Arsenicum iodatum in treatment of allergic rhinitis- a case study

Dr Meera Reghu

ABSTRACT
Allergic rhinitis, is a symptomatic disorder of the nose, induced after exposure to allergens via IgE-mediated hypersensitivity reactions and is prevalent worldwide and it is universally acknowledged as an extremely common condition.¹

It is a heterogeneous disorder that despite of its high prevalence is often undiagnosed.

Allergic Rhinitis is characterized by one or more symptoms include Sneezing, itching of nose, nasal congestion, rhinorrhoea. Many causative agents have been linked to rhinitis including pollen, moulds, dust mite and animal dander.¹

The burden of allergic rhinitis is enormous, constituting 55% of all allergies.  Reported incidence of allergic rhinitis in India ranges between 20%-30%. Studies have shown that prevalence of allergic rhinitis has been increasing in India over past few years.¹

Homoeopathy has great scope in this condition as this system of medicine consider the symptom totality and the present study has done to confirm and unravel the merits of treatment as the incidence and prevalence is increasing and offer the patient a rapid, gentle and permanent cure. Here, an attempt is made to study on the efficacy of Arsenicum iodatum in allergic rhinitis and hence prove the scope of homoeopathy in such conditions.

Keywords: Allergic rhinitis; Allergy; Arsenic iod.

INTRODUCTION

Allergic rhinitis, also called hay fever, is an allergic reaction that causes sneezing, congestion, itchy nose and sore throat.

It is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when we breathe in something which we are allergic to, such as dust, animal dander, or pollen. An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen, mold, animal dander, or dust, the body releases chemicals that cause allergy symptoms.

INCIDENCE AND PREVALENCE

The burden of allergic rhinitis is enormous, constituting about 55% of all allergies. About 20%-30% of Indian population suffers from a least on allergic disease. Reported incidence of allergic rhinitis in India also ranges between 20% and 30%. Studies have shown that prevalence of allergic rhinitis has been increasing in India over past few years. There has been a consistent rising trend of allergic rhinitis in childhood [6-14years old] over period of 15 years.75% of the children were affected with rhinitis in India.²

Many children start off with seasonal allergic symptoms that develop into year-round allergies that can be an even larger burden [brdy, 1997]

Allergic symptoms are so common that Seargrant [1997] stated that “once out of every five paediatric visits is allergy related’’. So many physician visits can add up when expenses are considered. It is estimated that 2.3 billion dollars are spent each year on allergic rhinitis related doctor visits concerning children under the age of 12 [blaiss, 2004b]

The number of children affected compared to 20 years ago has doubled [blaiss2004b]. It is now estimated that one third of the individuals diagnosed with allergic rhinitis are under that age of 18 [McCabe, 2008]. The incidence of allergic rhinitis in early childhood is less than 2% however the prevalence increases dramatically after age two once a child is repeatedly exposed to consecutive seasons of allergens in the air [McCbe, 2008]. Allergies can influence people of all ages and races, but heredity has a lot to do with whether an individual will become an allergic rhinitis sufferer or not.

If one or both parents of a child have allergies, the chances of the child inheriting those allergies go up considerably. If one parent has an allergy, the likelihood of a child inheriting the allergy is about 30%. However, if both parents have an allergy the likelihood climbs to 60%. Those numbers are much greater than the probability of a 10% chance of neither parent has an allergy [brdy, 1997].

Prevalence of allergic rhinitis can also be affected by location. Those who live in rural areas have higher probability of coming into contact with allergens, triggers allergic rhinitis symptoms compared to those who live in cities with a lower chances of coming into contact with allergen caused symptoms. [Greshwin & Klingerlhfer, 1998]. It should be noted that on matter what the circumstances, allergic rhinitis is not contagious and cannot be passed from one person to another.

Researchers on the International Study of Asthma and Allergies in Childhood [ISAAC] project 19, investigated the prevalence and possible causes of atopic diseases, using standardization methods to describe the prevalence and severity asthma, rhinitis and eczema with validated questionnaires in children around the world. ISAAC was divided into three phase

Phase 1: Allowed for the comparisons of prevalence within and between countries.

Phase 2: Provided a framework for etiological research into genetic lifestyle, environmental and medical care variables.

Phase 3: Reassessed prevalence and severity measurements at least 5 years after initial responses were obtained.

In India, ISSAC study was conducted in 14 centres. Phase 1 included 30,879 children in 6-7 years age group, 37,171 children in 13-14 years age group. The phase 1 revealed that nasal symptoms alone were present in 12.5% children in 6-7 years age group and 18.6% in 13-14 years age group. Hay fever alone was present in 5.5% in 6-7 years of age group and 8% in 13-14years of age group. Rhinoconjuctivitis was seen in 3.3% and 5.6% respectively.⁴

In Korea, the prevalence of perennial allergic rhinitis was 3.39% according to the survey of 71,120 patients who visited otolaryngology clinics of 23 tertiary referral centres between November 1999 and April 2000. According to surveillance of 42,886 Koreans using ISAAC questionnaire, 12-month prevalence of allergic rhinitis in elementary and middle school children [6-12 and 12-15 years] were 28.8% and 29.1% respectively.^3,5

Symptom phases:

Symptoms of rhinitis occur in two phases, early and late.

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:

• Nasal congestion and possibly plugged ears. Children may push their nose upwards with the palm of their hand or twitch their nose rabbit like to clear the obstruction.
• Mental change can include irritability, a slight decrease in attention span, worsened memory, and slower thinking.
• Other common physical symptoms include a decreased sense of smell or taste, plugged ears, sinus headache, post nasal drip or some combination. In severe rhinitis dark circles may develop around the eyes. The lower eyelid may be puffy and lined with creases.⁶

 HOMOEOPATHIC MANAGEMENT

ARSENICUM IODATUM
Iodide of arsenic, As I₃

Molecular weight: 455.64⁷

Specific gravity: 4.39

Melting point: 146 degree Celsius

Known: English: Arsenious iodide, French: Iodure d’arsenic, Germ: Arsenikjodur⁷

Description:

• An orange –red colored crystal – having the odor of iodine, gradually losing iodine on exposure to air.
• Soluble in water with partial decomposition, soluble in alcohol, ether, chloroform, & carbon di sulphide⁷
• Aqueous solution is yellow.
• It is prepared by treating arsenic with a solution of iodine in carbon-di-sulphide.
• Contains not less than 97% of AsI₃ with reference to the substance dried to constant weight at 105 degree.⁷

Identification: With nitric acid, it emits vapours of iodine.

Assay: Dissolve about 0.5g accurately weighed in 50ml of water, add about 2 g of sodium bicarbonate and titrate with 0.1 N iodine, using starch solution as indicator. Each ml of 0.1 iodine is equivalent to 0.0227 g of AsI₃⁷

History and authority: Allen’s Encyclop. Mat. Med, Vol. 1, 552.⁷

Preparation:

A)Trituration 2x                                        Drug strength 1/100

Arsenicum iodatum crystals                                          10 g

Saccharum lactis                                                          900g

To make one kilogram of the trituration

B)Potencies: 3x and higher to be triturated, 6x may be converted to liquid 8x⁷

Storage: All potencies up to 6x should be freshly prepared.

Caution: Not to be prescribed below 3x.⁷

Prescribed Dose: Second and third trituration⁷

CLINICAL:  Acne rosacea, aneurism, hay fever, angina pectoris, breast tumour of, bronchitis, catarrh, gastritis, laryngitis, pneumonia, liver affections of⁸

CHARACTERISTICS: This medicine was originally used by H.Nankivell, on analogical grounds, in cases of phthisis. It has had a short, independent proving and symptoms observed on patients have increased the pathogenesis. The conditions resemble more closely those of arsenic than those of iod < from cold wind >warmth. Great vital prostration. <from any exertion.⁸

Always taking cold, which brings on coryza and increases his catarrhal troubles.⁹

Nose: it has been a most useful remedy in hay fever. Most stubborn nasal catarrh with yellow discharges. Obstruction of nose. Much sneezing, ulceration of nose.

Thin, watery discharges from anterior and posterior nares, Sneezing. Hayfever, irritation and tingling of nose, constant desire to sneeze, irritating discharges. Nasal catarrh, profuse, thick discharges. The discharges irritates the membrane from which it flows and over which it flows.^7,8

Persistent but unsatisfactory sneezing.¹⁰

Mucus membrane is always red, swollen, itches. Swelling of tissue within the nose. Slight hacking cough with dry and stopped up nostrils.^{8, 9}

RELATIONS

Compare: Kali bi¹⁰  Bacillinum in acrid discharges, Nitric acid, Arum, Ars.⁸

Useful after: Sulphur in phthisis pulmonalis⁸

Antidote:  Bry.⁸

Complementary: Kali iod¹⁰, Phosphorus⁸

CASE STUDY

PRELIMINARY DATA

Name: Ms. Rd

Age: 22 years

Sex: Female

Religion: Hinduism

Education: B. Com

Occupation: Student

Marital status: Unmarried

Address: Kasargod

Date: 08\03\2018

CHIEF COMPLAINT
Patient presented with the complaint of sneezing, and coryza since 1 year and increased since 1 week.

LOCATION	SENSATION	MODALITIES	ACCOMPANIMENTS
Respiratory system: Nose Since 1 year On and off attack Gradual onset and gradual progression   Rx Allopathic medications[not better]	Sneezing+++ Watery nasal discharge Coryza++– thick watery discharges Nose block++	A/F-dust exposure++ <cold <cold intake     <night <lying down	Itching of eyes Redness of eyes Throat itching Appetite-decreased

HISTORY OF CHIEF COMPLAINT
Patient was apparently well 1 year back and started with the complaint of sneezing, coryza and nose block which was gradual in onset and gradual in progression, and is of on and off attack. Accompanied with itching and redness of eyes, and itching of throat and her appetite was reduced. The coryza gets aggravated by cold intake. Sneezing gets aggravated by dust exposure and cold, nose block is more in night and while lying down. There is no history of rise in temperature, bleeding from the nose, cough.

PAST HISTORY

• Past medical history: Nothing significant.
• Treatment history: Nothing significant.
• Surgical history:  Nothing significant.
• Family history:  Nothing significant.

PERSONAL HISTORY

Diet: Mixed

Appetite: Decreased

• Thirst: 2ltrs/day
• Bowel habits: 1 times/day, regular, no difficulties
• Bladder habits: 4-5times/day, no difficulties
• Craving:  Sweets⁺⁺
• Aversion: Sour foods⁺⁺
• Perspiration: Increased on palms
• Sleep: Good
• Dreams: Unremembered
• Thermally: Likes summer
• Can’t tolerate cold, chilly patient

LIFE SPACE INVESTIGATION

Patient hails from middle socio economic status. Both her parents were teachers. They were four children and she is the youngest one in the family.

Childhood:

Doesn’t mingle easily with others. Silent type.

School life:

Competitive, stage fear, obstinate

Friendly with others

Doesn’t like to study hard, do the preparation just before the   exam

• As a person,
• Shy and mild in nature
• Likes Company around her
• Obstinate about her matters

GENERAL PHYSICAL EXAMINATION

• Well oriented with time, place and person.
• Moderately built and nourished.
• No signs of pallor, cyanosis, clubbing, icterus, lymphadenopathy, edema.

Vital signs:-

• Temperature: 98.6 F
• Pulse rate: 80/beats minute
• Respiratory rate: 16 breaths / min
• Blood pressure: 110/70 mm of Hg.

Local examination

Inspection:

• Turbinate- enlarged bilaterally
• Throat clear
• Tongue clean
• Auscultation:
• Normal vesicular breath sounds heard
• No added sounds

Systemic examination

CVS

S1 S2 heard

No murmurs

INVESTIGATION DONE ON 8/3/18

Hb%- 12.1gm%                           Eosinophils- 6%

Wbc-7600                                    Monocytes-2%

Neutrophils- 49%                        AEC-456cells/mm

Lymphocytes- 63%

PROVISONAL DIAGNOSIS

Allergic Rhinitis

Sneezing- A/F dust

Coryza – thick nasal discharges

<cold

Nose block <night

Itching of eyes and throat

Redness of eyes

SECTOR TOTALITY

• Sneezing- A/F dust, <cold
• Coryza – thick nasal discharges
• <cold intake
• Nose block <night, <lying down
• Itching of eyes and throat
• Redness of eyes
• Appetite decreased

FIRST PRESCRIPTION

R_{X :} Ars Iod 200

GENERAL MANAGMENT

Diet:

• Intake of nutritious rich foods
• High dietary intake of seaweed, calcium, magnesium and phosphorus rich foods
• Raw milk consumption

Ancillary measures

• Keeping the windows and doors of the house and car closed
• Wear glasses or sunglasses when outdoors are open  to  avoid  pollen
• Avoid Exposure to smoke, strong perfumes and scents, fumes,  and outdoor pollution

FOLLOW UP CRITERIA

• Appetite
• Sneezing
• Watery nasal discharge
• Nose block
• Itching of eyes

FOLLOW UP’

DATE	SYMPTOM CHANGES										PRESCRIPTION
15.03.18   B.P: 120/80 mm of Hg Wt.: 51Kg O/E- Nose B/L turbinate enlarged. AEC-364cells/mm	1	2	3	4	5	6	7	8	9	10	RX 1.     Ars Iod 200 3-3-3 2.     2 grain tab 2-2-2 *  2 week
	D	D	>+	D	G
	Complaints are 60% better.   Thirst: good Sleep: good Bowel habits: Regular

 

DATE	SYMPTOM CHANGES										PRESCRIPTION
23.03.18   B.P: 110/80 mm of Hg Wt.: 51Kg O/E-Nose right turbinate enlarged AEC- 304cells/mm	1	2	3	4	5	6	7	8	9	10	RX 1.     Ars Iod 200 3-0-3   2.     2 grain tab 2 -0-2 * 1week
	D	D	>++	D	G
	Complaints are 80% better     Thirst: good Sleep: Good Bowel habits: Regular

REFERENCES

1. Min Y. The Pathophysiology, Diagnosis and Treatment of Allergic Rhinitis. Allergy, Asthma and Immunology Research. 2010; 2:65.
2. Shah A, Pawankar R. Allergic Rhinitis and Co-morbid Asthma: Perspective from India-ARIA Asia-Pacific Workshop Report. Asian Pacific Journal of Allergy and Immunology. 2009 Mar 1; 27(1):71.
3. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, Mitchell EA, Pearce N, Sibbald B, Stewart AW. International Study of Asthma and Allergies in Childhood (ISAAC): Rationale and methods. European Respiratory Journal. 1995 Mar 1; 8(3):483-91.
4. Beasley R, of Asthma TI. Worldwide variation in prevalence of symptoms of Asthma, Allergic Rhino Conjunctivitis, and Atopic eczema: ISAAC. The Lancet. 1998 Apr 25; 351(9111):1225-32.
5. Kay AB. Allergy and Allergic diseases. New England Journal of Medicine. 2001 Jan 4; 344(1):30-7.
6. Alastair Innes, Simon Maxwell, Davidson’s Essentials of Medicine, 2nd Edition 2016, Elsevier publications Pvt. Ltd
7. Verma N, Vaid I. Encyclopedia of Homoeopathic Pharmacopoeia with fingerprint testing, standardization methods, clinical uses and prescribed potencies. 1st Edition. New Delhi: B Jain Publishers (Pvt) ltd; 1995. p. 163-164.
8. H J Clarke, A Dictionary of Practical Materia Medica, B.Jain publishers (P) Ltd 2000.
9. Boericke William MD, Pocket Manual of HOMOEOPATHIC material medica & Repertory, LPE series Edition, B Jain Publishers (P) ltd. 2002
10. Phatak S.R., Materia Medica of Homoeopathic Medicine, Jain Publishers (P) ltd, 19

Dr Meera Reghu MD Part 1
Dept of Organon of Medicine & Homoeopathic Philosophy
Father Muller Homoeopathic Medical College & Hospital Deralakatte, Mangalore.