NASO RESPIRATORY ALLERGIES AND HOMOEOPATHY

Respiratory tract allergies are one of the commonest forms of illnesses affecting children, adolescents and even adults. The term ‘allergy’ was originally coined by Von Pirquet in 1906. The term ‘allos’ means altered and ‘eargen’ means reaction. Hence allergy means altered reaction. Allergy is caused by hypersensitivity of the immune system leading to a misdirected immune response. Immunity is the sum of all naturally occurring defense mechanisms that protect humans from infectious disease.

There is a big list of allergic respiratory diseases. Among these most important are
1. ALLERGIC RHINITIS – affecting the upper respiratory airway like nose, throat.
2. ALLERGIC ASTHMA – affecting the lower respiratory tract.

ALLERGIC RHINITIS

Two factors required for manifestation of allergic rhinitis are sensitivity to an allergen and its presence in the environment. Allergic rhinitis may be of 2 types.

a) Seasonal allergic rhinitis
It follows a well defined course of cyclical exacerbation. Approximately 20% of cases are strictly seasonal. The antigens concerned in the seasonal form of disorder are tree pollens in spring and grass pollens in summer, weeds and moulds. Symptoms of seasonal allergies cease with the appearance of frost.

b) Perennial allergic rhinitis
40% of cases are perennial which cause year-round symptoms. It is caused by antigens derived from house dust, fungal spores or animal dander.

Clinical manifestations:
Nasal itching brings on grimacing twitching and picking of the nose, which may result in epistaxis. Children with allergic rhinitis often perform the allergic salute an upward rubbing of the nose with an open palm or extended fingers. This maneuver gives rise to the nasal crease, a horizontal skin fold over the bridge of nose.
Typical complaints include intermittent nasal congetion, itching, sneezing, clear rhinorrhoea and conjunctional irritation. The patient may lose their sense of smell and taste. Some experience headaches, wheezing, and coughing. Nasal congestion is often more severe at night causing mouth breathing and snoring, interfering with sleep and inducing irritability.
Physical examination:
• Allergic gape – continuous open mouth breathing
• Allergic shiners – dark circles under the eyes.
• Transverse nasal crease.
• Conjunctival edema, itching, hyperemia.
• Nasal examination –edematous, boggy and bluish mucous membranes with little or no erythema; swollen turbinates.
• Thick, purulent nasal secretions indicate presence of infection.

Laboratory findings:
Nasal smear shows large number of eosinophils
• Elevated IgE,
• Specific IgE antibodies
• Positive allergy skin tests.
• Peripheral eosinophilia

Complications:
• Chronic sinusitis
• Asthma
• Eustachian tube obstruction and middle ear effusion
• Nasal polyps
• Orthodontic problems due to prolonged mouth breathing.

General Management
• Education to patient which includes reassurance.
• Identifying the allergen and avoidance of the same.
• Steam inhalation to reduce nasal block
• Diet rich in vitamin C
• Reduce bananas and straw berries in diet since they release histamines in body.

BRONCHIAL ASTHMA:
Bronchial asthma is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli. It manifests by widespread narrowing of the airways causing paroxysmal dyspnoea, wheezing or cough.
Asthma is the commonest chronic illness during childhood. In India prevalence of asthma in school going children has been reported between 4-20% in different geographic regions.

Two types of asthma are identified
Extrinsic Intrinsic
• Atopic asthma
• Hereditary predisposition
• Personal history of allergic rhinitis/atopic dermatitis
• Starts early in life
• Serum IgE level elevated
• Symptoms may be seasonal/perennial • Idiopathic/cryptogenic
• No hereditary predisposition.
• No history of allergies

• Starts late in life.
• Serum IgE levels are normal.
• Symptoms are perennial.

Risk factors associated with development of asthma include, family history of asthma and atopic diseases, bronchiolitis during infancy, sensitization to allergies during childhood and passive smoking. Exclusive breast feeding during first 6 months of life protects against development of asthma.

Clinical Features: The signs and symptoms of asthma include, cough, which sounds tight and is non productive early in the course of an attack; wheezing, tachypnea and dyspnoea with prolonged expiration and use of accessory muscles of respiration,cyanosis, hyperinflation of the chest, tachycardia, pulses paradoxus which may be present to varying degrees depending on the stage and severity of the attack. Cough may or may not be associated with wheezing.

Shortness of breath may be so severe that the child has difficulty walking or even talking. Patient may assume a hunched over, tripod-like the sitting position. Abdominal pain is common. Vomiting also may be associated. The child may sweat profusely and a low grade fever may develop during severe airway obstruction. Between exacerbations the child may be entirely free of symptoms and have no evidence of pulmonary disease on physical examination.

A barrel chest deformity is a sign of chronic unremitting airway obstruction of severe asthma. Harrison sulci, an anterolateral depression of the thorax at the insertion of the diaphragm, may be present in children with recurrent severe retractions. Clubbing of fingers is rarely observed.

Status asthmaticus:
It is the most intractable form of the asthmatic paraoxysms where the wheezing continues unabated for hours or days. There is distressing cough, tachycardia, sweating and increasing apprehension. The attacks may abruptly terminate with copious expectoration or may lead to complications or death from severe exhaustion.
It is important to remember that allergic rhinitis, eczema or urticaria may be followed by asthma; to this combination of skin and respiratory allergy the term athma eczema prurigo syndrome is sometime applied.
Exhaustion, confusion, reduced conscious level.

Laboratory findings:
1. Blood – Eosinophilia
– Total WBC count will be elevated if associated infection is present.
– Haematocrit elevated when dehydration is present or attacks are prolonged.
– Arterial blood gas analysis: Acidosis and Co2 tension may increase. Serum IgE is elevated in children with allergic asthma.
2. Sputum: Eoesinophils will be seen. Sputum will be tenacious, rubbery and whitish and eosin methylene blue stain usually discloses numerous eosinophils and the granules from disputed cells.
3. Skin tests may be positive: But it cannot be performed in acutely ill children, patients with diffuse skin disease or those who are receiving antihistamines.
4. Radiology: Increased bronchovascular and hilar markings, hyperinflation of chest. Patchy areas of atelectasis, prominent pulmonary arteries, areas of infiltration and bronchopneumonia esp in long standing cases.
5. Pulmonary Function tests: To assess degree of airway obstruction and disturbances in the gas exchange, in assessing the response to therapeutic agent and in evaluating the long term course of the disease. These tests reveals a decrease in the one second forced expiratory volume (FEV-1), decreased vital capacity (VC) and increased functional residual capacity (FRC).

Complications:
• emphysema
• generalized seizures
• bronchiectasis
• pneumothorax
• atelectasis
• collapse and corpulmonale
• tuberculosis –due to use of steroids.

TROPICAL EOSINOPHILIA
Syn: Weingarten syndrome, pulmonary eosinophiliosis.
This condition which is common in tropics is characterized by an absolute eosinophil count of 2000/cmm or more in peripheral blood and associated with respiratory symptoms. Current evidence suggests that eosinophilia is an allergic reaction to helminthic parasites particularly filarial worms.
It is a syndrome characterized by cough dyspnea a raised white cell count with persistent and absolute eosinophilia with systemic manifestations like fever loss of weight and lassitude. Chert X-ray shows ground glass appearance.

3. ALLERGIC BRONCHITIS
Inflammation of bronchi and bronchioles due to exposure to specific allergens
Aetiology:
1) Allergy
2) Infection –viral, bacterial
Clinical features:
• Dry brassy, irritating unproductive harsh cough.
• Dyspnea and wheeze.
• Scanty difficult expectoration with retrosternal pain due to tracheitis.
• Low grade fever.

HOMOEOPATHIC CONCEPT
There is a special mention about allergic diseases in Homoeopathic literatures under the heading IDIOSYNCRASY. Dr Samuel Hahnemann, founder of Homoeopathic system of medicine defined idiosyncrasy 200 years ago in his famous book Organon of Medicine as “Idiosyncrasies by which are meant peculiar corporeal constitutions which although otherwise healthy, posses a disposition to be brought into a more or less morbid state by certain things which seem to produce no impression and no change in many other individuals”.
Manifestations of allergic reactions and idiosyncracies are same. Both are hypersensitive reaction. An idiosyncratic individual is oversensitive to one or few things which doesn’t require treatment as the person in healthy, but allergic disorders are due to morbid susceptibility.
Successful Homoeopathic prescribing demands a detailed case taking to find out the evolution of disease, relation with life situation, also to find out characteristic symptoms. According to Hahnemann it is the constitution of an individual that becomes sick first. The objective of treatment should be the improvement of the constitution, so that sensitivity, which has gone bad, is corrected or brought within normal range. It has been proved, verified and confirmed that if a proper indicated constitutional treatment is given to the child for sometime, it improves the constitution. In due course, the attacks become lesser in frequency and severity. By constitutional approach we can prevent the recurrence of the complaint by modifying the altered susceptibility.
Miasmatic remedy can help to remove any miasmatic block obtained from the familial background, past history of patient and also the presentation.
Acute prescriptions are required during acute flare-ups.
Thus the concept of totality of symptoms and principle of individualization together enables the homoeopathic physician to perceive the disease in its whole content to make a suitable prescription.

Miasmatic classification of Allergic diseases :
A psoric recurrent cold would be a hypersensitive reaction to different factors like dust, some particular food items or even tension. It is marked by sneezing, running nose and malaise with or without temperature. It recovers without complication. Cough will be dry spasmodic with scanty expectoration which is better by rest and hot application.

The sycotic type of recurrent cold can lead to chest congestions and may lead in course of time to asthma. There can be loss of smell, snuffles in children, dry rattling cough which is more on slight exposure to cold. The recovery is slow.

Tubercular type of recurrent cold will lead to recurrent infections where tonsil and lymphnodes are involved. There can be post nasal dripping, thick catarrhal discharge, haemorrhages, deep cough with purulent greenish yellow expectoration. The complaints are aggravated by night (sunset to sunrise), over heating and better by nose bleeds and cold application. There will be associated prostration. Here recurrence will be frequent and recovery will be incomplete.

In syphilitic stage it may cause ulcerations of nasal septum or glands and other parts. Recovery will be difficult.

Some of the important Homoeopathic remedies used in various Nasorespiratory allergies are as follows:

1. ALLIUM CEPA:
• Important remedy for allergic rhinitis.
• Coryza, profuse watery and acrid nasal discharge with profuse bland lachrymation.
• Spring coryza; discharge burns and corrodes nose
• Hay fever: in August every year.

ANTIMONIUM TARTARICUM: •
A remedy for allergic rhinitis and bronchial asthma.
• Rattling of mucus with little expectoration
• Burning sensation in chest ascending to throat
• Cough excited by eating.
• Oedema and impending paralysis of lungs
• Child wants to be carried.

ARSENICUM ALBUM:•
A remedy for allergic rhinitis, allergic bronchitis and bronchial asthma
• Asthmatic breathing, must sit or bend forward < after midnight. • Unable to lie down for fear of suffocation • Thin, watery excoriating discharge. • Sneezing without relief. • Cough with scanty, frothy expectoration CALCAREA CARB
• Remedy for allergic rhinitis and bronchitis
• Coryza, takes cold at every change of weather.
• Catarrhal symptoms with hunger.
• Coryza alternates with colc.
• Stoppage of nose with fetid yellow discharge

CHAMOMILLA •
Remedy for allergic rhinitis and asthmatic bronchitis
• Coryza with inability to sleep.
• Irritable dry tickling cough.
• Suffocative tightness of chest with bitter expectoration in day time.
• Rattling of mucus in child’s chest.
• Child irritable fretful, quiet only when carried, capricious

DROSERA •
Good for allergic bronchitis and asthma.
• Spasmodic, dry cough, the paraoxysms follow each other very rapidly.
• Yellow expectoration.
• Harassing and titillating cough in children
• Cough commences as soon as the head touches the pillow.
• Asthma when talking with contraction of throat at every word uttered.
• “minute gun” cough during day, whooping at right.
< warmth, drinking, singing, lying down, after midnight. HEPAR SULPH •
Good remedy for hay fever and bronchitis
• Sneezes every time he goes into cold dry wind.
• Discharge smell like old cheese.
• Cough when any part of body is uncovered
• Asthma: short deep breathing, must bend head back and sit up.
• Sensation of a splinter, fish bone or plug in throat.

IPECAC •
Good remedy for bronchial asthma and bronchitis
• Cough dry spasmodic constricted.
• Cough incessant and violent with every breath.
• Child becomes stiff and blue in the face.
• Violent dyspnoea with wheezing and anxiety about the stomach.
• Child looses breath with gagging and vomiting of mucus, bleeding from nose or mouth.
• Tongue clean.

KALI BICH •
Remedy for rhinitis, Bronchitis etc.
• Violent sneezing, coryza with obstruction of nose.
• Snuffles in children, esp fat chubby babies.
• Discharge-thick ropy, greenish, yellow

NATRUM SULPH •
Good remedy for humid asthma in children.
• Asthma with every change to wet weather
< damp weather. • Must hold chest when coughing • Rattling in chest at 4 and 5a.m. • Cough with thick ropy, greenish expectoration. • Delayed resolution in pneumonia, pain through lower left chest. • Nasal catarrh, with thick yellow discharge and salty mucus. NUX VOMICA
• Remedy for allergic rhinitis, bronchitis and asthma.
• Coryza fluent in day time, stuffed up at night and outdoors.
• Asthma with fullness in stomach morning or after eating.
• Cough with sensation as if something were torn loose in chest.
• Tight dry hacking cough at times with bloody expectoration.

PHOSPHORUS •
Remedy for chronic catarrh, allergic bronchitis.
• Chronic catarrh with small haemorrhages
• Cough < cold air, talking, from going from warm room into cold air • Hard dry tight racking cough PULSATILLA
• Remedy for rhinitis and bronchitis
• Coryza, yellow mucus, abundant in morning stoppage in evening.
• Stoppage of left nostril.
• Dry cough < evening, night • Urine emitted with cough • Expectoration bland, thick, bitter, greenish SAMBUCUS •
Remedy for allergic bronchitis, asthma
• Dry coryza of infants; nose dry and completely obstructed.
• Paroxysmal, suffocative cough, coming on about midnight.
• Child wakes up suffocated, face livid blue
• Child inspires but cannot expire sleeps into attack.
• Cough deep, dry precedes the fever paroxysm.

CAUTION:
1. It is wise to take Homoeopathic Medicines for allergic respiratory disorders after consulting a qualified Homoeopathic physician.
2. The above mentioned few medicines should be taken in appropriate dosage only after medical consultation.