Dr Rajni G
KEYWORDS- Allergic rhinitis, allergic rhinitis and homeopathy, allergic rhinitis and the similimum, therapeutics of allergic rhinitis, hay fever.
It is a type of inflammation of the nasal mucous membrane due to the over reaction of the immune system to any kind of allergens present in the environment. The first accurate description is from the 10th century physician- Rhazes1. Pollen was identified as the cause by Charles Blackleyin 18592. The mechanism was determined by Clemens Von Pirquetin 19063. According to The American Academy Of Allergy, Asthma and Immunology (AAAAI),around 8% of adults in the United States experience allergic rhinitis of some kind. In western countries, between 10-30% of people are affected in a given year. It is most common between the age group of 20 to 404. It is a condition that affects 40- 60 million Americans5. It affects 30% population in India6. It is commonly known as Hay fever.
An inflammatory condition of the nose characterized by sneezing, rhinorrhoea and obstruction of nasal passages; may be associated with conjunctival and pharyngeal itching, lacrimation and sinusitis7.
- Grass pollen
- Dust mites
- Animal saliva
- Animal dander
Exposure to allergens generates allergen-specific IgE after T-cell release of interleukins 4 and 13, and B-cells producing IgE antibody which produces sensitization which leads to cross link of atleast two IgE antibodies bound to the high-affinity IgE receptor on presensitized effector cells, that is, mast cells or basophils8.
Phases of allergic response-
- Early phase-
Duration- 20 minutes to an hour.
Symptoms includes- sneezing, pruritus and clear rhinorrhea.
Mediator- Histamine appears to be a major mediator.
- Late phase-
Duration- begins in 3 to 6 hours, peaks at 6 to 8 hours and subsides in 12 to 24 hours.
Symptoms- sneezing, nasal obstruction, lacrimation, etc.
Mediator- chemokines and cytokines play a major role. Eosinophil activates release of leukotrineswhich develops nasal congestion.
- Seasonal – It occurs only in a particular season or only for a limited period of the year. It is also called as intermittent allergic rhinitis. It is caused by sensitivity to airborne mold spores or to pollens from trees, grasses or weeds.
- Perennial– It remains throughout the whole year. It is also called as persistent allergic rhinitis. It is generally caused by sensitivity to dust mites, pet dander, mold or cockroaches.
- Clear rhinorrhea9
- Stuffiness of the nose
- Itching in the nose and the eyes
- Heaviness in the head or headache
- Hyposmia/ anosmia10
- Some skin complains like urticareas also can be present.
- Facial pain and fullness10
- Feeling of chest tightness
- Genetic factors.
- Environmental factors.
- Production of IgE.
- Temperature changes
- Cold climate
- Air pollution
On physical examination, it may show following:
- Conjunctival swelling.
- Nasal polyps or enlarged nasal turbinates.
- Swelling of the eyelids.
- Middle ear effusion12.
A detailed history taking along with the following investigations may help to confirm the diagnosis:
- Skin-prick testing13–
A small volume of a set of known allergens is injected into the dermis and any “weal and flare” reaction is taken as a positive response to that allergen.
- Blood test13–
RAST (Radioallergosorbent test) detects specific circulating IgE antibodies.
- Nasal smear-
It may reveal large number of eosinophils and presence of neutrophils14.
- Viral rhinitis
- Bacterial rhinitis
- Vasomotor rhinitis
- Hormonal rhinitis
- Rhinitis medicamentosa
- Atrophic rhinitis
- Gustatory rhinitis
- Avoid exposure to dust or exposure to any allergen as much as possible.
- Wearing mask may prevent entering of the allergens.
- Use of glasses or sunglasses.
Homoeopathy deals with the person as a whole, not partly based on the disease name. In homeopathy any of the remedies can be used for any of the disease conditions if it is similar to the totality (whether acute or chronic). Hence non of the remedies can be specifically used for allergic rhinitis. Here I am only pointing out remedies which most often are used for this condition and has a prominent action on respiratory symptoms producing symptoms of allergic rhinitis.
- Allium cepa– Ailments from- damp cold winds or colds and odors of flowers. Sneezing with increasing frequency. Profuse watery, acrid nasal discharges with burning, redness, rawness of the wings of nose and upper lip. It starts on the left side and goes to the right. Sensation of fullness in the nose due to congestion with occasional epistaxis. Bland lachrymation. Headache especially frontal and occipital in location. Earache with coryza. Appetite decreased with increased thirst. < evening, indoors, every year in august.>open air.
- Ammonium phosphoricum– Sneezing with excessive running from nose with excessive lachrymation, only in the morning.
- Aesculus hippocastanum– Catarrhal affections with cough. Coryza and sneezing with pressure at the root of nose. Enlarged turbinates. Stinging and burning in the posterior nares and soft palate. Eyes feels heavy and hot with lachrymation. Sensitiveness to cold air.
- Agraphis nutans– Ailments from- smell of lilies and exposure to cold winds. Catarrh with chilliness. Want of covering. Adenoids. Enlarged tonsils. Throat and ear affections with free discharges.
- Ailanthus glandulosa– Copious, thin and bloody discharge from the nose. Rawness in the nostrils with sneezing. Loss of smell. Congestion of nose and eyes. Purulent lachrymation. Stitching pain in the chest. Frontal headache. Tongue dry and brown. Pain in swallowing extends to ears. <morning, >hot drinks.
- Ambrosia artemisiaefolia– Lachrymation and intolerable itching of the eye-lids. Watery coryza; sneezing. Nosebleed. Congested feeling of nose and head.
- Arsenicum album– Thin, watery and excoriating coryza with burning in the nose. Sneezing. Tingling in the nose. Burning pain in the eyes with burning acrid lachrymation. Hardness of hearing and buzzing before the ears from nose blows. Mental and physical restlessness. Irritability. Prostration. Dryness of the mouth with thirst for cold water. White or yellowish coated dry tongue. Bitter taste in mouth, <morning. Burning in the chest <lying down, <open air, <wet weather, <change of weather, >closed rooms, >heat. Cannot lie down for fear of suffocation. Exhaustion from least exertion. Periodical hay-fever <cold in any form.Old and chronic catarrh with nose bleed and ulceration. Headache. Cannot bear the sight and smell of food.” “Sneezing without relief”.Kent says, “it is difficult to separate nose symptoms from the throat symptoms. The cold begins in the nose and goes down in the throat.”
- Arsenicum iodatum– Chronic nasal catarth. Discharge like glue or yellow honey or greenish. Thin, watery and excoriating discharge from posterior nares. Sneezing, burning pain in eyes. Colds with hunger. Intense thirst for cold water. Dull aching headache <morning, <stooping. Pain over root of the nose. Hay-fever. Catarrh of middle ear. Irritation and tingling of nose. Ulcers in the nose<sneezing, <open air. Coryza with cough and dyspnoea. Loss of smell. <Dry cold weather, <in room.
- Arum triphyllum– Right nostril open, left blocked with burning fluid discharge from nose. Can breathe only with mouth open. Catarrh of lachrymal sac. Acrid, excoriating and blood-streaked discharges. Rawness and soreness in the nose. Quivering of upper eyelid, especially left. <Lying down, <north-west wind.
- Bromium (bromine)– Ailments from dust. Severe coryza with sneezing and soreness in nose. Bleeding of nose. Obstruction of right nostril. Margins of nose corroded. Annual coryza. Lachrymation from right eye, especially. Fan like motion of alae. Acute coryza of june or july. Cold with first hot weather; with headache. Cold sensation of the mucous membrane of the nose as if cold from inhaling cold air. Rawness round about the nostrils. <Warmth, <overheating, <warm room, <dust, <draft. >Nose bleed, >motion, >riding.
- Cyclamen europaeum– Fluent coryza with sneezing in the morning. Loss of smell or diminished smell sensation. Aversion to open air but open air ameliorates. <Warm rooms, >evening. Watery discharge from nose. Pressing pain over nasal bone. Itching in the ears with sneezing.
- Eucalyptus globulus– Thin, watery and foul chronic catarrh. Nose does not stop running; stuffed up sensation with tightness across the bridge. Involvement of frontal sinuses. Dull congestive headache during coryza.
- Eupatorium perfoliatum– Coryza with sneezing and aching in every bone. Soreness and pain in occiput. Pain full eyeballs. <Night, <motion, <cold air,>sweating, >getting on hands and knees. Pain in the head as if it would burst. Fever.
- Euphrasia officinalis– Ailments from- windy weather and cold air. Sneezing and fluent coryza <night while lying down, with cough and expectoration. Obstruction of the nose. Profuse secretion of mucous from both anterior and posterior nares. Acrid lachrymation with photophobia. Aching in the eyes with redness and itching. Catarrhal headache. Swelling of nasal mucous membrane. <Warmth, <light, <night, <lying down, >coffee (though warmth aggravates).
- Gelsemium sempervirens– Ailments from- sun heat, damp weather. Sneezing with tingling in the nose <early morning. Fullness feeling in the nose extending to neck. Fluent coryza with profuse watery acrid discharge which corrodes the nostrils. Hay-fever. Heaviness of the eyelids with the difficulty in opening the eyes. Swelling if turbinates. Dull headache. Fever or feverish feeling. Soreness in the chest. Coryza of warm climates. Coldness of extremities but heat in the back and of the head. Congestion of the eyes with lachrymation. Occipital headache as hammering.
- Hepar sulphur– Inflammation and swelling of the nose with redness. Pain in the nose “as of a bruise” <touch. Increased power of smell. Coryza mainly on one side along with roughness in the throat. Weariness in all the limbs. Fever may or may not accompany. Sneezing with running nose on slightest (every) exposure to cold or dry wind. Ulcerated soreness of nostrils. Hay-fever. Discharge smells like “decomposed cheese or sour”. Want of covering.
- Hydrastis canadensis– Watery coryza of excoriating nature, with burning and rawness in the nose. Thick, ropy, yellow mucous and sometimes white, <Inside the room. Sneezing and fullness over eyes. Frontal headache which is dull in nature, >pressure. Air feels cold in the nose. Profuse secretion of tears. Tends to blow nose frequently. Feels suffocating when lying on left side. Post nasal dripping.
- Iodium-Fluent coryza with much sneezing. Secretion of hot mucous more profuse than usual. Lachrymation and frontal headache (throbbing in nature), <stooping, <warm room. Pain “as from excoriation” in the eyes, <open air. General heat of skin. Loss of smell. Acute nasal engorgement with high blood pressure. Constant motion of the eyeballs. Increased hunger. Takes cold on the slightest provocation. Copious watery discharge. Stuffed up nose; difficulty in breathing. Ulceration of the nose. Feeling of a tight band around the head. Alae as if spread wide apart.
- Ipecacuanha– Coryza with stoppage of the nose (has to sit up to breathe) and nausea. Loss of smell. Continued sneezing. Tendency of nose bleed (bright red blood) with the colds. Profuse gushing lachrymation. >Closing eyes, >open air, <warmth, <lying.
- Justicia adhatoda– Coryza profuse, fluent and acrid with constant sneezing and lachrymation. Loss of smell and taste. Coryza with cough. Fullness and heaviness of the head with heat sensation.
- Kalium bichromicum– Fluent coryza <in open air, <in the evening. Sneezing <morning. Obstruction of nose <morning. Discharge of acrid, watery mucous which excoriates nose and lips with streaks of blood. Shooting pains from the root of nose >hard pressure. Nasal speech. Sensation “as if two loose bones rubbed against each other” on blowing nose. Expired air feels hot. Ulceration on the septum. Violent burning <touch. Cessation of discharge causes violent headache, from occiput to forehead. Loss of smell. Foetid smell from nose. Snuffles of fat children. Inflammation of frontal sinuses. Difficulty in breathing through nose. Chronic inflammation of frontal sinuses.
- Kalium chloricum– Violent catarrh with much sneezing and profuse mucous discharge. Drawing pain or irritation in the root of the nose. Nose bleed only from right nostril <at night. Violent cough with coryza. Appearance of sparks of light before eyes< sneezing. Heaviness in forehead. Jerking in upper and lower part if the frontal bone on sneezing<coughing, <cold.
- Kalium iodatum– Stoppage of nose with running nose. Clear, watery, thin, green or yellowish green discharge of corrosive nature. Discharge from anterior nares. Burning in the nostrils. Violent paroxysmal sneezing. Loss of smell. Redness of eyes and nose with lachrymation. Increased thirst. Nasal voice. Alternate heat and chilliness. Frontal headache. Redness of the tip of nose. Involvement of frontal sinuses. Unbearable pain at the root of nose. Every change of weather brings coryza <in open air (though other symptoms ameliorates in open air), <least of cold. Pain through the cheek bones.
- Mercurius corrosivus– Swelling and redness of nose. Fluent coryza with rawness in nostrils and loss of smell. Discharge from nose like “glue” which dries up in posterior nares. Frequent nose bleed. Acrid lachrymation. Post-nasal swelling. Swollen red nose.
- Mercurius sulphuricus– Sneezing with fluent coryza from sunshine (exposure to sun rays). Itching of nose with swelling and redness of the tip of nose. Dryness of mucous membrane. Post-nasal swelling. Frontal headache with burning in cheeks.
- Natrium arsenicosum– Watery discharge from nose. Post-nasal dripping of thick, bland, yellowish mucous with stuffed up feeling in the nose, <night, <morning, <becoming cold, cold, <wet weather. Desire to lie down and not to be disturbed. Pain in forehead and root of nose, <open air. Fluent coryza alternating with dry. Redness of nose. Pain in the roof of nose with frequent and violent sneezing.
- Natrium muriaticum– Fluent or dry coryza with loss of smell and taste. Bleeding of nose, <stooping. Discharge thin, watery like “raw white of an egg”. Internal soreness of nose. Cold commencing with sneezing, <morning (early). Stoppage of nose after 3rd day of coryza. Involuntary urine when sneezing. Small ulcers in nose.
- Pulsatilla partensis– Soreness in the nose. Ulceration of nostrils and of the alae nasi. Greenish or yellowish foetid nasal discharge, <morning, <evening. Cannot breathe when in closed rooms, >open air. Obstruction of nose occasionally present. Loss of taste and smell. Constant shivering. Pain in the nasal bones. Thirstlessness. Chill, fever and sweat sometimes may be present. Chronic catarrhs.
- Phosphorous– Redness and swelling of nose with painfulness to touch. Polypus in nose. Ulcerations. Blows blood every time. Acute sense of smelling. Foul imaginary smell. Profuse discharge of yellow, greenish, bloody purulent mucous from nose with inflammation of throat and frequent sneezing. Dullness or confusion of the mind. Fan-like motion of nostrils.
- Sabadilla– Dryness of upper nose. Violent spasmodic sneezing with corryza. Sensibility to smell garlic. Confusion of mind. Lachrymation. White watery profuse mucous discharges from nose. Influenza. Hay-fever. Nose bleed (bright red blood) from posterior nares. Severe frontal pain. Redness of eyes. Burning and obstruction of nose, <odors of flowers, <odor of dye, >inhaling hot air. Prolonged coryza. Periodical attacks (june or august). Itching in the nose.
- Sanguinarinum nitricum– Watery mucous from both nostrils. Frequent sneezing and profuse lachrymation. Sensation in the nose “as if he has taken string horse-raddish”. Burning pain in nostrils bilaterally. Soreness of the nostrils. Discharge from posterior nares tinged with blood.
- Scilla maritima (squilla maritima)– Constant sneezing and fluent acrid coryza. Sneezes during cough. Tendency to rub eyes, <morning. Involuntary urination on sneezing. Ulcerated nostrils. Dyspnoea, >sitting, <cold water.
- Solanum nigrum– Nose deep red but the tip of nose black. Sneezing. Acute profuse coryza with watery discharges from right nostril (left being closed). Burning in the nose with swelling and pain. Sensation of chilliness alternating with heat.
- Trifolium pratense– Coryza which preceds hay-fever. Watery discharge from nose with irritation, <night. Sensation “as if breathing hot air”.
NEED TO KNOW IN ACUTE CASE-
- Preliminary data-
- Chief complaint-
- What? (Exact symptoms)
- When? ( For how long it is there)
- How? (Any certain ailments after which it started)
- Modalities (of each symptoms, sneezing, cough, etc)
- Discharge characters (both of nose and eyes)
- Senses of taste and smell (whether increase, decreased or absent)
- Any heat or chill
- Medications taken.
SOME REPERTORIAL RUBRICS-
- Synthesis repertory-
- Nose- Coryza, annual-
- Nose- Hay fever
- Nose- Coryza, dust agg.
- Nose- August in.
- Murphy’s Repertory-
- Clinical- Hay fever
- Clinical- allergies (hay fever)
- Clinical- allergies- rhinitis
- Nose- coryza- annual
- Kent’s repertory-
- Coryza- annual (hay fever)
- Coryza- annual, august
- Sneezing- dust causes,
- Sneezing- hay asthma with,
- Nose- coryza, sneezing- hay fever,
- Nose- hay fever, headache with,
- Phatak’ repertory-
- Coryza- annual (hay fever)
- Phatak’s biochemic repertory-
- Coryza, hay fever,
- Boger’s synoptic key-
- Nose and accesory cavities- coryza- annual
- Boericke’s repertory-
- Nose- coryza, fluent
- Nose- sneezing
- J T Kent
- E B Nash
- William Boericke
- John Henry Clark
- Henry Clark Allen
Dr Rajni G., MD(Hom.)
Dept. of Organon of Medicine
Naiminath Homoeopathic Medical College, Hospital & Research Center
Agra, Uttar Pradesh