A Case of Allergic Rhinitis

Date: 20/06/12

Name: Miss. MDS

Age/Sex: 12 yrs/Female

Religion: Hindu

Education: VIII std

Occupation: Student

Father:34 years

Mother: 30 years

Brother: One studying in V std

Diet: Vegetarian

Address: Shaskiya Colony, Latur

Location	Sensation	Modalities	Accompaniments
Respiratory System
1. Nose– Mucous Membrane	Irritation	A/F cold breeze2+
Onset: Since 5 to 6 months	Sneezing2+	< Early Morning
Duration: 10 Mins	Paroxysmal2+	< Night
Progress: Rapid	Coryza2+ thin to thick discharge Irritation
Frequency: Daily 4- 5 times Intensity: Moderate
2. Throat Frequency: Occasional		> Antihistaminic

Febrile Convulsions- Took Antiepileptic medication for 1 year

Mother had allergic rhinitis

Appearance: Lean Skin: Fair Perspiration: General; Partial- Tip of Nose, no odor Appetite and Hunger: Normal Thirst: Normal Cravings: Spicy3+, Junk Food2+ Aversion: Sweets2+ Stool: Unsatisfactory, Consistency: Normal, Urge: Normal

Urine: Normal Sleep: Initially difficulty to sleep, afterwards sleeps normally; alert Dreams: No dreams Ailments from: Getting wet leads to coryza Menarche: Not yet established Thermal State: Chilly

The patient, from a middle class family stays with her father who works as a senior peon at a Government office at Latur, her mother, a housewife and a younger brother studying in V standard. Her grandparents stay in the village away from her residence and she meets them occasionally. The family has good interpersonal relationship among them. The patient does not contribute in household work as physical exertion exhausts her and also she doesn’t like to work. She has average performance in academics. She forgets about her assignments and needs constant supervision from her mother for their completion. She gets exhausted after reading or writing one or two pages. She also forgets about her belongings in school and is scolded by her parents and teachers. After scolding she becomes angry but never retaliates. She likes studying Marathi and Maths, drawing and also likes to travel. She has fear of lightening, dark, ghosts, lizards, cockroaches, rats and cats. She avoids these fearful things and if exposed to these, she needs someone to be near her.

General condition: Fair

Temperature: Afebrile

Pulse: 80 /min

RR: 18 /min

Weight: 32 kg

Height: 138 cms

Nose: No discharge, Congestion

Tongue: Moist

Throat: NAD

Teeth: Normal

CNS: NAD

CVS: S1S2 Normal

R/S: Clear

P/A: Soft

* RR- Respiratory Rate, CNS- Central Nervous System, CVS- Cardiovascular System, R/S- Respiratory System, P/A- Per Abdomen

Allergic Rhinitis	Cause	Exposure to Cold
	Effect	Nasal mucous membrane irritation Coryza: Thin to thick discharge Sneezing: Paroxysmal O/E- Nose: Nasal congestion
	Predisposing Factors	Heredity: Mother: Allergic Rhinitis

Past History: Febrile convulsions

Family History: Mother had history of allergic rhinitis

Sensitivity at mental and physical level

Mental and physical exertion leading to exhaustion

Susceptibility: Moderate

Potency: 200 (Considering the moderate intensity of symptoms, level of susceptibility and miasmatic understanding)

Repetition: Infrequent- Chronic case having hypersensitivity at mind and body level.

Selection of Repertory: This case has qualified mental and physical generals hence Kent’s repertorial approach has been selected.

Rubrics	Classification & Evaluation of Symptoms
Mind, A/F Mental Exertion	Qualified Mental Causative Modality
Mind, A/F Physical Exertion	Qualified Physical Causative Modality
Mind, A/F Exposure to Cold	Qualified Causative Modality
Mind, Fearsome	Characteristic Mental Emotional Symptom
Mind, Indolent	Characteristic Mental Behavioural Symptom
Mind, Desires to Travel	Characteristic Mental Emotional Symptom
Generalities, Thermal State Chilly	Characteristic Physical General
Generalities, Cravings: Spicy3+	Characteristic Physical General
Generalities, Cravings: Junk Food2+	Characteristic Physical General
Generalities, Aversion: Sweets2+	Characteristic Physical General
Generalities, Sleep, Alert	Characteristic Physical General
Generalities, Stools UnsatisfactoryGeneralities, Stools Unsatisfactory	Characteristic Physical General
Perspiration, Partial, Tip of nose	Characteristic Physical General

Chilly	Totality & Symptoms Covered	Hot	Totality & Symptoms Covered
Calc Phos	20/8	Sulphur	21/9
Phos	20/8	Lycopodium	18/7
Sepia	20/8	Pulsatilla	15/8

Calcarea phosphorica, Phosphorous and Sepia are the closely coming up remedies in repertorisation and need a finer differentiation. Inability to withstand any mental and physical exertion leading to indolence, early exhaustion and aversion to work is the core of Calcarea group. Lots of fears, the behaviour and the way of dealing with the scolding by the lack of emotional reaction due to fearsome nature is also characteristic of Calcarea phosphorica. In Phosphorous the inability to withstand any mental and physical exertion leads to profound exhaustion. Where as in Sepia, the inability to withstand any mental and physical exertion leads to indifference, indolence and irritability. Both Calc. and Phosphorous are covering the totality and therefore Calcarea phosphorica is selected for this patient as it covers both the remedy characteristics.

Thermal status of patient is chilly.

Calcarea phosphorica

Calcarea phosphorica 200 single dose at bedtime

Advice: Avoid exposure to cold and to have proper covering of face to avoid contact with cold breeze.

Follow up

Date	Follow Up	On Examination	Action
17/09/12	Patient reported after 3 months. In these 3 months (20/06/12 – 17/09/12) patient had no coryza, sneezing or any other complaint. Now since 4 days due to exposure to cold for 3-4 hrs, she has coryza- watery discharge1+, sneezing2+ paroxysmal. Mild throat irritation. Once she had mild fever; she took Tab Levocetrizine (Antihis-taminic) 1 tablet which gave temporary relief.	Afebrile Pulse- 88/min Nose- Congestion of Mucous Membrane Throat- NAD S/E: R/S- Clear	Sabadilla 200 3 pills Qds x 3 days (After 3 days of completion of acute treatment) Followed by Calcarea phosphorica 200 1Dose HS
	Appetite and thirst is normal. Interpretation: Disease: Acute exacerbation of chronic disease Prescription: Acute Totality for Acute Prescribing: A/F Exposure to Cold Inflammation of nasal mucous membrane Watery nasal discharge Paroxysmal sneezing On repertorisation: Sulphur: 9/4(Hot), Calcarea carbonica: 8/4, Natrum muri-aticum: 8/4 (Deep Acting), Nux vomica: 8/4, Phos-phorus: 8/4 Rhus Tox: 8/4, Sabadilla: 8/4 – Considering its functional pathology and the expression of disease.		Placebo Pills TDS x 7 Days
10/10/12	Earlier acute episode relieved with Sabadilla. Last week had one acute episode of coryza and sneezing which lasted for one day and was >3+ on its own. any Antihistaminic not taken Interpretation Body is able to come out of acute condition without the need of acute remedy i.e.	Afebrile P- 80/min Nose- Normal Throat- NAD S/E: R/S- Clear	Tuberculinum 1M single dose at bedtime Followed by Calcarea phosphorica 200 1Dose HS Placebo Pills
	improved immunity against cold.		TDS x 7 Days
	Recurrence of acute episode and considering the miasmatic load, need of prescribing antimiasmatic remedy to enhance immunological response to disease producing stimuli and to reduce the recurrence of disease.
24/11/12	Occasional coryza. No other complaints.	Afebrile, P- 78/min Nose- Normal Throat- NAD S/E: R/S- Clear	Calcarea phosphorica 200 1 Dose HS Placebo Pills TDS x 7 Days
02/01/13	No complaints in 3 months. Not even a single episode of coryza occurred.	Afebrile, P- 78/min, Nose- Normal, Throat- NAD	No treatment