MY EXPERIENCE IN A CASE OF NASO-BRONCHIAL ALLERGY

Gyandas G. Wadhwani MD(Hom)

Chief Medical Officer (Homeopathy), Directorate of ISM& Homeopathy; Senior Lecturer (Organon of Medicine & Homeopathic Philosophy), Dr B. R. Sur Homeopathic Medical College, Hospital & Research Centre, Govt. of NCT of Delhi, India. Email: homoeopathygyan@gmail.com

Introduction Allergic rhinitis is a common clinical condition characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose and palate triggered by allergens. It is also frequently associated with postnasal drip, cough, irritability and fatigue. Allergic asthma is another common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction and bronchospasm which is also triggered by allergens. The symptoms include wheezing, cough, chest tightness and shortness of breath; clinical signs include prolonged expiration, a rapid heart rate (tachycardia) and additional lung sounds. Most of these patients get worse after exercising in cold air or after inhaling any type of smoke, dust, fumes, and sometimes strong smells. Allergic rhinitis and asthma are linked by epidemiological, histological1, physiological2 and immuno-pathological3 characteristics and by a common therapeutic approach. It is a well-recognized fact that uncontrolled allergic rhinitis may be associated with worsening of co-existing asthma, and optimal treatment of allergic rhinitis may improve co-existing asthma. To facilitate appropriate recognition and treatment of the common inflammatory process throughout the airways they are known as Allergic rhinobronchitis or Naso-bronchial allergy.(1,2,3) This syndrome has a spectrum of severity that ranges from rhinitis alone, Rhinitis with airway hyper-responsiveness and no asthma symptoms and the coexistence of equally severe rhinitis and asthma. Triggering allergens include dust, pollen, spores, viral infections, drugs like - blockers, exercise, cold air, smoke, fog and emotional stress etc. Diagnosis may be confirmed by positive skin test, chest x-ray, increased eosinophil count and presence of specific IgE antibodies in serum. Homoeopathy enjoys mass acceptance for providing curative treatment in cases of allergy. Our materia medica and repertories give indications/ pointers for various

1 2

The upper and lower airways are lined by the respiratory epithelium Both the diseases may be linked by the nasobronchial reflex (application of allergen to the nasal mucus membrane in the upper airway can induce changes in the lower airway forced expiratory volume) 3 They are linked by similar early- and late-phase allergic responses throughout the airways and by the systemic immunologic response to airborne allergens

remedies useful in such cases. Though polychrest remedies like sulphur, lycopodium, pulsatilla, apis, natrum mur etc. rule the roost in most of the cases of allergy, but some cases demand remedial help from one of the smaller drugs of our materia medica- small because they have neither been proved exhaustively nor have they been enriched with numerous clinical symptoms. Case report A 21 years old girl consulted us for persistent breathlessness, coughing and wheezing due to which she had been unable to lie down for the previous three nights. She was short statured (about 5 feet tall), medium built, bespectacled and was wearing a sweater even though it was a warm day of June. History revealed that she had been subject to recurrent attacks of cold and cough since she was ten years old for which she usually took allopathic treatment. Each episode started with sneezing and nasal discharge, which was watery initially and later on became thick & yellowish along with occipital headache, acrid lachrymation, burning in eyes and pain in cheek-bones. Since last three years, these episodes were followed by severe bouts of cough, difficulty in breathing, wheezing, sensation of heaviness and internal coldness in chest. The inhalers and anti-allergic drugs prescribed by the chest-specialist were proving to be of no help. Her complaints were triggered by smoke, dust, fog, smell of cooking food, perfumes, deodorants. < slightest draft of cold air, exertion and in winters > warm drinks PAST ILLNESSES Recurrent pustular eruptions on body in summers since the age of 3yrs till 11 yrs for which she took allopathic treatment. Measles-childhood Jaundice-13 yrs of age Dysentery- thrice till she was 18 yrs old FAMILY HISTORY Sister- Skin allergy Father- DM, HT Maternal Grandmother- CA stomach, Asthma MENSTRUAL HISTORY Menarche- 13yrs Cycle- regular, 4-5 days/ 30 days No associated complaints. GENERALS Appetite- Good

Thirst- Decreased normally but during complaints increased+++ Desire- Pepper mint++++ (which she took regularly and would even make her feel better whenever she was stressed), Spicy++ Bowels- Irregular timings Sleep- Felt very sleepy even during daytime especially when unwell Perspiration- Poor Thermal Reaction- Chilly++++, needed much warm clothing in winters and could not tolerate A.C. even in peak summers LIFE & ACCESSORY CIRCUMSTANCES She was born and brought up in a middle class family in a small town. Being the youngest child in the family, she was well taken care of. She had moved to Delhi last year in order to pursue higher studies after completion of engineering. No major upheavals in life till date. MIND & DISPOSITION She was expressive, amiable, sensitive and friendly. Though short-tempered she would also calm down soon. ON AUSCULTATION Diminished breath sounds; end-expiratory rhonchi b/l. Analysis The most striking features (characteristic symptoms) in the case were her marked chilliness, sensation of internal coldness and her craving for pepper-mint. The latter was so marked that it seemed to relieve her of any kind of stress too. Prescription Mentha piperita 30 TDS for first 3 days Mentha piperita 30 BD for following 3 days Mentha piperita 30 OD for 3 days thereafter This was followed by placebo. Follow up She improved after the very first dose and within 3 days her breathing became near normal and auscultation revealed that her breath sounds were normal. She was followed up for nearly one year and needed no further repetition of the remedy and could cope with all weather changes and dust smoke better. Her requirement of inhaler and anti-allergic medications stopped completely. Few minor episodes of cold and cough also did not require any other remedy. She continues to do well without any medication and now leads a drug free life. Discussion

Hahnemann explains in aphorism 153 of organon, In this search for a homoeopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines, in order to find among these an artificial morbific agent corresponding by similarity to the disease to be cured, the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and most solely to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure (4) The three most characteristic features of the case were found to correspond with the remedy Mentha piperita, in our material medica. The consumption of pepper mint is known to produce a sensation of coolness at the place it comes in contact with in mouth/ throat. William Boericke, in Homoeopathic Materia Medica, has written under the drug Mentha piperita, Stimulates the cold perceiving nerves, so just after taking it, a current of air at the ordinary temperature seems cold(5). T.F. Allen in his Handbook of Materia Medica and Homoeopathic Therapeutics has written under the same remedy, It seems to have removed extreme sensitiveness to cold(6). I was also reminded of a case of uncontrolled hypertension cured by my teacher Prof. L. M. Khan, by a single dose of Mentha piperita 200, based on the marked sensation of internal coldness along the blood vessels and a strong craving for pepper mint.(7) Conclusion Naso-bronchial allergy is a bane of the current era of dwindling vitalities and increasing ecological imbalance. Homeopathy, practiced on the principles of organon along with a thorough study of the materia medica, can certainly provide curative treatment in this clinical condition as the case study shows. References

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Gupta SK, Dutta SK. Nasobronchial allergy or allergic rhinobronchitis; the unified concept: a review with a special reference to India. Indian J Chest Dis Allied Sci. 2001 Oct-Dec;43(4):217-22. Broide DH. Research Shows That Allergic Rhinitis Has an Impact on Asthma as accessed at http://cme.medscape.com/viewarticle/452167 on 168-13 Togias A. Mechanisms of nose-lung interaction. Allergy. 1999;54 (suppl 57):94-105. Hahnemann S. Organon of Medicine. B Jain Publishers (P) Ltd, India. 2008 Boericke W. Homoeopathic Materia Medica. B Jain Publishers (P) Ltd, India. 2009 Allen TF. Handbook of Materia Medica and Homoeopathic Therapeutics. B Jain Publishers (P) Ltd, India. 2002 Khan L.M. Pleasure of Prescribing. B Jain Publishers (P) Ltd, India. 2009