THE HOMOEOPATHIC THE HOMOEOPATHIC TREATMENT OF ALLERGIC TREATMENT OF ALLERGIC

RHINITISRHINITISDr. Smita Brahmachari,Dr. Smita Brahmachari,

M.D. (Repertory) from N.I.H., Kolkata.M.D. (Repertory) from N.I.H., Kolkata.M.O., Dept. of AYUSH, M.O., Dept. of AYUSH,

Govt. of NCT Delhi.Govt. of NCT Delhi.

Introduction Introduction AllergyAllergy is a state of abnormal sensitivity to a substance that

ordinarily cause no irritation to people without this sensitivity.

It can be designated as an acute antibody reaction due to an ‘insult’ from a protein element which is treated by the internal environment as an unwanted foreign substance.

Almost anything that we touch, swallow or inhale may cause an allergic response. Substances that produce allergies are called AllergensAllergens. There are literally hundreds of allergens.

The most common allergens most common allergens are the pollen of trees, grasses and weeds, spores, smoke, dust, animal hairs, certain foods, drugs, dyes, paints, cosmetics, chemicals etc.

Importance of early diagnosis of an Importance of early diagnosis of an allergic conditionallergic conditionThe early awareness of allergies to both the physician, family

and patient will help to treat and manage the case in a proper way to make cure rapidly and permanently and can save from more serious complications.

Allergy is an indication of internal disturbance. It requires proper treatment on the basis of Law of Similia (Homoeopathy) rather than using suppressive medicines. Constitutional / antimiasmatic homoeopathic medicine travel long way in both curing and preventing the episodes of recurrence.

In fact children have very poor immune response (morbid susceptibility) to all diseases, so such cases in particular we can avoid the complication at the same time we can improve and strengthen the immune system for fighting against future diseases by well chosen Homoeopathic antimiasmatic medicine.

Are allergies curable?Are allergies curable?Not only removal of the cause of the allergy

(the allergen) is enough for cure.It is very difficult to remove many allergen

whom we are facing in day to day life.The best way to cure allergies is to go through

the study of defective soil or the patient as a person treat that and make them free from sensitivity to the allergens, then we can eradicate the problem and make them free from allergens.

The nose is separated into two passages by a wall of cartilage called the septum and is lined with a membrane that produces mucus.

The mucus, a thin clear liquid, traps small particles and bacteria that are drawn into the nose as a person breaths. The trapped bacteria usually remain harmless in healthy individual.

Normally, a cycle of congestion and decongestion occurs continuously throughout the day.

Rhinitis describes a group of symptoms, including runny nose, itching and sneezing that are caused by excessive exposure to environmental irritants, such as cigarette smoke, chemicals, changes of temperature, stress exercise or other factors may provoke symptoms of rhinitis in people who are susceptible to different kind of allergens.

If symptoms last less than six weeks, the condition is referred to as acute rhinitis (such as flu, infectious rhinitis).

When rhinitis lasts for a long period, the condition is called chronic rhinitis (such as allergic rhinitis, chronic infectious rhinitis etc.).

Three Clinical types have been recognized: Seasonal – Symptoms appear in or around a particular season

when the pollens of a particular plant, to which the patient is sensitive, are presenting the air. (Relation to homoeopathy, in psoricpsoric patient symptoms of allergy aggravate in winter season, in syphiliticsyphilitic patient symptoms aggravate in summer season and in sycoticsycotic patient symptoms aggravate in rainy season.)

Perennial – Symptoms are present through out the year caused by dust, household mites, air pollution, and pet dander.

Occupational – Dust related to the occupation causes rhinitis. Symptoms are like perennial type.

Predisposing factors: Heredity: Allergic rhinitis generally presents in atopic individuals; i.e. in person with a family

history of a similar or related symptom complex. Psychological: Emotion and anxiety often seen. Endocrinal: More common during puberty, pregnancy and menopausal period. Changes of Temperature: Temperature variation and seasonal changes. Westernization: Westernized life styles, like as wall carpeting, cat and dog ownership etc., ultimately

increases the allergies. Immunization – Childhood immunization against infectious diseases cause over all higher allergy

rates.

Precipitating factors: Inhalants: - Inhalation of pollens, smokes and dusts, house dusts, powders, tobacco smoke, animal

excreta, molds, dust mite etc. Ingestants (foods): Egg, Crabs, Prawns, Brinjals, Pine Apples, Milk products, Nuts etc. Infection: Bacterial allergy. Drugs: Aspirin, Iodine, antibiotic etc often cause allergic reaction. Synthetic materials .

• AR is caused by exposure to an airborne allergen in a predisposed individual.

• Activation of both humoral (B-cell) and cytotoxic (T-cell) immune responses with subsequent allergen specific IgE responses causes release of inflammatory mediators.

• The response is increased as antigen is passed to regional lymph nodes for greater T-cell activation.

Interleukin and cytokine release causes specific activation of mast cells, eosinophils, plasma cells, basophils and other T-cells.

Many of these circulating cells then migrate into the nasal and ocular epithelium where they contribute directly to symptoms through proinflammatory mediators, including histamine, prostaglandins and kinins.

The cardinal symptoms of seasonal nasal allergy include paroxysmal sneezing, 10-20 sneezes at a time nasal obstruction, watery nasal discharge and itching in the nose. Itching may also involve eyes, palate or pharynx and loss of taste. Some may get bronchospasm. The duration and severity of symptoms may vary with the season.

Symptom of perennial allergy are not so severe as that of the seasonal type. They include frequent colds, persistently stuffy nose, loss of sense of smell due to mucosal oedema, post nasal drip, chronic cough and hearing impairment due to eustachian tube blockage or fluid in the middle ear.

Systematic symptoms include general malaise, fatigue, irritability and insomnia.

Clinical featuresClinical featuresSigns of allergy may be seen in the nose, eyes, ears, pharynx or larynx. Nasal signs. – Include pale and oedematous nasal mucosa which may appear bluish.

turbinate are swollen. Thin, watery or mucoid discharge is usually present. Ocular signs. – Include oedema of lids congestion and cobble-stone appearance of

the conjunctiva, dark circles under the eyes (allergic shiners). Otologic signs. – Include retracted tympanic membrane or serious otitis media as a

result of eustachian tube blockage. Pharyngeal signs:- Include granular pharyngitis due to hyperplasia of submucosal

lymphoid tissue. A child with perennial allergic rhinitis may show all the features of prolonged mouth breathing as seen in adenoid hyperplasia. Orthodontic problems occur due to prolonged mouth breathing.

Laryngeal signs: Include hoarseness of voice and oedema of the vocal cords. Sign of Sinusitis – Localized facial tenderness on palpation, especially in

conjunction with purulent anterior or posterior nasal discharge. Sign of allergic Crease: It is a crease which develops across the nose due to

repeated rubbing of the nose.

DiagnosisDiagnosis Clinical Symptoms – In clinical terms allergic rhinitis can be defined as symptoms

of nasal itching, sneezing, discharge or nasal blocking which occur for more than 1 hour on most days.

The diagnosis of seasonal allergic rhinitis depends largely on an accurate history of occurrence coincident with pollination of the offending weeds, grasses or trees.

The continuous character of perennial allergy rhinitis due to contamination of the home or place of work makes historic analysis difficult, but there may be a variability in symptoms that can be related to exposure to animal dander, dust mite, and cockroach allergens or work related allergens such as latex.

The diagnosis of allergic rhinitis is often straight forward. A history of potential allergic trigger is very helpful. A history of potential allergic triggers include enquiry into the seasonality of symptoms and whether symptoms are work related (i.e. occur at work or in the evening following work, with improvement at weekends and during holiday periods). The home environment, including the presence of domestic pets or birds, fitted carpets central heating or non-synthetic bedding should be established.

A personal or family history of atopy is extremely common in patients with allergic rhinitis.

N.B. Careful present, past, family and allergic history are helpful for Diagnosis.

DiagnosisDiagnosis

On physical examination the mucosa of the turbinates is usually pale because of venous engorgement.

Nasal polyps, which are yellowish boggy masses of hypertrophic mucosa, are associated with long standing allergic rhinitis.

X-ray of paranasal sinuses: mucosal thickening of lining mucosa, polypoid hypertrophy, is seen more commonly in maxillary antrum. In obstructive cases deviation of septum is present.

Blood count shows eosinophilia and elevated IgE levels.

SKIN ALLERGY REPORTSKIN ALLERGY REPORT

The blood tests for allergic disease are immunoassays that measure the level of IgE specific to a particular allergen.

The tests can be used to evaluate sensitivity to various allergens, for example, to common inhalants such as dust mites, pollens etc.

Types of immunoassays include ELISA, FEIA (Fluorescent enzyme immunoassay) and radioallergosorbent assay (RAST).

The sensitivity varies from 60 – 95% and they identify specific allergens.

Differential diagnosisDifferential diagnosis Allergic rhinitis: Seasonal, Perennial, occupational most patients with

allergic rhinitis have allergic symptom triggers, eosinophil rich nasal secretions, allergen specific IgE to inhalant allergen and a family history of allergic disease.

Non-allergic rhinitis:Perennial (vasomotor): Constant symptom of profuse, clear rhinorrhoea

and nasal congestion without correlation to specific allergen exposure or signs of atopy.

Cold-air-induced:- Nasal congestion and rhinorrhoea on exposure to cold, windy weather occur in both allergic and non-allergic people.

Non-allergic rhinitis with eosinophilia Syndrome: Most often seen in adults and characterized by eosinophilia on nasal smears with negative testing for allergens.

Infectious rhinitis:- Bacterial, viral, fungal. Drug induced rhinitis: Oral contraceptives, reserpine derivatives, topical

decongestant (rhinitis medicamentosa), beta blockers (eye drops).

Differential diagnosis (contd.)Differential diagnosis (contd.) Mechanical Obstruction:-

Septal Deviation: Common and might exacerbate nasal obstruction in allergic rhinitis.

Foreign body: Unilateral purulent nasal discharge is the usual manifestation of a foreign body and resolves after removal.

Choanal atresia or stenosis: it is diagnosed early in life specially bi-lateral choanal atresia. Early diagnosed by nasal endoscopy and axial computed tomography of the mid-facial skeleton.

Adenoid hypertrophy:- Common cause of nasal obstruction in children. Neo plastic:

Benign:- Nasal polyps, naso-pharyngeal angiofibroma, inverted papilloma.

Malignant:- Adeno carcinoma, sqamous cell carcinoma, esthesioneuroblastoma, lymphoma, rhabdomyosarcoma

Complications Complications Recurrent sinusitis because of obstruction to the sinus ostia. Nasal polyp. Serous otitis media. Orthodontic problems and other ill effects of prolonged mouth

breathing especially in children. Bronchial asthma (28 to 50% patients with asthma and upto 30% with

eczema have allergic rhinitis. These conditions have been termed “atopic disease” and patients who have them we often called “atopic”.

Chronic fatigue syndrome. In the immune system due to triggers response the release of a number

of immune factors, importantly cytokines, powerful factors that can cause fatigue, joint aches and fever, which can also affect the hypothalamus-pituitary-adrenal system in the brain.

The conventional method of treatment of The conventional method of treatment of nasal allergies are nasal allergies are antihistaminesantihistamines and and

intranasal corticosteroidsintranasal corticosteroids. Many patients . Many patients who find initial benefit from these who find initial benefit from these medications complain that allergy medications complain that allergy

symptoms eventually return after several symptoms eventually return after several months of use.months of use.

The line of treatment can be divided into two parts:

›Preventive /adjunctive treatment.

›Curative treatment.

Avoiding or reducing exposure to airborne allergens is the most effective means of alleviating symptoms of AR.

Nasal saline irrigations are a very useful adjunct in the treatment AR to mechanically flush the allergens from the nasal cavity.

When symptoms are extremely bothersome, a search for offending allergen may prove useful by skin testing or by serum RAST testing by an allergist.

Removal of a pet from the house to avoid animal danders, exterminating cockroaches by chemical or pesticides,

Utilization of air filtration devices (air cleaners, filters for air conditioners and vacuum cleaner) to minimize the concentrations of air borne pollens.

Careful food storage, A particular food article which the patient is fumed allergic can be eliminated from the diet.

Travel to non-pollinating areas during critical periods and even a change of domicile to eliminate a mold spore problem may be necessary.

Control dust-mites by allergen avoidance includes use of plastic lined covers for mattresses, pillows and comforters and elimination of carpets and drapes.

Avoid dust and mold. Since this is difficult and it may be impractical for you to create an "allergy-proof" home, at least make sure your bedroom is as allergen-free as possible.

Treatment on the basis of healing art, based on constitution and anti – miasmatic medicine, makes the immune power of the body balanced and at the same time frees it from painful symptoms.

To alleviate/cure the allergic condition, a detailed and thorough case taking is strongly emphasized. Aphorisms (Organon of Medicine) 82 – 104, 6, 67, 205 – 209 must be followed along with footnotes of aphorism 88, 89, 90 and 94.

The homoeopathic approach to treating The homoeopathic approach to treating allergies is based on the understanding allergies is based on the understanding that symptoms are the body’s effort to that symptoms are the body’s effort to correct an imbalance in the system. correct an imbalance in the system. Rather than controlling or suppressing Rather than controlling or suppressing the symptoms, the homoeopath prescribes the symptoms, the homoeopath prescribes a micro-dose of an individually chosen a micro-dose of an individually chosen medicine that has capacity to create medicine that has capacity to create symptoms similar to those the allergic symptoms similar to those the allergic person is experiencing.person is experiencing.

Homoeopathic medicines for:1.1. Acute allergy attacks Acute allergy attacks – these medicines

are effective in reducing exacerbated allergic symptoms, but generally do not prevent the recurrence of symptoms in future.

2. Underlying chronically ill state chronically ill state that gives rise to recurrent allergy symptoms – antimiasmatic medicines reduce the frequency and intensity of symptoms and cures a person with allergy symptoms.

PSORAPSORA- Sensation of dryness in nose, due to deficient

function of mucus secreting glands (due to atrophy of mucus secreting glands in pseudo-psora and syphilis).

- Thin acrid discharge with burning (also seen in sycosis).

- Redness of nasal orifice (marked redness in pseudo - psora).

- Hypersensitivity to smell e.g., smell of perfumes, flower, cooking food etc.

SYCOSISSYCOSIS - Red, swelled, knobby nose (Borax, Rhus tox, Thuja).- Allergic rhinitis.- The discharge is scanty, usually mucus; generally they

cannot breathe through the nose or blow any mucus from it, but the slightest amount of discharge relieves the congestion and stopped-up feeling.

- The snuffles is moist and there is no ulceration and no crusts.

- Polyp, nasal turbinate hypertrophy (also seen in pseudo-psora)

SYPHILISSYPHILIS- Depression of root of nose or deformed shape of

nose.- Atrophic rhinitis with very offensive discharge.- Complete loss of smell.- Snuffles (also seen in sycosis) with clinker

formation.- Crusts are thick, large, green, brown, black filling

the whole nasal cavity; frequently they have to be removed, but soon form again.

- Destruction of nasal bone, deviated nasal septum.

PSEUDO-PSORA/ TUBERCULARPSEUDO-PSORA/ TUBERCULAR- Epistaxis which relieves most of the

complaints.- Thick, yellow offensive nasal discharge and

sometimes bloody.- The catarrhal discharge is constantly dropping

down the throat.- Marked congestion of nasal orifice.- Recurrent catch cold with susceptible to dry

cold (susceptible to moist cold in syco-psora)

“In the worst forms of hay-fever (allergic In the worst forms of hay-fever (allergic rhinitis), where there is much sneezing, rhinitis), where there is much sneezing, and with much local trouble, we find it and with much local trouble, we find it often depends on the tubercular taint often depends on the tubercular taint with an acquired latent sycosis with an acquired latent sycosis ingrafted. Of course psora is greatly ingrafted. Of course psora is greatly magnified in all of these cases, but magnified in all of these cases, but purely psoric cases are easily cured by purely psoric cases are easily cured by the homoeopathic remedy, while there the the homoeopathic remedy, while there the mixed miasm is present, it is extremely mixed miasm is present, it is extremely difficult to curedifficult to cure ”…..”…..The Chronic Miasms The Chronic Miasms

""In the hay-fever type of troubles, In the hay-fever type of troubles, which is one of the most troublesome which is one of the most troublesome conditions we have to deal with, we conditions we have to deal with, we have as the base psoric, the syphilitic have as the base psoric, the syphilitic and the sycotic. The sycotic remains and the sycotic. The sycotic remains latent during the active period, but latent during the active period, but will come out later, after proper will come out later, after proper treatment has been instituted. These treatment has been instituted. These cases are always difficult to treat, cases are always difficult to treat, and still more difficult when serum or and still more difficult when serum or vaccine treatment has been vaccine treatment has been givengiven ”…..The Principles and Art of Cure by ”…..The Principles and Art of Cure by Homoeopathy. Homoeopathy.

1. In a double blind clinical study done by representatives of the Glasgow Homoeopathic Hospital in collaboration with researchers from the University of Glasgow, it was found that homoeopathy was successful in significantly diminishing the symptoms of hay fever. The study of 144 patients with hay fever showed that those given a homoeopathic dose of mixed pollen medicine (a mixture of 12 different species of grass pollens given in a potency of 30c) had 6 times much improvement compared to those given placebo. The subjects were allowed to take a conventional medicine that temporarily diminished symptoms if need was felt. Those patients on homoeopathic medicine required the drug half as often as those people given the placebo. The study was published in prestigious medical journal Lancet.

(Reilly DT, Taylor MA, “Is homoeopathy a placebo response? Controlled trial of Homoeopathic potency, with pollen in hayfever as model,” Lancet, 1986, Oct 18, 2/ 8512/ 881-6).

2. “A multicentric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children,” Indian journal of Research in Homoeopathy/2010/ vol.4/No.2/april-june/23-32.

3. “Random controlled trial of homoeopathy versus placebo in perennial allergic rhinitis,” British medical journal/2000/vol.321/471-476.

4. “Immunology and homoeopathy,” Evidence based complementary alternative medicine/december 2006/vol.8, issue 4/ 397 – 409.

5. “How healthy are chronically ill patients after 8 years of homoeopathic treatment, results from a long term observational study,” British medical council public health/ 2008/ vol.8/413.These clinical studies using Homoeopathy have reported These clinical studies using Homoeopathy have reported beneficial effects from allergy related conditions. The findings beneficial effects from allergy related conditions. The findings indicate potential benefits of the Homoeopathic intervention in indicate potential benefits of the Homoeopathic intervention in reducing symptoms and improving quality of life in patients reducing symptoms and improving quality of life in patients suffering from allergic rhinitis. suffering from allergic rhinitis.

SINGLE MEDICINES FOR ARSINGLE MEDICINES FOR AR

SYNTHESIS REPERTORY ( 9.1 edition):SYNTHESIS REPERTORY ( 9.1 edition):- Hay fever with itching in ear: Agaricus.- With palate itching: Agaricus- With asthmatic breathing: Carcinosin- With asthmatic breathing in august: Allium cepa and

until fall: Sinapis nigra.- Autumn agg.: Dulc. and Psor.- In spring: All cepa, Gels., Lach., Naja., Sabad., Sang. and Tub. - Change of temperature agg.: Dioxinum- Warm room amel>: Lecithinum

SINGLE MEDICINES FOR ARSINGLE MEDICINES FOR AR

- SYNTHESIS REPERTORY ( 9.1 edition):SYNTHESIS REPERTORY ( 9.1 edition):- Beginning stage: Rosa damascena.- Chronic: Carcinosin- Recurrent: Carcinosin.- Periodical every year: Bambusa arundinacea.- Prophylaxis: Ars alb., Kali phos., Psor.- Dust agg.: Lycoperisecum esculentum.- Fine dust in air: Belladonna- New grass: Dulcamara.- Grief from: Nat mur.- Sun exposure to: Dioxinum

SINGLE MEDICINES FOR ARSINGLE MEDICINES FOR AR

REPERTORY OF HERING’S GUIDING SYMPTOMS OF OUR MATERIA MEDICAREPERTORY OF HERING’S GUIDING SYMPTOMS OF OUR MATERIA MEDICA

- Hay fever, yearly, in August, worse in morning, with sneezing: Allium cepa.

- Cannot be near cut grass or new mown hay: Dulcamara.- Either nostril affected/ alternately with the other: Sinapis nigra.- With rawness in chest: Carbo veg.- At seaside: Dulcamara- With morning sneezing: Gelsemium.- Rose cold with asthma, sick and faint from odor of flowers:

Sanguinaria

SINGLE MEDICINES FOR ARSINGLE MEDICINES FOR AR

- REPERTORY OF HERING’S GUIDING SYMPTOMS OF OUR MATERIA MEDICAREPERTORY OF HERING’S GUIDING SYMPTOMS OF OUR MATERIA MEDICA

- With sensitive to odor of flowers: All cepa.- With aching in eyes: Cimicifuga- If suppressed: Bell and Calc carb.- With heaviness in forehead, impatient mood: Nux vom.- Severe headache and redness of lids: Sabadilla- Constant sneezing: Dulcamara.- With annual asthma: Sticta; asthma coming on about last of

August: Silicea; asthma on about 20th of August: Psorinum; comes on July 28th stays till frost: Sinapis nigra.

- With asthma in damp weather: Sinapis nigra.

CONCLUSIONCONCLUSION

Allergic rhinitis is a very common disorder that can significantly impact patient quality of life.

The diagnosis is made through a comprehensive history and physical examination.

Further diagnostic testing using skin-prick tests or allergen-specific IgE tests is usually required to confirm that underlying allergies cause the rhinitis.

The homoeopathic therapeutic option available for the treatment of allergic rhinitis is very effective in managing symptoms and is generally safe and well-tolerated.

THANK YOUTHANK YOU