A Case of Allergic Rhinitis - homeopathy360
Clinical

A Case of Allergic Rhinitis

Case study
Preliminaries
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
Chief Complaints
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
Past History
Febrile Convulsions- Took Antiepileptic medication for 1 year
Family History
Mother had allergic rhinitis
Physical Generals
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
Life Space Investigation
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.
Examination Findings
General Examination
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
Systemic Examination
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
Case Processing
Disease Diagnosis
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
Hahnemannian Classification of Disease: Chronic
Miasm
  • Fundamental Miasm: Tubercular
Past History: Febrile convulsions
Family History: Mother had history of allergic rhinitis
  • Dominant Miasm: Tubercular
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.
Repertorial Totality with Classification and Evaluation of Symptoms
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
Repertorial Sheet
 Figure 1. Repertorial Sheet using Radar software
Repertorial Result
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
Differentiation of Remedies
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.
Final Selection of Constitutional Remedy
Calcarea phosphorica
First Prescription
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
Bibliography
  1. Bhargava et al., 1998. Short Textbook of ENT Diseases, 4th ed. Usha Publications, Mumbai, India
  2. Boger Boenninghausen’s, 2012. Characteristics Materia Medica & Repertory with Word Index, 37th ed., B. Jain Publishers, New Delhi, India.
  3. Tiwari, 2012. Essentials of Repertorization, 5th ed. B. Jain Publishers, New Delhi, India
  4. Boericke William, 1999. Pocket Manual of Homoeopathic Materia Medica, 9th ed. Modern Homoeopathic Publication, Calcutta, India
  5. Radar 10 Software.

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