Allergic rhinitis and homoeopathy

Dr Priya James

ABSTRACT
Allergic rhinitis is a chronic, inflammatory condition triggered by IgE-mediated hypersensitivity reactions to inhaled allergens. It frequently coexists with other atopic conditions such as asthma and allergic conjunctivitis and can profoundly affect quality of life by impairing daily activities, work productivity, social interactions, and overall well-being. Key risk factors include environmental and occupational allergen exposure, as well as a strong genetic predisposition.

Homoeopathy offers a holistic and individualized approach to the management of allergic rhinitis, focusing on correcting the underlying susceptibility, strengthening the body’s natural defense mechanisms, and promoting long-term healing rather than mere symptomatic relief.

Key words: Allergic rhinitis, sneezing, nasal congestion, Homoeopathy, hypersensitivity

DEFINITION
Rhinitis is defined clinically as sneezing attacks, nasal discharge or blockage occurring for more than 1 hour on most days.

ALLERGIC RHINITIS
 It is a disorder in which there are episodes of nasal congestion, watery nasal discharge and sneezing.

It may be seasonal  or perennial and is due to an immediate hypersensitivity reaction in the nasal mucosa.

Seasonal or intermittent rhinitis

• Cause: Allergy to grass/tree pollen and mold spores (e.g., Aspergillus fumigatus).
• Peak Season: May–July in Northern Europe; varies globally and is often exacerbated during harvest seasons.
• Symptoms: Nasal congestion, sneezing, and itching affecting the eyes and soft palate.

Perennial or persistent rhinitis

• Allergic Rhinitis: Reaction to house dust, fungal spores, animal dander.
• Irritant-Induced Symptoms: Triggered by odours, fumes, perfumes, cold air, dry atmosphere.
• Acute Infectious Rhinitis: Usually viral in origin.
• Secondary Bacterial Infection: Can involve sinuses, causing purulent nasal discharge, facial pain, pressure, and possible fever.

PATHOGENESIS OF ALLERGIC RHINITIS

1. Entry and Initial Immune Response

• Inhaled allergen enters the nasal mucosa.
• Allergen is recognized by B lymphocytes, leading to the production of IgE antibodies.
• IgE antibodies bind to mast cells (sensitization phase).

2. Mast Cell Degranulation

• On subsequent exposure to the same allergen, mast cells degranulate.
• Release of mediators:
  • Histamine
  • Proteases
  • Prostaglandins
  • Leukotrienes
  • Cytokines

3. Immediate Phase Reaction (within minutes)

• Symptoms:
  • Sneezing
  • Nasal itching
  • Rhinorrhoea (watery nasal discharge)
  • Nasal congestion
• Histamine increases epithelial permeability, leading to:
  • Exudation and secretion
  • Nasal blockage (peaks at 15–20 minutes after exposure)

4. Cellular Immune Activation

• Antigen-presenting cells activate T cells.
• Release of inflammatory cytokines:
  • IL-4, IL-5, IL-9, IL-13, and GM-CSF.
• Activation of a Th2 immune response:
  • Recruitment of eosinophils, basophils, neutrophils, and T lymphocytes to the site.

5. Late Phase Reaction (6–8 hours later)

• Chronic inflammation develops due to continued immune cell infiltration.
• Symptoms:
  • Persistent nasal obstruction
  • Nasal hyper-reactivity
  • Anosmia (loss of smell)

CLINICAL FEATURES

In seasonal allergic rhinitis

• Frequent sudden attacks of sneezing
• profuse watery nasal discharge
• Nasal obstruction
• These attacks last for a few hours and are often accompanied by

pruritus, watering of the eyes and conjunctival irritation.

Skin hypersensitivity tests with the relevant antigen are usually positive in seasonal allergic rhinitis

In perennial rhinitis
More continuous and usually less severe than seasonal allergic rhinitis.

Skin hypersensitivity tests with the relevant antigen are usually less useful in perennial rhinitis.

DIAGNOSIS

• Identification of the etiological causes is based on the pattern, chronicity, and seasonal variation of symptoms
• History of medication
• Occupational exposure,
• Environmental history and identification of the precipitating factors.
• Physical examination -deviation of the nasal septum (dns), polyps, or enlarged turbinates.
• Allergen skin or in vitro testing is useful in detecting allergic rhinitis

Biopsy findings

• Early Phase: Mast cell activation → Release of mediators (e.g. histamine, prostaglandins, leukotrienes).
• Cellular Infiltration: TH2 cells, eosinophils, basophils, and some neutrophils infiltrate the tissue.
• Experimental Surrogate: This progression from early mast cell activation to late cellular infiltration is used as a model for rhinitis or asthma.

MANAGEMENT

• Thorough dust removal from the bed area
• leaving a window open
• washing all bedding once weekly, are often helpful.
• Avoidance of pollen and antigens from domestic pets
• The following medications, singly or in combination, are usually effective in both seasonal and perennial allergic rhinitis:
• An antihistamine (such as loratadine or cetirizine)
• Sodium cromoglicate nasal spray
• Glucocorticoid nasal spray, eg: beclomethasone, dipropionate, fluticasone, mometasone or budesonide.
• Immuno therapy (desensitization)

When symptoms are very severe, resistant to usual treatments and seriously interfering with school, business or social activities.

HOMOEOPATHIC REMEDIES FOR ALLERGIC RHINITIS

1. Allium Cepa
   • Profuse, watery nasal discharge with burning sensation.
   • Sneezing with acrid tears and bland nasal discharge.
   • Worse in warm rooms; better in open air.
2. Sabadilla
   • Intense sneezing with copious nasal discharge.
   • Itching and tingling in the nose.
   • Worse from cold air and better from warm drinks.
3. Natrum Muriaticum
   • Nasal congestion with watery discharge.
   • Sneezing triggered by exposure to sunlight.
   • Worse in the morning and from emotional stress.
4. Arsenicum Album
   • Thin, watery nasal discharge with burning sensation.
   • Restlessness and anxiety accompany symptoms.
   • Worse at midnight and from cold air.
5. Pulsatilla
   • Thick, yellow-green nasal discharge.
   • Symptoms shift frequently and change in intensity.
   • Worse in warm rooms; better in fresh air.
6. Nux Vomica
   • Stuffy nose with difficulty breathing.
   • Irritable and sensitive to external stimuli.
   • Worse in the morning and from strong odors.
7. Euphrasia
   • Profuse, bland nasal discharge with acrid tears.
   • Burning and irritation in the eyes.
   • Worse in the evening and indoors.
8. Kali Bichromicum
   • Thick, stringy nasal discharge.
   • Sinus congestion with pressure at the root of the nose.
   • Worse in cold weather and from damp conditions.
9. Gelsemium
   • Sneezing with flu-like symptoms.
   • Weakness and drowsiness accompany nasal congestion.
   • Worse in humid weather and from emotional excitement.
10. Mercurius Solubilis

• Profuse nasal discharge with offensive odor.
• Sensitivity to temperature changes.
• Worse at night and from sweating.

CONCLUSION
Homoeopathy offers a personalized approach to managing allergic rhinitis by addressing individual susceptibility and stimulating the body’s natural healing response. Remedies such as Allium cepa, Sabadilla, and Natrum muriaticum help alleviate symptoms based on specific patient presentations. Integrating homoeopathy with lifestyle adjustments and allergen avoidance can provide long-term relief and improve overall well-being.

REFERENCES

• Boericke W, Boericke OE. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. 3rd rev. & aug. ed. New Delhi: B. Jain Publishers; 2010.
• Feather A, Randall D, Waterhouse M, editors. Kumar and Clark’s Clinical Medicine. 10th ed. London: Elsevier; 2020.
• Jameson JL, Fauci AS, Kasper DL, Hauser SL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 21st ed. New York: McGraw Hill; 2022.
• Kamath SA, Shah SN, Munjal YP, editors. API Textbook of Medicine. 12th ed. New Delhi: Jaypee Brothers Medical Publishers; 2022.
• Ralston SH, Penman ID, Strachan MWJ, Hobson RP, editors. Davidson’s Principles and Practice of Medicine. 24th ed. Edinburgh: Elsevier; 2022.

Dr. Priya James
MD Scholar Department of Practice of Medicine
Guide: Dr. G Rajachandra
MD ,Associate professor Department of Practice of Medicine
Father Muller Homoeopathic Medical College, Mangalore
Email:srpriyafcc1990@gmail.com