Sneezing in response to naturalistic bright light exposure

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This study aimed to characterise the light conditions inducing PSR. Methods One male PSR-affected participant logged sneezing events during a 30-day real-world light exposure study. An indoor setup using a multi-primary LED source and an integrating sphere delivered 30-second light stimuli while pupillometric data were collected. Results A total of 82 sneezing events were recorded, averaging 2.73 sneezes/day (range: 1–6 per event). Illuminance increased tenfold before sneezing, peaking 2 minutes prior, and returned to baseline within 10 minutes. Despite exposure to 150+ stimuli, artificial sneezing was not induced, though high illuminance consistently triggered tickling sensations. Conclusions Sudden increases in environmental lighting can provoke PSR. While artificial stimuli elicited only tickling, further refinement of the protocol could enable reliable PSR induction, thereby facilitating mechanistic research. 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F1000Research 2025, 14 :1134 ( https://doi.org/10.12688/f1000research.167964.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Study Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] Lucien Bickerstaff https://orcid.org/0000-0002-2683-8130 1,2 , Josef Trinkl 2 , Stephan Munkwitz https://orcid.org/0000-0002-9559-5566 2 , Manuel Spitschan https://orcid.org/0000-0002-8572-9268 1,2 Lucien Bickerstaff https://orcid.org/0000-0002-2683-8130 1,2 , Josef Trinkl 2 , Stephan Munkwitz https://orcid.org/0000-0002-9559-5566 2 , Manuel Spitschan https://orcid.org/0000-0002-8572-9268 1,2 PUBLISHED 17 Oct 2025 Author details Author details 1 Technical University of Munich, Munich, Germany 2 Max Planck Institute for Biological Cybernetics, Tübingen, Germany Lucien Bickerstaff Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Josef Trinkl Roles: Investigation, Writing – Review & Editing Stephan Munkwitz Roles: Investigation, Writing – Review & Editing Manuel Spitschan Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Public Health and Environmental Health collection. Abstract Background The photic sneeze reflex (PSR) is a common but underexplored phenomenon where bright light triggers sneezing, affecting ~30% of the population. This study aimed to characterise the light conditions inducing PSR. Methods One male PSR-affected participant logged sneezing events during a 30-day real-world light exposure study. An indoor setup using a multi-primary LED source and an integrating sphere delivered 30-second light stimuli while pupillometric data were collected. Results A total of 82 sneezing events were recorded, averaging 2.73 sneezes/day (range: 1–6 per event). Illuminance increased tenfold before sneezing, peaking 2 minutes prior, and returned to baseline within 10 minutes. Despite exposure to 150+ stimuli, artificial sneezing was not induced, though high illuminance consistently triggered tickling sensations. Conclusions Sudden increases in environmental lighting can provoke PSR. While artificial stimuli elicited only tickling, further refinement of the protocol could enable reliable PSR induction, thereby facilitating mechanistic research. READ ALL READ LESS Keywords lhotic sneeze reflex, light-induced sneezing, bright light exposure, environmental lighting, sneezing reflex, reflex sensitivity, illuminance, pupillometry, nonvisual light effects, light-triggered sensations, real-world light logging, visual stimuli, multi-primary LED, integrating sphere, reflex threshold Corresponding Author(s) Manuel Spitschan ( [email protected] ) Close Corresponding author: Manuel Spitschan Competing interests: M.S. declares the following potential conflicts of interest in the past five years (2021–2025). Academic roles: Member of the Board of Directors, Society of Light, Rhythms, and Circadian Health (SLRCH); Chair of Joint Technical Committee 20 (JTC20) of the International Commission on Illumination (CIE); Member of the Daylight Academy; Chair of Research Data Alliance Working Group Optical Radiation and Visual Experience Data. Remunerated roles: Speaker of the Steering Committee of the Daylight Academy; Ad-hoc reviewer for the Health and Digital Executive Agency of the European Commission; Ad-hoc reviewer for the Swedish Research Council; Associate Editor for LEUKOS, journal of the Illuminating Engineering Society; Examiner, University of Manchester; Examiner, Flinders University; Examiner, University of Southern Norway. Funding: Received research funding and support from the Max Planck Society, Max Planck Foundation, Max Planck Innovation, Technical University of Munich, Wellcome Trust, National Research Foundation Singapore, European Partnership on Metrology, VELUX Foundation, Bayerisch-Tschechische Hochschulagentur (BTHA), BayFrance (Bayerisch-Französisches Hochschulzentrum), BayFOR (Bayerische Forschungsallianz), and Reality Labs Research. Honoraria for talks: Received honoraria from the ISGlobal, Research Foundation of the City University of New York and the Stadt Ebersberg, Museum Wald und Umwelt. Travel reimbursements: Daimler und Benz Stiftung. Patents: Named on European Patent Application EP23159999.4A (“System and method for corneal-plane physiologically-relevant light logging with an application to personalized light interventions related to health and well-being”). With the exception of the funding source supporting this work, M.S. declares no influence of the disclosed roles or relationships on the work presented herein. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The rest of the authors have no competing interests. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Bickerstaff L et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Bickerstaff L, Trinkl J, Munkwitz S and Spitschan M. Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.12688/f1000research.167964.1 ) First published: 17 Oct 2025, 14 :1134 ( https://doi.org/10.12688/f1000research.167964.1 ) Latest published: 20 Mar 2026, 14 :1134 ( https://doi.org/10.12688/f1000research.167964.2 )  There is a newer version of this article available. Suppress this message for one day. Key points • The manuscript presents a case study investigating the photic sneeze reflex (PSR), a common but underexplored phenomenon triggered by bright light exposure. • It combines real-world light exposure measurements with controlled laboratory experiments , offering a detailed characterization of the conditions that elicit PSR. • The findings highlight the role of sudden changes in illuminance as a trigger for PSR and propose improvements for experimental protocols to enable further mechanistic research. • This case study provides a foundation for future investigations into the PSR and their clinical and physiological significance. Background Photic sneezing is a widespread phenomenon, characterised by sneezing in response to bright light exposure (typically direct sunlight), reportedly affecting up to around 20-30% of the population ( Askenasy, 1990 ; Dean, 2012 ; Everett, 1964 ; Kulas et al., 2017 ; McKusick, 2003 ; Morris, 1987 ). The photic sneeze reflex (PSR) has been documented for decades ( Askenasy, 1990 ; Féré, 1890 ; Sédan, 1954 ), if not centuries, but despite its relatively high prevalence, is poorly understood. Some studies have attempted to further clarify the genetic and neural mechanisms involved in the reflex ( Breitenbach et al., 1993 ; Chowdhury et al., 2019 ; Collie et al., 1978 ; Hydén & Arlinger, 2009 ; Langer et al., 2010 ; Peroutka & Peroutka, 1984 ; Sasayama et al., 2018 ), leading to no conclusive results. There is at present no reliable in-laboratory stimulus to induce photic sneezing ( Trinkl et al., 2025 ). To understand the naturalistic antecedents of the PSR, we examined sneezing in response to bright light exposure under naturalistic conditions while a photic sneezer logged their sneezes. In addition, we characterised tickle sensations and pupil responses to bright light exposure using white-light stimuli varying parametrically in illuminance. Methods Real-world light exposure measurements and photic sneeze logging Real-life, daytime light measurements were carried out in summer between 12 July 2022 and 10 August 2022 (30 days) in and around Tübingen, Germany, as the participant went about his daily life. The participant, a healthy 21-year-old male (author LB of this manuscript), followed a Monday to Friday, 9-to-5 work schedule, working mostly indoors at a desk, at times with no natural light at all (only artificial light). Measurements were continuous from approximately 08:00 to 21:00, with a sampling frequency of 30 s. An ActTrust2 wearable actigraph with light logger (Condor Instruments, São Paolo, Brazil) was worn as a necklace so it would rest on the torso facing forwards. This provided a good compromise between accurate measurements (i.e., in the same direction as the corneal plane) and practical comfort. The device was fixed to the torso using a magnetic plate resting between the participant’s torso and their clothing, to prevent unwanted tilt or flipping. Every time the PSR manifested, the participant would self-report the sneeze event in a sneeze log datasheet implemented on Notion. Each entry contain the precise date and time of the sneeze (to the minute) and the number of sneezes for that event, since one sneeze event can contain multiple sneezes. Analysis of light exposure and PSR event data The precise logging of each sneeze event allowed to obtain the average light exposure levels 20 min before and after the event. This was then compared to a reference – measured to be the average illuminance over 40-min, randomly-chosen time windows (n = 100), when no sneeze event was reported. Individual contrasts between light exposure before and at each sneeze event were also analysed. Pre-sneeze light levels were averaged in time windows of 5 to 2 min before the sneeze event, and sneeze light levels in time windows ranging from 1 min before to 1 min after the sneeze event. PSR induction in controlled conditions A custom setup was used to elicit the PSR under controlled laboratory conditions. While wearing a head-mounted eye tracker for pupillometry (Pupil Core, Pupil Labs, Berlin, Germany), the participant was exposed to bright light emitted by a 10-primary light source (Spectra Tune Lab, Ledmotive, Barcelona, Spain) light into an integrating sphere. Two paradigms were used to elicit the PSR: 1. A “one-shot” paradigm, where the participant would follow a 10-minute dark adaptation period, and then be exposed to a single light stimulus lasting 30 seconds; 2. And a 30-minute paradigm, where the protocol was identical but instead of one single stimulus, 24 stimuli were presented to the participant in succession, with 60 seconds of refractory darkness between the stimuli. The photopic illuminance of the light stimulation varied between four different pre-set illuminance settings, measured at approximately 440, 1100, 4400 and 17600 lx (photopic) at eye-level using a calibrated spectroradiometer (STS-VIS, Ocean Optics, Ostfildern, Germany). An additional dark setting (0 lx) was included in the 30-min experiment. In addition to pupillometry, self-reports of sneeze onset (yes/no) and tickling sensation ratings from 0 (no tickle at all) to 10 (strong enough tickle to induce a sneeze) were obtained. Results Real-life light measurement and photic sneeze logging Over the 30 day period, a total of 82 sneeze events were recorded, for an average of 2.73 sneezes per day. The number of sneezes range from 1 to 6 sneezes per event. Generally, a strong increase in light exposure can be observed in the few minutes leading to the sneeze event ( Figure 1 ). Only one instance of photic sneezing was reported when light levels decreased before the sneezing event occurred. More specifically, a 10-fold increase in light intensity can be noticed just before photic sneezing on average, with quartiles within 2× to 30×. The difference in light intensity is significant in the 20 minutes surrounding the sneeze event. Pre-sneeze illuminance ranges from around 20 lx to 20 000 lx, while light levels at sneeze events range from around 1 000 lx to almost 30 000 lx (excluding the outlying instance mentioned just above, where illuminance fell to around 40 lx). Figure 1. (A) Average light exposure 20 minutes before and after the sneeze event (n = 82). Reference is the average light exposure over randomly-chosen 40-minute windows, in which no sneeze event was recorded (n = 100). The light sensor was worn for 30 days during daytime (around 08:00 to 21:00), while all sneeze events were logged in parallel. Shaded error bars show standard error of the mean (SEM) and black dots show significance (independent t-test, p < .000610 after Bonferroni correction). (B, C) Difference between light exposure before (-5 to -2 min) and during (±1 min) sneeze events (linked t-test, t(81) = -8.21, p = 2.9e-12). (D) Average pupil diameter before and after light onset, for the one-shot paradigm. (E) Average pupil diameter during the 30-second light stimulations, for the 30-minute paradigm. (F) Comparison of the average pupil size as a function of illuminance for the two paradigms, mean ± STD. (G) Tickle ratings for the one-shot paradigm. (H) Tickle ratings for the 30-minute paradigm. (I) Comparison of the average tickle ratings as a function of illuminance for the two paradigms, mean ± STD. After the sneeze event, the average illuminance typically falls back down to baseline levels within 10 minutes. The average light levels around photic sneezing events always remain above the reference, corresponding to the average illuminance for 100 time windows in which no photic sneeze was reported. Indeed, when sneezing was reported, the light levels almost always stayed above 500 lux, whereas when no sneezing was reported, they mostly remained below 500 lux. Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace. PSR induction in controlled conditions In the experiments, we were unable to elicit a PSR using our laboratory stimuli. Despite exposure to more than 150 stimuli, the experimental setup could not induce sneezing in the participant. However, tickling sensations were consistently reported, and very high – although rare – values of 10/10 show that sneezing was very close under high light intensity. Both pupil and tickle ratings followed a monotonic relationship with the photopic illuminance of the stimuli. Conclusion This study provides a detailed characterization of photic sneezing in a known photic sneezer. Real-world data showed that sudden increases in illuminance often precede photic sneezing. These findings reinforce the connection between rapid light intensity changes and the PSR, while also suggesting thresholds of illuminance that may be critical for its manifestation. Despite being unable to artificially elicit sneezes in a controlled setting, the strong tickling sensations observed suggest that the experimental paradigm is promising with further refinement. Future studies should investigate the variability in individual responses to artificial stimuli, and the underlying genetic, neurological and sensory mechanisms of the PSR. Additionally, expanding the study to a larger cohort will be essential to understand phenotypic variation and interindividual differences in the PSR. Ethics approval and consent to participate This study was reviewed by the Ethics Committee of the Technical University of Munich (2024-74-W-SB). The participant gave informed consent in written form. Preprint This manuscript was preprinted on bioRxiv ( Bickerstaff et al., 2024 ). Availability of data and materials All code and data are available: • Data: https://doi.org/10.17617/3.LO8EXZ ○ Dataset for Bickerstaff et al., 2024 (DOI: 10.1101/2024.12.11.627890), containing pupillary data, subjective reporting data, light exposure and sneeze logging data and associated metadata. Data is provided in two forms: a full dataset containing all raw and exported data, and an exports-only dataset. • Code: https://github.com/tscnlab/BickerstaffEtAl_F1000Research_2025 ○ Code repository for Bickerstaff et al., 2024 (DOI: 10.1101/2024.12.11.627890), containing a reproducible Python pipeline for generating the outcomes (analysis results and figures) presented in the manuscript. Acknowledgements Not applicable. References Askenasy JJ: The photic sneeze. Postgrad. Med. J. 1990; 66 (781): 892–893. PubMed Abstract | Publisher Full Text | Free Full Text Bickerstaff L, Trinkl J, Munkwitz S, et al. : Sneezing in response to bright light exposure: A case study in a photic sneezer.2024. Publisher Full Text Breitenbach RA, Swisher PK, Kim MK, et al. : The photic sneeze reflex as a risk factor to combat pilots. Mil. Med. 1993; 158 (12): 806–809. PubMed Abstract | Publisher Full Text Chowdhury T, Sternberg Z, Golanov E, et al. : Photic Sneeze Reflex: Another Variant of the Trigeminocardiac Reflex? Future Neurol. 2019; 14 (4): FNL32. Publisher Full Text Collie WR, Pagon RA, Hall JG, et al. : ACHOO syndrome (autosomal dominant compelling helio-ophthalmic outburst syndrome). Birth Defects Orig. Artic. Ser. 1978; 14 (6B): 361–363. PubMed Abstract Dean L: ACHOO Syndrome.Pratt VM, Scott SA, Pirmohamed M, et al. , editors. Medical Genetics Summaries. National Center for Biotechnology Information (US); 2012. Reference Source Everett HC: Sneezing in response to light. Neurology. 1964; 14 (5): 483. Publisher Full Text Féré C: Note sur l’éternuement provoqué par les excitations lumineuses. Comptes Rendus Des Séances de La Société de Biologie. 1890; 2 (31): 555–557. Hydén D, Arlinger S: On light-induced sneezing. Eye. 2009; 23 (11): 2112–2114. PubMed Abstract | Publisher Full Text Kulas P, Hecker D, Schick B, et al. : Investigations on the prevalence of the photo-induced sneezing reflex in the German population, a representative cross-sectional study. Eur. Arch. Otorrinolaringol. 2017; 274 (3): 1721–1725. PubMed Abstract | Publisher Full Text Langer N, Beeli G, Jäncke L: When the Sun Prickles Your Nose: An EEG Study Identifying Neural Bases of Photic Sneezing. PLoS ONE. 2010; 5 (2): e9208. PubMed Abstract | Publisher Full Text | Free Full Text McKusick VA: ACHOO Syndrome. OMIM. 2003. Morris HH: ACHOO syndrome. Prevalence and inheritance. Cleve. Clin. J. Med. 1987; 54 (5): 431–433. PubMed Abstract | Publisher Full Text Peroutka SJ, Peroutka LA: Autosomal dominant transmission of the ‘photic sneeze reflex’. N. Engl. J. Med. 1984; 310 (9): 599–600. PubMed Abstract | Publisher Full Text Sasayama D, Asano S, Nogawa S, et al. : A genome-wide association study on photic sneeze syndrome in a Japanese population. J. Hum. Genet. 2018; 63 (6): 765–768. PubMed Abstract | Publisher Full Text Sédan J: Réflexe photo-sternutatoire. Rev. Otoneuroophtalmol. 1954; 26 : 123–126. PubMed Abstract Trinkl J, Bickerstaff L, Munkwitz S, et al. : Stimulus conditions eliciting sneezing in response to bright light. Exp. Brain Res. 2025; 243 (2): 56. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Oct 2025 ADD YOUR COMMENT Comment Author details Author details 1 Technical University of Munich, Munich, Germany 2 Max Planck Institute for Biological Cybernetics, Tübingen, Germany Lucien Bickerstaff Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Josef Trinkl Roles: Investigation, Writing – Review & Editing Stephan Munkwitz Roles: Investigation, Writing – Review & Editing Manuel Spitschan Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests M.S. declares the following potential conflicts of interest in the past five years (2021–2025). Academic roles: Member of the Board of Directors, Society of Light, Rhythms, and Circadian Health (SLRCH); Chair of Joint Technical Committee 20 (JTC20) of the International Commission on Illumination (CIE); Member of the Daylight Academy; Chair of Research Data Alliance Working Group Optical Radiation and Visual Experience Data. Remunerated roles: Speaker of the Steering Committee of the Daylight Academy; Ad-hoc reviewer for the Health and Digital Executive Agency of the European Commission; Ad-hoc reviewer for the Swedish Research Council; Associate Editor for LEUKOS, journal of the Illuminating Engineering Society; Examiner, University of Manchester; Examiner, Flinders University; Examiner, University of Southern Norway. Funding: Received research funding and support from the Max Planck Society, Max Planck Foundation, Max Planck Innovation, Technical University of Munich, Wellcome Trust, National Research Foundation Singapore, European Partnership on Metrology, VELUX Foundation, Bayerisch-Tschechische Hochschulagentur (BTHA), BayFrance (Bayerisch-Französisches Hochschulzentrum), BayFOR (Bayerische Forschungsallianz), and Reality Labs Research. Honoraria for talks: Received honoraria from the ISGlobal, Research Foundation of the City University of New York and the Stadt Ebersberg, Museum Wald und Umwelt. Travel reimbursements: Daimler und Benz Stiftung. Patents: Named on European Patent Application EP23159999.4A (“System and method for corneal-plane physiologically-relevant light logging with an application to personalized light interventions related to health and well-being”). With the exception of the funding source supporting this work, M.S. declares no influence of the disclosed roles or relationships on the work presented herein. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The rest of the authors have no competing interests. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 20 Mar 2026, 14:1134 https://doi.org/10.12688/f1000research.167964.2 version 1 Published: 17 Oct 2025, 14:1134 https://doi.org/10.12688/f1000research.167964.1 Copyright © 2025 Bickerstaff L et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Bickerstaff L, Trinkl J, Munkwitz S and Spitschan M. Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.12688/f1000research.167964.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 17 Oct 2025 Views 0 Cite How to cite this report: Kalentakis Z. Reviewer Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.185114.r437041 ) The direct URL for this report is: https://f1000research.com/articles/14-1134/v1#referee-response-437041 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 Jan 2026 Zacharias Kalentakis , National and Kapodistrian University of Athens, Athens, Greece Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.185114.r437041 The article presents a very clever approach to studying PSR under controlled laboratory conditions. However, several aspects of the manuscript need clarification or expansion before it can be considered for publication: Background / Introduction ... Continue reading READ ALL The article presents a very clever approach to studying PSR under controlled laboratory conditions. However, several aspects of the manuscript need clarification or expansion before it can be considered for publication: Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. Overall, the study concept is original and promising, but the manuscript needs substantial revision in terms of methodological clarity, data presentation, discussion of findings, and integration with up-to-date literature. Is the background of the case’s history and progression described in sufficient detail? Partly Is the work clearly and accurately presented and does it cite the current literature? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Is the case presented with sufficient detail to be useful for teaching or other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Otorhinolaryngology, Rhinology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kalentakis Z. Reviewer Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.185114.r437041 ) The direct URL for this report is: https://f1000research.com/articles/14-1134/v1#referee-response-437041 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 20 Mar 2026 Manuel Spitschan , Technical University of Munich, Munich, Germany 20 Mar 2026 Author Response We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex ... Continue reading We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. We have expanded our discussion of theories regarding the pathophysiology of the PSR, citing relevant literature, and added text to further justify the rationale for the study (i.e. absence of evidence despite attempts through experimental approaches) Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. We have added a sentence describing gap between data collection and publication It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. It is already mentioned that author LB of the manuscript is the subject of the case report, implying that the participant was aware and trained regarding the experimental methods. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. We have added text to describe the medical history of the subject and absence of clinical assessment Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. We expanded and restructured the results section significantly, adding more quantitative descriptions of the real-world light exposure data. Added geometric means and standard deviations for the light exposure data (Figure 1B). Added statistical tests performed. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. We now describe and discuss the 7/82 cases where light decreased and a photic sneeze was recorded. After having another look at the data, it was found that more than one observation had this characteristic, which was an oversight. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. “The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup)…”: This is addressed in the discussion and limitations section; “…and how future studies might address this issue.”: Lines 208 to 220: This is addressed in the conclusion section Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). These points are now addressed by adding a joint Discussion and Limitations section Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. We now describe the clinical relevancy of studying the PSR It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. We have added text to suggest investigating thresholds for PSR induction The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. We have made it clear that tickles and sneezes are linked while not independent from each other References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. The Trinkl et al., 2025 mini-review is the most up-to-date reference on the topic of PSR and is referenced multiple times in the case report. This case report only references critical and relevant literature. We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. We have expanded our discussion of theories regarding the pathophysiology of the PSR, citing relevant literature, and added text to further justify the rationale for the study (i.e. absence of evidence despite attempts through experimental approaches) Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. We have added a sentence describing gap between data collection and publication It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. It is already mentioned that author LB of the manuscript is the subject of the case report, implying that the participant was aware and trained regarding the experimental methods. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. We have added text to describe the medical history of the subject and absence of clinical assessment Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. We expanded and restructured the results section significantly, adding more quantitative descriptions of the real-world light exposure data. Added geometric means and standard deviations for the light exposure data (Figure 1B). Added statistical tests performed. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. We now describe and discuss the 7/82 cases where light decreased and a photic sneeze was recorded. After having another look at the data, it was found that more than one observation had this characteristic, which was an oversight. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. “The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup)…”: This is addressed in the discussion and limitations section; “…and how future studies might address this issue.”: Lines 208 to 220: This is addressed in the conclusion section Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). These points are now addressed by adding a joint Discussion and Limitations section Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. We now describe the clinical relevancy of studying the PSR It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. We have added text to suggest investigating thresholds for PSR induction The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. We have made it clear that tickles and sneezes are linked while not independent from each other References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. The Trinkl et al., 2025 mini-review is the most up-to-date reference on the topic of PSR and is referenced multiple times in the case report. This case report only references critical and relevant literature. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 20 Mar 2026 Manuel Spitschan , Technical University of Munich, Munich, Germany 20 Mar 2026 Author Response We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex ... Continue reading We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. We have expanded our discussion of theories regarding the pathophysiology of the PSR, citing relevant literature, and added text to further justify the rationale for the study (i.e. absence of evidence despite attempts through experimental approaches) Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. We have added a sentence describing gap between data collection and publication It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. It is already mentioned that author LB of the manuscript is the subject of the case report, implying that the participant was aware and trained regarding the experimental methods. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. We have added text to describe the medical history of the subject and absence of clinical assessment Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. We expanded and restructured the results section significantly, adding more quantitative descriptions of the real-world light exposure data. Added geometric means and standard deviations for the light exposure data (Figure 1B). Added statistical tests performed. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. We now describe and discuss the 7/82 cases where light decreased and a photic sneeze was recorded. After having another look at the data, it was found that more than one observation had this characteristic, which was an oversight. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. “The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup)…”: This is addressed in the discussion and limitations section; “…and how future studies might address this issue.”: Lines 208 to 220: This is addressed in the conclusion section Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). These points are now addressed by adding a joint Discussion and Limitations section Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. We now describe the clinical relevancy of studying the PSR It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. We have added text to suggest investigating thresholds for PSR induction The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. We have made it clear that tickles and sneezes are linked while not independent from each other References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. The Trinkl et al., 2025 mini-review is the most up-to-date reference on the topic of PSR and is referenced multiple times in the case report. This case report only references critical and relevant literature. We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. We have expanded our discussion of theories regarding the pathophysiology of the PSR, citing relevant literature, and added text to further justify the rationale for the study (i.e. absence of evidence despite attempts through experimental approaches) Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. We have added a sentence describing gap between data collection and publication It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. It is already mentioned that author LB of the manuscript is the subject of the case report, implying that the participant was aware and trained regarding the experimental methods. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. We have added text to describe the medical history of the subject and absence of clinical assessment Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. We expanded and restructured the results section significantly, adding more quantitative descriptions of the real-world light exposure data. Added geometric means and standard deviations for the light exposure data (Figure 1B). Added statistical tests performed. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. We now describe and discuss the 7/82 cases where light decreased and a photic sneeze was recorded. After having another look at the data, it was found that more than one observation had this characteristic, which was an oversight. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. “The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup)…”: This is addressed in the discussion and limitations section; “…and how future studies might address this issue.”: Lines 208 to 220: This is addressed in the conclusion section Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). These points are now addressed by adding a joint Discussion and Limitations section Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. We now describe the clinical relevancy of studying the PSR It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. We have added text to suggest investigating thresholds for PSR induction The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. We have made it clear that tickles and sneezes are linked while not independent from each other References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. The Trinkl et al., 2025 mini-review is the most up-to-date reference on the topic of PSR and is referenced multiple times in the case report. This case report only references critical and relevant literature. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Wilkins A. Reviewer Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.185114.r427886 ) The direct URL for this report is: https://f1000research.com/articles/14-1134/v1#referee-response-427886 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 12 Nov 2025 Arnold Wilkins , Department of Psychology, University of Essex, Colchester, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.185114.r427886 Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as ... Continue reading READ ALL Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. Is the background of the case’s history and progression described in sufficient detail? Partly Is the work clearly and accurately presented and does it cite the current literature? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Is the case presented with sufficient detail to be useful for teaching or other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: vision science, migraine, epilepsy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Wilkins A. Reviewer Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.185114.r427886 ) The direct URL for this report is: https://f1000research.com/articles/14-1134/v1#referee-response-427886 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 20 Mar 2026 Manuel Spitschan , Technical University of Munich, Munich, Germany 20 Mar 2026 Author Response We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is ... Continue reading We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. We have now detailed what effects temperature could have and cited relevant literature. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. We have now added medical history and clinical evaluation of participant, and also detailed what effects UV could have and cited relevant literature. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. We have now detailed what the phantom array is, what effects it could have and cited relevant literature. We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. We have now detailed what effects temperature could have and cited relevant literature. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. We have now added medical history and clinical evaluation of participant, and also detailed what effects UV could have and cited relevant literature. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. We have now detailed what the phantom array is, what effects it could have and cited relevant literature. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 20 Mar 2026 Manuel Spitschan , Technical University of Munich, Munich, Germany 20 Mar 2026 Author Response We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is ... Continue reading We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. We have now detailed what effects temperature could have and cited relevant literature. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. We have now added medical history and clinical evaluation of participant, and also detailed what effects UV could have and cited relevant literature. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. We have now detailed what the phantom array is, what effects it could have and cited relevant literature. We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. We have now detailed what effects temperature could have and cited relevant literature. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. We have now added medical history and clinical evaluation of participant, and also detailed what effects UV could have and cited relevant literature. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. We have now detailed what the phantom array is, what effects it could have and cited relevant literature. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Oct 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 20 Mar 26 read read Version 1 17 Oct 25 read read Arnold Wilkins , University of Essex, Colchester, UK Zacharias Kalentakis , National and Kapodistrian University of Athens, Athens, Greece Enrique Germany Morrison , Université Catholique de Louvain, Bruxelles, Belgium Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Morrison E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Apr 2026 | for Version 2 Enrique Germany Morrison , Université Catholique de Louvain, Bruxelles, Belgium 0 Views copyright © 2026 Morrison E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions General Comment: The Case-Report Manuscript is interesting, the design is original, and the naturalistic (Real Case Scenario) in addition to laboratory pairing is a legitimate contribution for a poorly standardized phenomenon. The structure of the manuscript and supporting figures are well constructed and easy to follow. I would just propose some comments linked to minor modifications/additions for providing stronger, reproducible conditions of the reported test settings. Following there are some brief section by section comments. Methods Section: 1) The statistical analysis is not sufficiently specified in the Methods. The Results mention independent t-tests, Bonferroni correction, geometric means, log10 ratios, paired t-test, and exclusion of one outlier, but the Methods do not define the analytic pipeline with enough precision. I would suggest adding a discrete “Statistical analyses” subsection. It should state: whether illuminance was log-transformed before hypothesis testing; how the 100 random non-sneeze windows were sampled; whether windows could overlap each other or occur adjacent to sneeze events; what constituted the outlier and whether its exclusion was prespecified; why a paired t-test was chosen; and how multiple testing was handled across the 20-minute peri-event trajectory. Without this, the analysis is not fully reproducible. 2) You should define exactly what counted as one “event,” how multiple sneezes within one event were grouped, whether a minimum inter-event interval existed, and whether the timestamp was entered contemporaneously or retrospectively. Because the participant is also an author and knew the study aim, the self-report procedure is particularly important and should be described more rigorously. A brief note on instruction/familiarization is still warranted, even if the participant was the investigator. 3) Real-world light measurement should be described and stated as a torso-based proxy for corneal illuminance, not a near-equivalent. The current wording says this configuration offered “a good compromise between accurate measurements” and corneal-plane alignment, but this is optimistic. The later discussion rightly acknowledges positional and directional mismatch. That limitation should be foreshadowed in Methods, not introduced only after the fact. 4) You should specify the exact number of one-shot trials and 30-minute sessions, the total number of stimuli per illuminance level, the order/randomization of intensity presentation, adaptation conditions before the 30-minute protocol, fixation instructions, eye-tracking preprocessing, blink handling, pupil metric used for analysis, and room/environmental conditions including approximate ambient temperature. Given that the discussion invokes UV absence, PWM, and thermal stability as plausible reasons for null induction, the laboratory stimulus description should be correspondingly more detailed. Results Section: 5) The laboratory null result needs stronger numerical reporting. State plainly: “0 of >150 stimuli induced sneezing.” Then provide at least one compact sentence with tickle ratings by illuminance level and paradigm, for example median or mean ± SD per level. Right now, the claim of a monotonic relationship is visually plausible from Figure 2, but it is not numerically anchored in the text and no formal statistical test is reported for pupil or tickle outcomes. 6) Also, the abstract’s “peaking 2 minutes prior” should either be explicitly quantified in the main text or softened in the abstract. Conclusion Section: 7) The treatment of tickle is also slightly overstated. It is reasonable to interpret high tickle ratings as evidence of partial engagement of whatever pathway leads toward sneezing, but that remains inferential. It is not demonstrated that nasal tickle in this setup is a validated surrogate endpoint for PSR. The paper should say so directly. A precise formulation would be: “Tickle ratings may represent a proximal subjective correlate of the response, but they cannot be assumed to be equivalent to sneeze induction.” Is the background of the case’s history and progression described in sufficient detail? Yes Is the work clearly and accurately presented and does it cite the current literature? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Is the case presented with sufficient detail to be useful for teaching or other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Biomedical Engineering, Neuroscience, Data and Signal Processing, Sensors. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Morrison EG. Peer Review Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.196705.r473896) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1134/v2#referee-response-473896 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Kalentakis Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Mar 2026 | for Version 2 Zacharias Kalentakis , National and Kapodistrian University of Athens, Athens, Greece 0 Views copyright © 2026 Kalentakis Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Congratulations on your work, “Sneezing in Response to Naturalistic Bright Light Exposure.” The study is well-structured and thoughtfully designed, offering valuable insights into a relatively underexplored topic. All suggested revisions have been thoroughly addressed. Competing Interests No competing interests were disclosed. Reviewer Expertise Otorhinolaryngology, Rhinology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Kalentakis Z. Peer Review Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.196705.r469324) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1134/v2#referee-response-469324 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Kalentakis Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Jan 2026 | for Version 1 Zacharias Kalentakis , National and Kapodistrian University of Athens, Athens, Greece 0 Views copyright © 2026 Kalentakis Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The article presents a very clever approach to studying PSR under controlled laboratory conditions. However, several aspects of the manuscript need clarification or expansion before it can be considered for publication: Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. Overall, the study concept is original and promising, but the manuscript needs substantial revision in terms of methodological clarity, data presentation, discussion of findings, and integration with up-to-date literature. Is the background of the case’s history and progression described in sufficient detail? Partly Is the work clearly and accurately presented and does it cite the current literature? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Is the case presented with sufficient detail to be useful for teaching or other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Otorhinolaryngology, Rhinology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 20 Mar 2026 Manuel Spitschan, Technical University of Munich, Munich, Germany We thank the reviewer for their insightful comments, which we respond to below. Background / Introduction The background section should provide more detailed information on the photic sneeze reflex (PSR), including its underlying pathophysiology. In particular, it should be clearly explained how sudden exposure to light can trigger the reflex. A more thorough review of the relevant literature on PSR would strengthen the rationale for the study. We have expanded our discussion of theories regarding the pathophysiology of the PSR, citing relevant literature, and added text to further justify the rationale for the study (i.e. absence of evidence despite attempts through experimental approaches) Methods The methodology should clarify why the data were collected in 2022 while the manuscript was only submitted in 2025. Any delays or reasons (e.g. additional analyses, interruptions, etc.) should be briefly explained. We have added a sentence describing gap between data collection and publication It should be stated whether and how the study participant was trained or instructed regarding PSR, especially given that they were asked to complete questionnaires that are central to the research data. Details on instructions, familiarization procedures, or pilot testing would be useful. It is already mentioned that author LB of the manuscript is the subject of the case report, implying that the participant was aware and trained regarding the experimental methods. The manuscript does not mention whether the participant has any relevant medical history. It should be specified whether the participant underwent clinical evaluation by an ENT specialist, ophthalmologist, and/or neurologist prior to inclusion, and whether any conditions that could influence PSR were excluded. We have added text to describe the medical history of the subject and absence of clinical assessment Results The results section should provide a more detailed quantitative presentation of the data, rather than relying mainly on diagrams. Numerical values, measures of variability, and any statistical tests performed should be clearly described in the text. We expanded and restructured the results section significantly, adding more quantitative descriptions of the real-world light exposure data. Added geometric means and standard deviations for the light exposure data (Figure 1B). Added statistical tests performed. The observation that exposure to bright light induces the reflex is somewhat expected; however, the isolated observation that the reflex was triggered once when light levels were reduced requires stronger support and discussion. This finding should be substantiated with more detailed data and, if possible, a plausible explanation or hypothesis. We now describe and discuss the 7/82 cases where light decreased and a photic sneeze was recorded. After having another look at the data, it was found that more than one observation had this characteristic, which was an oversight. Main Limitation: Failure to Elicit PSR The experiments did not succeed in reliably eliciting PSR. This is a major limitation of the study and should be explicitly acknowledged and discussed. The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup) and how future studies might address this issue. “The authors should comment on possible reasons (e.g. stimulus parameters, individual variability, experimental setup)…”: This is addressed in the discussion and limitations section; “…and how future studies might address this issue.”: Lines 208 to 220: This is addressed in the conclusion section Discussion and Limitations The manuscript essentially lacks dedicated Discussion and Limitations sections. These should be added. The Discussion should interpret the findings in the context of existing literature, explain the implications of both the positive and negative results, and address the unexpected observations (e.g. reflex on light reduction). A Limitations paragraph should summarize the main methodological and conceptual constraints of the study (single participant, failure to elicit reflex, lack of comprehensive clinical evaluation if applicable, etc.). These points are now addressed by adding a joint Discussion and Limitations section Conclusion and Future Directions The conclusion should elaborate on how the attempted experimental induction of PSR can contribute to future research, even if the primary aim was not fully achieved. We now describe the clinical relevancy of studying the PSR It would be particularly interesting to investigate and report the minimum light intensity required to trigger PSR and to compare this threshold across multiple individuals. Even if this was not done in the present study, it could be proposed as a concrete direction for future work. We have added text to suggest investigating thresholds for PSR induction The authors should also clarify that the sensation of a tickle in the nose does not necessarily lead to a sneeze, and that not every sneeze is preceded by such a sensation. This distinction is important for interpreting subjective reports and questionnaire data. We have made it clear that tickles and sneezes are linked while not independent from each other References The reference list would benefit from the inclusion of more recent and comprehensive bibliographic sources on PSR and related reflexes, to ensure that the manuscript is aligned with current knowledge. The Trinkl et al., 2025 mini-review is the most up-to-date reference on the topic of PSR and is referenced multiple times in the case report. This case report only references critical and relevant literature. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Kalentakis Z. Peer Review Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.185114.r437041) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1134/v1#referee-response-437041 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Wilkins A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 12 Nov 2025 | for Version 1 Arnold Wilkins , Department of Psychology, University of Essex, Colchester, UK 0 Views copyright © 2025 Wilkins A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. Is the background of the case’s history and progression described in sufficient detail? Partly Is the work clearly and accurately presented and does it cite the current literature? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Is the case presented with sufficient detail to be useful for teaching or other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise vision science, migraine, epilepsy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 20 Mar 2026 Manuel Spitschan, Technical University of Munich, Munich, Germany We thank the reviewer for their insightful comments, which we address below. Given that the experimenters were unsuccessful in inducing sneezing in the lab by light stimulation one is led to wonder what the important differences between lab conditions and the conditions under which sneezing typically occurs. These may be characterised as reflecting differences in the individual's physiology and differences in the light stimulation. As regards the individual's physiology, thermal comfort is one obvious difference between the natural and lab conditions. Sneezing is usually occasioned when an individual feels the cold, something they are more likely to do when outside than indoors. We are told that "Sneezing often took place during transitions between environments, e.g., walking from home to the bus station, or from the bus station to the workplace." Presumably the indoor temperature was stable and comfortable, unlike the conditions prevalent when sneezing occurred. Thermal instability is therefore a consideration. We have now detailed what effects temperature could have and cited relevant literature. There were also important differences between the light used in the lab and the daylight outside. The multiLED source did not provide stimulation below 400nm. It is possible that the UV present outdoors contributed to sneezing, given that Askenasy notes that keratitis has been reported to enhance the photic sneeze reflex. If LB wears glasses this is unlikely to be an important concern given that CR39 lenses filter out most light below 380nm. If LB does not, however, there is the (admittedly remote) possibility that UV played a role. We have now added medical history and clinical evaluation of participant, and also detailed what effects UV could have and cited relevant literature. Another indirect concern is that the light engine used pulse width modulation (PWM). Some individuals can discriminate steady from intermittent light at frequencies exceeding 15kHz. Those that can do so tend to suffer eye-strain in everyday life. The intermittent light generates a spatial pattern during a saccade known (unfortunately) as the phantom array. It is remotely possible that the phantom array interfered in some way with eye movements or with appreciation of the bright light. If coloured fringes were visible during a saccade owing to the differences in PWM between the various LED sources, this would have been a distraction, if nothing more. We have now detailed what the phantom array is, what effects it could have and cited relevant literature. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Wilkins A. Peer Review Report For: Sneezing in response to naturalistic bright light exposure [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :1134 ( https://doi.org/10.5256/f1000research.185114.r427886) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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