Allergic Rhinitis is the most common form of respiratory allergy, affecting 15- 20% of the general population. Evidence-based homoeopathy is concerned with the clinical verification of symptoms used in homoeopathic practice within the framework of the concept of similarity.
Keywords: Allergic rhinitis; Allergy.
DEFINITION : Allergic rhinitis is defined clinically as the condition giving rise to one or more of the symptoms of nasal itching, nasal obstruction, and increased secretion of mucus and sneezing which persists for more than one hour on most days. Pathologically it is defined as inflammation of the mucous membrane of the nose.
Allergic rhinitis arises from alteration in the reactivity to an exogenous antigen (allergen). So it is known as extrinsic rhinitis. Another term uses for it is Hay fever. It is seasonal due to elicitation by air-borne pollens, it can be perennial in an environment of chronic exposure.2
- Predisposing cause:
- Genetic factors – it plays an important role, chances of children developing allergy are 20% and 47% respectively, if one or both parents are allergic.8
- Age – it may start at infancy or at old age, but usual age of onset is 12 – 16 years of age.
- Sex – no sex predilection
- Seasonal variation is seen in seasonal allergic rhinitis and perennial rhinitis continues throughout the year.8
- Exciting cause
- Sulphur dioxide in air
- Inert dust in the environment
- Cold air inhalation
- Occupational factors- agent inhaled in work place as in agricultural workers, farmers
- Psychological factors – prolonged stress can become a maintaining cause
- Persistent exposure to allergens
- A long continued mental stress.9,10
Sensitization to Allergens:
Antigen-presenting cells [APCs], present in the mucosal surface, process allergens and has some peptides from allergens on the major histocompatibility complex [MHC] class 2 molecules. This MHC class 2 molecules and antigen complex take a role as the ligand of T-cell receptors on Naive CD4 T – cells, which results in differentiation of Naive CD4T cells to allergen-specific Th2 cells. Activated Th2 cells secrete several cytokines, which induces specific IgE and proliferation of eosinophils, mast cells, and neutrophils. Produced antigen-specific IgE binds to high-affinity IgE receptors on mast cells or basophils.2
Early and Late Reactions:
When allergic rhinitis patients are exposed to allergens, allergic reactions develop in 2 different patterns according to the time sequence.
Early reaction, sneezing and rhinorrhoea develop in 30 minutes and disappears as It is the response of, type1 hypersensitivity. The other is the late reaction, which shows nasal obstruction approximately 6 hours after the exposure to allergens and subsides slowly. Eosinophil chemotaxis is the main mechanism in the late reaction, which is caused by chemical mediators produced in the early reaction. Several inflammatory cells, eosinophils, mast cells, and T cells migrate to the nasal mucosa, break up and remodel normal nasal tissue, and these result in nasal obstruction.7
When the respiratory epithelium is destroyed and nerve endings are exposed to cytotoxic proteins from eosinophils, sensory nerve fibers are excited by non-specific stimuli and stimulate, the so-called retrograde axonal reflex. This makes the sensory nerve fibers secrete neuropeptides such as substance P and neurokinin A, which include contraction of smooth muscles, mucous secretion of goblet cells, and plasma exudation from capillaries.
It is one of the clinical characteristics of allergic inflammation. Due to eosinophilic infiltration and destruction of the nasal mucosa, the mucosa becomes hyperactive to normal stimuli and causes nasal symptoms such as sneezing rhinorrhoea, nasal itching, and obstruction. This is a non-immune reaction that is not related to IgE.
1] Early phase symptoms:
- Runny nose
- Frequent or repetitive sneezing
- Watery or itchy eyes
- Itching in the nose, throat, or roof of the mouth
2] Late phase symptoms:
- Congestion of nose and ears feels plugged.
- Mental change can include irritability, a slight decrease in attention span, worsened memory, and slower thinking.
- Pale blue edematous nasal mucosa.
- Bulky edematous turbinate’s with bluish/pinkish tingle of the mucosa.
- Mucus coated with clear/ mucous secretions.
- The septum may be thickened due to mucosal swelling.
- Turbinate Hypertrophy
- Recurrent sinusitis because of obstruction to the sinus Ostia
- Nasal polyp
- Serous otitis media
- Suppurative otitis media
- Bronchial asthma
- Acute otitis media
- Skin prick test:
- Absolute eosinophil counts:
- Total and specific IgE
- Peak nasal inspiratory flow rate (PNIFR)
- Congenital and acquired Immunodeficiency syndromes
- Automatic mucociliary abnormalities
- Structural defects- polyps, deviated nasal septum
- CSF rhinorrhea- secondary to trauma or surgery.7,8
Homoeopathic medicines have an advantage in allergic rhinitis. It helps in managing both acute episodes as well as to reduce the chronicity.
Allergic Rhinitis has its definite onset, location, sensation, modalities, and concomitants, which help to individualize the person.
The disharmonious functioning of the vital force is considered a disease. It is considered a chronic disease because it has no acute exacerbation of symptoms at the time.
Dr. Samuel Hahnemann in his Organon of Medicine Aphorism 117 Explained as hypersensitivity to a substance which is the person’s own peculiar corporeal constitution. Manifestations of “hypersensitivity” or “hyper-responsive” reaction (allergy reaction) and “idiosyncrasies” are similar. There is an acquired idiosyncrasy that is born with the patient.9
Stuart Close in his lectures ‘The Genius of Homoeopathy’ says idiosyncrasy is a habit or quality of an organism peculiar to the individual. It is a peculiarity of the constitution inherited or acquired which makes the individual morbidity; susceptibility to some agents or influence which would not so affect others without passing to set for the more fully the modern scientific explanation of this phenomenon.10
As told by Dr. Kent, ‘it is a man that is sick to restore to health, not his body, not his tissue. This tissue could not become sick unless something before the body’. The external disease is the out-word expression of the internal derangement. In any disease, not only the organs/system but the patient as a whole is affected which is true for rhinitis too. The balance between the environment and the individual is distributed.
By idiosyncrasy, we mean a habit or quality of the organism peculiar to the individual. It is a peculiarity of constitution inherited or acquired; which makes the individual morbidity susceptible to some agent or influence which would not affect others.11
It is defined as the general quality of the living organism to receive the stimuli and, the power to react to stimuli. Susceptibility is one of the fundamental attributes of life uponit depend on all functioning, all vital process, physiological and pathological.10
Herbert A Roberts in his ”The Principles and Art of Cure by Homoeopathy” says susceptibility is defined primarily as the’ reaction of the organism to external and internal influences. Phases of susceptibility are the power of assimilation and nutrition. One man’s meat is another man’s poison. Human beings are always susceptible to infection and are contagious. He explained susceptibility as very an expression of vacuum. The vacuum attracts and pulls the things very needed, which are on the samelevel of vibration as they want in the body. This has an attractive force which draws the disease which is on the same level.12
James Tyler Kent in his “Lectures on Homoeopathic Philosophy” says as a suspension of influx. When causes ceases to flow in a particular direction resistance is offered for causes flow only in the direction of least resistance appears influx ceases; the cause no longer flows in, i.e; in the stage of contagion, there is the limit influx, if the man continues to get the disease, he would receive enough to kill him, until death. Medicines has greater power in affecting the state of health and the natural diseases will be cured.11
According to homoeopathy the cause of the disease are not the ‘allergens’ but the problem is with the suffering person, so by modifying the susceptibility, will try to correct this basic tendency.
Hahnemann in aphorism 72 ‘Organon of Medicine’ speaks of chronic disease as dynamic derangement caused by dynamic infection with chronic miasm. They have a small beginning imperceptible, with gradually increasing momentum, which vital force is not able to quill and the organism helplessly suffers in an increasing manner and intensity until is ultimately destroyed.9
Miasm is an invisible, inimical, dynamic principle that permeates into the system of a living creature, creating a stigma in the constitution which by suitable anti-miasmatic treatment can be eradicated. If effective anti-miasmatic treatment does not take place then the miasm will persist throughout the life of the person and will be transmitted to the next generation.
Miasm is a defense mechanism adopted by the body to save the body against continuous exposure to hostile forces.14
- Contaminated picture —- the disease is contaminated or masked through a lack of expression of symptoms or manifestations due to emotional, physical, or iatrogenic suppressions.
- Conjoint picture —- symptoms of various medicines (ALLOPATHIC and HOMOEOPATHIC) are superimposed.
- Scarcity of symptoms —- condition in which it is difficult to ascertain symptoms i.e. one-sided diseases such as insomnia, migraine, fatigue syndrome, etc.
OBSERVATIONS OF DR HAHNEMANN
Dr. Hahnemann worked for 12 long years with incessant thoughts, tireless investigations, accurate observations, careful experiments, and also uninterrupted medications.
After being convinced that all chronic ailments expressed by the patient had their roots in a deeper-lying original evil, he concluded that the original evil spotted must be of a ‘miasmatic chronic nature’- as was perfectly evident that once it had developed it could not be eradicated even by the vigorous or robust constitution. It grew worse with the addition of more serious symptoms right up to the end of life.9
EVOLUTION OF MIASMS
From frequent observations, Hahnemann had discovered that almost all chronic diseases, which would not yield to the usual homeopathic remedies, had some connection with a ‘previous outbreak of itch’.
Finally probing patients and their prior illness, he concluded that there are three local visible diseases which are chronic diseases occurring later in life.
3 groups are as follows:
- Psora: Group of diseases which followed initial symptoms of skin that ‘Itch’
- Sycosis: Group of diseases which followed the treatment of symptoms on skin that is ‘Veneral’
- Syphilis: Group of diseases which followed initial symptoms on skin that is ‘Chancre’.14
PATHOPHYSIOLOGY OF MIASMS
- Physiological- Psora
- Morphological constructive- Sycosis
- Morphological destructive- Syphilis
Environmental stimuli at the sensory, intellectual, and emotional levels evoke lightning and exaggerated responses than in a normal individual.
The psoric manifestation evident in allergic respiratory disorder manifest as cold, which begins with sneezing, redness, heat, and sensitivity to the touch when blown for. Discharges which are thin, watery, and acrid, sensitivity to touch to smell when the air possesses freely with burning and the complaints are more during morning hours, cold, during sleep and relieved during warm weather, and natural discharges. Itching and burning of eyes which are not better by rubbing. Psora itself gives no physiological change of structure. Another miasm should be present to produce the change.
At the level of the chest, Psora manifests as dry cough teary, spasmodic, and annoying dryness in the nose.14
Allergic expressions are mostly seen in the patient with a family history of bronchial asthma with a clear nose for some time. He cannot get a particle of air through his nasal passages due to local congestion and thickening of mucus membrane and enlargement of turbinate and polyps. A red swollen nose with enlarged capillaries snuffles in children, the discharge is acrid, yellowish-green scanty expectoration which smells like fish brine. The cough of Sycosis has very little expectoration. Complaint aggravated in autumn or winter often trouble begins with coryza, much sneezing, profuse watery discharge followed by coughing spells with scanty expectoration. Better by abnormal discharges.14
In the tubercular phase, the indolent symptoms make a large effect on survival and return to normal. In the miasm the phase of hyperactivity is prolonged. In the worst form of hay fever when there are many troubles it often depends on the tubercular faint with an acquired latent Sycosis. Discharges soon become thick, yellow in the color of the odor of old cheese, and postnasal dripping which constantly drips down the throat. The cough is deep, prolonged, and worse in the morning. These patients are often worse at night which they dread.
Usually prone to complications like sinusitis, tonsillitis, and otitis media. As seen forced mobilization, hectic activity with poor resources and ultimately leads to exhaustion and debility at all levels and debility causes recurrent respiratory tract infection.14
Usually present with the thick crust often filling the whole nasal cavity. The crusts are dark greenish-black along with the destruction of nasal bones and deviated nasal septum. And there is a complete loss of smell. Postnasal dripping with predominant aggravation at night is associated with fatigue dry cough and supportive tendency.14
SYMPTOMATIC CLASSIFICATION OF ALLERGIC RHINITIS ACCORDING TO MIASM
|Location||Nose Nasal septum||Nose Nasal mucosa||Nose Nasal septum Nasal mucosa||Nose Nasal septum Nasal bone|
|Sensation||increased sensitivity to smell profuse epistaxis nostril as it was stuffed up dryness of the nose loss of power of smell sneezing, redness, heat sensitiveness discharge thin, watery, acrid26||loss of smell redness of nose moist -if purulent very scanty odor of fish congested nose discharge is yellow-greenish and scanty -recurrent acute coryza Discharge is copious, watery, and excoriating enlarged turbinate||profuse hemorrhage bright and difficult to arrest sneezing the discharge becomes thick, purulent catarrhal discharge is thick, usually yellow the odor of old cheese or sulphate of hydrogen post-nasal dripping26||loss of smellsnuffles ulceration thick crusts usually filled in the whole nasal cavity crusts are dark, greenish-black, and not always offensive with the destruction of bone|
|Modalities||<odor of cooking <smell of flower <perfumes <touch <cold >warm weather||<cold air <autumn or winter season <dampness >summer||<eating <exercise <dampness <morning26 >nose bleeding||<night|
|Concomitants||children from sycosis parents complicated with gout take cold easily at the slightest exposure -red nose26||headache, vertigo, and congestion of the brain acne rosacea||Fatigue dry cough suppurative tendency|
- Min Y. The Pathophysiology, Diagnosis, and Treatment of Allergic Rhinitis. Allergy, Asthma and Immunology Research. 2010; 2:65.
- Allergic Rhinitis [Internet]. En.wikipedia.org. 2019 [cited 4 February 2019]. Available from: https://en.wikipedia.org/wiki/Allergic_rhinitis
- Frenkel M, Hermoni D. Effects of Homeopathic intervention on medication consumption in Atopic and Allergic Disorders. Alternative Therapies in Health and Medicine. 2002 Jan 1; 8(1):76-9.
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Dr Meera Reghu
MD Part 1
Dept of Organon of Medicine & Homoeopathic Philosophy,
Father Muller Homoeopathic Medical College & Hospital, Deralakatte,