Elena starnutisce ogni primavera, come se avesse sempre la stessa allergia.

Italian often leaves subject pronouns out because the verb ending already shows the person and number.

Here, Elena is already named, so lei would be unnecessary:

• Elena starnutisce... = Elena sneezes...

You could say Lei starnutisce..., but that would usually add emphasis, contrast, or clarification.

Because the verb is starnutire, an -ire verb that uses the -isc- pattern in some forms.

Present tense of starnutire:

• io starnutisco
• tu starnutisci
• lui/lei starnutisce
• noi starnutiamo
• voi starnutite
• loro starnutiscono

So starnutisce is the normal he/she sneezes form.

Ogni means every, and in Italian it is normally followed by a singular noun:

• ogni giorno = every day
• ogni anno = every year
• ogni primavera = every spring

So even though the meaning is repeated over time, the noun stays singular after ogni.

The comma separates the main clause from the comparison clause:

• Elena starnutisce ogni primavera
• come se avesse sempre la stessa allergia

This is very natural in written Italian. The second part adds a comment or comparison, so the comma helps mark that break clearly.

Come se means as if.

It introduces a clause describing how something seems or appears, not necessarily a fact:

• Parla come se sapesse tutto. = He speaks as if he knew everything.
• Elena starnutisce..., come se avesse... = Elena sneezes..., as if she had...

So come se is a very common trigger for the subjunctive.

Because after come se, Italian normally uses the subjunctive, not the indicative.

Here:

• ha = indicative present of avere
• avesse = imperfect subjunctive of avere

So:

• come se ha... ❌
• come se avesse... ✅

This is one of the most important patterns to learn:

• come se + subjunctive

Not really in the usual sense.

Although avesse is the imperfect subjunctive, in this sentence it does not mean the allergy is in the past. It is used because of the grammar after come se.

So the idea is still connected to the present situation:

• Elena sneezes every spring
• it seems as if she had the same allergy every time

This is similar to English, where as if she had can also refer to a present impression, not only to the past.

Avesse is the third-person singular imperfect subjunctive of avere.

Imperfect subjunctive of avere:

• io avessi
• tu avessi
• lui/lei avesse
• noi avessimo
• voi aveste
• loro avessero

Since the subject is Elena, the sentence needs lui/lei avesse.

In Italian, stesso/a is very commonly used with a definite article:

• lo stesso problema = the same problem
• la stessa idea = the same idea
• la stessa allergia = the same allergy

So stessa allergia by itself would sound incomplete in this sentence. The article is the normal choice.

Sempre means always, and here it reinforces the idea of repetition:

• come se avesse sempre la stessa allergia

The sense is:

• every spring, it seems to be the same thing again
• as if she always had the same allergy returning

So sempre works with the whole idea of having the same allergy again and again, not just with allergia alone.

In standard Italian, come se is normally followed by the imperfect subjunctive or pluperfect subjunctive, not the present subjunctive.

So:

• come se avesse ✅
• come se abbia ❌ in standard usage here

A useful rule is:

• come se + imperfect subjunctive for a present/unreal comparison
• come se + pluperfect subjunctive for an earlier unreal comparison

For example:

• Parla come se sapesse tutto.
• Parlava come se avesse saputo tutto.