Allergy wise, I've never really had anything bad, though I think I started to get a bit of hayfever around the time my ITP came on. My sister is the one with allergies to everything.

And another thing I've just realised... with low platelets (on or off Prednisolone) I get dry scaly bits on the pads of my palms and a rough patch of dermatitis on my tummy. But when the counts go up (with or without Prednisolone), I don't get these.

I find all this a bit weird; these all seem like allergy symptoms, yet nothing is calming my immune system down. The dry skin on my palms really seems like some kind of inflammation thing - the first place I get peticchiae is on my palms, and I think it's because I type all day, always using my hands.

I'm going to keep a proper record.

Thanks for your thoughts!

This (3 year old) thread is interesting to me. FWIW, I have hairline dermatitis that seems closely tied to low counts.

Also, I have (infrequent) pin prick like itches (all over) that seem to also coincide with low counts. The itch will go away by merely touching the spot. If you've ever had platelet transfusion itching, it is like that but less intense.

With some investigation, I wonder if this type of itching is related in some way to platelets, 'Dendritic cells', and 'Immune complex' activity. Note that dendritic cells are found in the nose, skin, and other places.