Allergic rhinitis and utility of Boerick’s repertory

Dr Riya Verma

Over the recent years there has been a rise in the amount of people suffering from “Rhinitis” “of people use over the counter products to relieve nasal stuffiness & conditions like sneezing, running nose, sore throat & cough. Allergic rhinitis, which occurs during Allergic Rhinitis” is a very commonly prevalent condition all over the world. Every year millions a specific season, is called “seasonal allergic rhinitis”. When it occurs throughout the year, it is called “perennial allergic rhinitis”.  In such a common clinical condition, the conventional system of medicine has a limited scope& treats this clinical condition with antihistamines, decongestants, topical & systemic steroids, which in addition to sedation can produce dizziness, tinnitus, blurred vision, tremors, dry mouth& poor concentration. 

 Allergic rhinitis is a common clinical condition we encounter in our OPD & the fact is that, homoeopathy can deal with this state effectively. This study will be beneficial for middle n lower income group of people suffering from it as  treatment of Allergic Rhinitis  in old school of medicine is not only costly but it also cause patients number of side effects adding more problem to patient. Homoeopathy is a wholistic science. It treats the patient not only in the most harmless way but also cures permanently ,along with this Homoeopathy is one of the most economical  treatment hence it will be beneficial to the society in many ways.

ALLERGIC RHINITIS

 It is a symptomatic disorder of the nose induced after exposure to allergens via IgE-mediated hypersensitivity reactions, which are characterized by 4 cardinal symptoms of watery rhinorrhea, nasal obstruction, nasal itching and sneezing. The eyes, ear, sinuses, and throat can also be involved.

TYPES  Allergic rhinitis takes two different forms:-

SEASONAL RHINITIS: – Symptoms of seasonal allergic rhinitis can occur in spring, summer and early fall. They are usually caused by allergic sensitivity to airborne mold spores or to pollens from grass, tree and weeds.

INTRINSIC ASTHMA – People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by dust mites, pet hair or dander, cockroaches or mold. Underlying or hidden food allergies rarely cause perennial nasal symptoms.

AETIOLOGY
Allergic rhinitis is due to an immediate hypersensitivity reaction in the nasal mucosa. 

Seasonal antigens include pollens from grasses, flower, weeds or trees; grass pollen is responsible for hay fever. This is however a world –wide problem, which may be aggravated during harvest seasons.

Perennial allergic rhinitis may be a specific reaction derived from house dust, fungal spores or animal dander, but similar symptoms can be caused by physical or chemical irritants- for example, pungent odours or fumes, including strong perfumes, cold air and dry atmospheres. 

CLINICAL FEATURES
In the seasonal type, there are frequent sudden attacks of sneezing, with profuse watery nasal discharge and nasal obstruction. These attacks last for a few hours and are often accompanied by smarting and watering of the eyes and conjunctival infection. In perennial rhinitis, the symptoms are similar but more continuous and generally less severe. Skin hypersensitivity tests with the relevant antigen are usually positive in seasonal allergic rhinitis, but are less useful in perennial rhinitis.

PATHOPHYSIOLOGY OF AR
Allergic rhinitis represents a persistent inflammation in terms of activation of eosinophils and constant upregulation of the proinflammatory cytokine IL-1beta in the pollen season and thereafter. Persistent inflammation may furthermore lead to the dysregulation of local cellular immunity by reducing the number and activity of neutrophils on the mucosal surface. In the allergic rhinitis, there is epithelial mast cell accumulation and tissue infiltration by eosinophils. Activation of these cells can be observed by electron microscopy and by elevated levels of tryptase and eosinophils cationic protein in nasal lavage fluid. Seasonal increases in the antigen presenting cells (Langerhans cell) are also evident.

DIAGNOSIS:
The key to diagnosis of AR is awareness of signs and symptoms. IgE antibody tests to detect specific allergens are the standard method used today; however, in addition, diagnosis must be confirmed with a positive history and demonstration that the symptoms are the results of IgE-mediated inflammation. Allergy testing may reveal the specific allergens to which an individual is sensitive.                                             

Skin testing is the most common method of allergy testing. This may include a patch test to determine if a particular substance is causing the rhinitis, or an intradermal, scratch, or other test. If some individuals are not able to undergo skin testing, the Radioallergosorbent test (RAST) blood test may be helpful in determining specific allergen sensitivity. Peripheral eosinophilia can be seen in differential leukocyte count.

DIFFERENTIAL DIAGNOSIS

  • Vasomotor rhinitis
  • Gustatory rhinitis 
  • Anatomic rhinitis
  • Nasal polyps 
  • Acute sinusitis 
  • Chronic sinusitis 
  • Viral rhinosinusitis

 PREVALENCE
Allergic rhinitis is another major allergic disease which is ignored both by the patients and doctors. The Indian Council of Medical Research found the prevalence allergic rhinitis in 3.5% of population of India. In cases of children allergic rhino-conjunctivitis occurred in 3.3% of children aged 6-7 years and 5.6% of children aged 13-14 years in India. In school girls aged 4-17 years the prevalence was found to be 21.27%.  The overall prevalence of AR is 26.1% in school children. When seen along with socio-economic status, the prevalence was 27.1% in lower class, 33.3% in middle class and 28.6% in upper class in urban area and 11.1% in village area of Delhi. Also in a study it has been found that tobacco users had higher prevalence of rhinitis (55% of tobacco users compared to 12.8% no-tobacco users).

HOMOEOPATHIC APPROACH WITH BOERICK’S REPERTORY
Homeopathy is a medical science based on the law of similia similibus curanter, Homoeopathic science is based on individualization in which prescription is done on the basis of Totality of symptoms. Homeopathic approach towards management of Bronchial Asthma is constitutional taking into account the patient’s physical symptoms along with their mental and genetic makeup that individualizes the person. Early intervention with Homeopathy can assist in preventing further progress and cures allergic rhinitis  

In this study I am taking the help ofThe pocket Manual of Homoeopathic MateriaMedica& Repertory, in treating bronchial asthma n try to access its usefulness in such cases .It is written by Dr. Oscar E.Boericke, M.D. It is the most widely used bed side clinical repertory which has been attached to Homoeopathic Materia Medica by William Boericke, M.D. the repertory compilation is mainly based on the material medica by William Boericke . It is a Clinical repertory and it was completely remodelled and brought up to date by embodying much of the available material. It was published in 1927. These repertories facilitate the election of a remedy on the basis of pathological similarity , causation , modalities and concomitants . These repertories can be used for repertorization of cases where clinical conditions mask the characteristics of the patient. In such cases the physician finds the prominent common symptoms with a few modalities and concomitants. These cases need the help of clinical repertory

PLAN& CONSTRUCTION OF REPERTORY
Boerick’s Pocket Manual of Homoeopathic Materia Medica&Repertory comprised of four sections. Its first section is of Materia Medica written by Dr. W. Boericke , second section comprised of Repertory compiled by Dr. Oscar .E. Boericke , third section contain Therapeutics and in last section Index is given.

The repertory has total 1409 medicines ,Technical /clinical terms are often used as rubrics. Remedies are arranged in alphabetical order and the italics indicate the more frequently verified clinical remedy.Because of two types of typography used to indicate the intensity of remedies , it is more practical for reference work and Repertoriztaion.

RUBRICS FOR ALLERGIC RHINITIS

Some of the important rubric of allergic rhinitis   is mentioned underchapter NOSE as

INFLAMMATION (rhinitis); Acute, catarrhal from pollen irritation, HAY FEVER, rose cold

Summercatarrh;Ambro.,Aral.,Ars., Ars-i., Euphr., Lach., Naphtin., Psor., Ran-b., Sabad., Sangin-n.,Sin-n., Stict.

Inflammation, acute, catarrhal, ordinary cold in head; All-c., Acon., Ars., Ars-i., Arum-t., Bry., Camp., Dulc., Euphr., Lach., Naphtin., Pso., Ran-b.,Sabad.,Sangin-n., Sin-n.,Stict.

CORYZA; DRY (stuffy colds, snuffles);Am-c.,Calc., Cham., Hep., Kali-bi., Lyc., Nat-m.,Nux-

v., Samb.,Stict.

Alternately dry and fluent:Ars., Lac-c.,Nat-ar., Nux-v., Sin-n.

Crazy, Fluent, watery (running cold);Ail.,All-c., Ambro.,Aral.,Ars.,Ars-i., Arum-t., 

Brom.,Euphr., Gels., Just., Kali-i., Merc., Nat-ars., Nat-m., Quill., Sabad., Sangin-n.

Lachrymation, sneezing:All-c.,Ars., Cycl.,Euphr., Gels., Just.,Kali-i., Nat-m.,Nux-v.,Sabad.

Inflammation, chronic atrophic (Sicca):Alum.,Calc-f., Hep., Kali-i., Lem-m.,Lyc.,Sep., Stict., Sulph.

Inflammation, chronic catarrhal:Alum., Am-m., Calc., Eucal., Hep., Hippoz., Hydr., Kali-bi., Nat-c., Puls., Sep.

Inflammation, purulent in children:Calc.,Kali-bi., Lyc.

TYPES OF DISCHARGES IN RHINITIS; Acrid, watery, fluent, hot, or thin mucus:All-c., Am-m., Ambro., Aral., Ars.,Ars-i., Gels., Iod., Kali-i., Merc-c., Nat-ar., Nat-m., Sabad., Sangin-n.,

          ALBUMINOUS, clear mucus:Kali-m.,Nat-m

          Bland mucus:Euphr.,puls.

          Bloody mucus:Arum-t., Hep., Merc-i-r,Phos.

          Green, yellow, fetid (purulent or mucus-purulent);Bals-p., Calc., Dulc.,Hep., Hydr., Kali-bi., Kali-s., Lyc., Merc., Puls.

SENSITIVENESS of nose to air, touch; Aesc., Ant-c., Arum-t., Hep.

SNEEZING (sternutation); All-c., Aral.,Ars., Cycl., Euphr., Gels., Ip.,  Kali-i., Sabad., Sangin-n., Stict.

Sneezing, chronictendency; Sil.

Sneezing, ineffectual; Ars.

Sneezing, worse coming into warm room; rising from bed; handling peaches; All-c.

Sneezing, worse in cool air:Ars.,Hep., Sabad.

Sneezing, worse in evening;Glyc.

Sneezing, worse in morning;Nux-v.

Sneezing, worse in immersing hands in water;Lac-d.,Phos.

STOPPAGE, Stuffiness;Acon., Am-c.,Arum-t., Aur., Cham., Hep., Kali-bi., Lyc., Nux-v., Puls., Samb., Sin-n.,Stict.

Stoppage, alternating nostrils; Lac-can., Nux-v.

Swelling; Ars-, Aur., Kali-bi., Lem-m., Mer-c., Nit-ac.

REFERENCES:

  • Davidson’s Practice of Medicine 21st Edition.
  • R. Alagappan;Manual of practical medicine ; Jaypee brothers medical publishers (p) ltd.
  • T.Shashikant ; Eesentials of repertorization.
  • BoerickeO. E.; Pocket manual of Homoeopthic Materia Medica & Repertory 
  • Shafei H.F. et al ; Individualized Homoeopathy in a group of Egyptian asthmatic children ; Homoeopathy.
  • emedicine.medscape.com/article/134825-differential.
  • acaai.org/allergies/types/hay-fever-rhinitis.
  • www.ncbi.nih.gov
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