Manisha¹ and Ashok Kumar Sharma²

¹M.O.(Shalakya Tantra),C.B.P.A.C.S.,Khera Dabar,Najafgarh,New Delhi, India. ²Lecturer(Sharir rachna),A and U Tibbia College, Karol Bagh, New Delhi, India.

Abstract

Allergic rhinitis is a global health problem and is increasingin prevalence. The international study of Asthma and Allergies in childhood (ISAAC) noted the prevalence of allergic rhinitis vary widely from .8 to 39.7% in different countries throughout the world. It is an acute IgE mediated, type-1 hypersensitivity reaction of nasal mucosa in response to antigenic substance[allergen] associated with episodic attacks of sneezing, watery rhinorrea and watering of the eyes.

Keywords

Allergic Rinitis; Vaataja pratishaya; Rhinosinusitis; Dusta pratishaya

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Copy the following to cite this article: Manisha, Sharma A. K. Allergic Rinitis W.S.R. Vaataja Pratishaya and Rhinosinusitis W.S.R.Dusta Pratishaya - An Emerging Consideration in 21stcentury. Biomed Pharmacol J 2012;5(2)

Copy the following to cite this URL: Manisha, Sharma A. K. Allergic Rinitis W.S.R. Vaataja Pratishaya and Rhinosinusitis W.S.R.Dusta Pratishaya - An Emerging Consideration in 21stcentury. Biomed Pharmacol J 2012;5(2). Available from: http://biomedpharmajournal.org/?p=2559

_Introduction

Allergic rhinitis is a most common disease in present era. in Ayurveda it is considered as dust pratishya . it occurs due to various infections in the sinuses and nasal membrain. This includes paroxysmal bouts of sneezing,watery rhinorrhoea and nasal obstruction with itching of nose.This may be associated by non nasal manifestation like watering and itching of the eyes, itching of the palate  and in some it may be associated with broncospasm.Patient may complain of hyposmia or anosmia. At the other side Pain,fatigue and other symptoms of chronic rhinosinusitis can have significant effect on the quality of life.The condition can cause emotional distress,impaired normal activity and reduced attendance at work or school.

Material and Methods

Risk factors

There is strong genetic predisposition to allergic rhinitis,one parent with a history of allergic rhinitis has about 30% chance of producing offspring with the disorder.The risk  increases  to 50%  if both parents have a history of allergies.

Predisposing factors

1Age

Young patients are more affected,about 70% of the cases present with symptoms of nasal allergy before 30 years of age.

Sex

Males are more commonly affected with male to female ratio of about 3:2.

Industrialization and urbanization: Incidence of allergic  rhinitis is ever increasing because

of industrialization and urbanization responsible for environment pollution.

IgA deficiency state makes the patient more prone for allergy.

Living conditions

Residential and  workplace conditions play a significant role in the etiology.Crowding,dusty environment,air-conditioned rooms may predispose.

Environmental factors

Depends on the aerobiological flora  of the particular  environment.Based on this  the allergic  manifestation  may be a)seasonal and b)perennial.

Common allergens

Inhalant:Commonest cause(Pollen and dust including house dust mite-75%,fungus animal dander,miscellaneous) Food allergy.

Figure 1 Click here to View figure

Pathophysiology

This is complex,involving cells mediators ,cytokines,chemokines,neuropetides and  adhesion molecules which cooperate in a complex network to produce the specific symptoms of allergic rhinitis and the nonspecific hyperactivity:The reaction can be considered in four phases-

Sensitization

subsequent reaction to allergen-early phase

late phase reaction

systemic activation

Clinical features

All symptoms are simply a manifestation of the body^, defence mechanism to the allergen.

Classical:Mainly seen in seasonal allergic rhinitis.This includes paroxysmal bouts of sneezing,watery rhinorrhoea and nasal obstruction with itching of nose.This may be associated by non nasal manifestation like watering and itching of the eyes, itching of the palate  and in some it may be associated with broncospasm.Patient may complain of hyposmia or anosmia. In perennial allergy  the symptoms are usually less severe and may present as recurrent cold or nasal stuffiness with  sneezing  and watery rhinorrhoea. Nasal mucosa is usually bilaterally swollen,pale or bluish in colour,oedematous and covered with  watery secretions.

Importance of investigations

Before starting the treatment the physician and patients should  try to identify trigger  factors for allergic symptoms.( http://emedicine.medscape.com)

Figure 2 Click here to View figure

Non specific

Nasal smear for eosinophils,total WBC count and differential count,absolute eosinophil count,histamine test.

Specific tests

Skin tests

Subcuticular test[(Prick/scratch test)-simple,cheap and safe ],intradermal skin test,skin end point titration tests

Skin testing must always be undertaken where emergency equipment is available.

Nasal cytology

In allergy patients have increased eosinophils of more than 10%

Invitro tests

1.Radio-allergo-sorbant test(RAST)

2.Fluoro-allergo-sorbant test(FAST)

3.Paper immune-allergo-sorbant test(PRIST)

Other tests-To rule out associated pathology(X-ray PNS,CT OMC, Diagnostic nasal  endoscopy),PFT

Management

Snehakarma

Sweda Karma

Sneha Nasya like in Arditha vote

Snigda dhuma pana(dhoom nasya)

Niruha vasti with vatahar dravya

Yoga used in allergic rhinitis

Nasya karma                                   Oral medicines                                  Rasayanam¹

Anu tail                                            Haridra khand                                    Chayavanprasha²

Shadbindu tail  nasya                    Shirishashav                                       Guduci rasayana³

Shirishaadi nasya                            Panchmool ghrit

Pippalyadi nasya                             Vyaaghri ghrita

Vyaaghri ghrit                                 Vidarigandhadi ghrit

Rohishadi yoga                               Panchlavan ghrit

pradaman nasya                            Rasnadi ghrit

Tulsi boiled Leukewarm haridra milk

Yava kshara+ghrit

Pathya

Patient should advised to take light,lukewarm water,oleus,vata hara diet,hot water for  drinking and bath,resting in hot and perfect room  without the pollution of dust and smoke.Patient should be free from tensions,worry,exercise,irrelevant talking and coitus etc.

Figure 2 Click here to View figure

CHRONIC RHINOSINUSITIS w.s.r. DUSTA PRATISHYAYA⁴

The term ‘sinusitis’ refers  to a group of disorders characterized by inflammation of the mucosa of the paranasal sinuses.Because the inflammation nearly  always also involves the nose,it is now generally accepted that ‘rhinosinusitis’ is the preferred term.Chronic sinusitis is rhinosinusitis of atleast 12 consecutive weeks duration.

Prevalance and impact

By 1992,rhinosinusitis was the fifth most common diagnosis where an antibiotic was prescribed. It is one that is associated with significant direct and indirect costs.Pain, fatigue and other symptoms of chronic rhino sinusitis can have significant effect on the quality of life. The condition can cause emotional distress, impaired normal activity and reduced attendance at work or school. (American academy of otolaryngology,www.entnet.org) Predisposing factors include mechanical obstruction, focal infection, decreased mucociliary function, allergy, immunodeficiency state, autoimmune and hormonal imbalance  etc.

Clinical features

In practical setting, the focus is on those patients in whom inflammation leads to symptoms. Because of this important relationship to symptoms, the Rhino sinusitis Task Force^, s

Definitions include a group of symptoms to be applied to these conditions to allow for clinical diagnosis.

Rhino sinusitis symptoms/signs (requires two major factors, or one major and two minor).

Major  symptoms                                                             Minor symptoms

Facial pain/pressure                                                         Headache

Facial congestion/fullness                                               Fever(non acute)

Nasal obstruction/blockage                                             Halitosis

sNasal discharge/purulence/discolored                       Fatigue

posterior drainage

Hyposmia/Anosmia                                                          Dental pain

Purulence on nasal examination                                    Cough

Fever(acute RS only)                                                         Ear pain/pressure/fullness

Investigations

X-Ray PNS (water’s view/caldwall view)

CT imaging of the PNS (axial&coronal)

Diagnostic  nasal endoscopy

Management

The antimicrobial resistance appears  to be increasing in rhinosinusitis,so there is need  of new herbal formulations and alternative  therapies to combat such problems.

1.Krimi hara treatment

2.Kshaya hara treatment

3.Rasayana therapy

4.Dhoom nasya

5.Pratishaya treatment

Yoga used in rhino sinusitis

Oral medicine                                           Nasya⁵                                        Rasayanam

Chitrak Haritaki                                         Anu tail                                     Chayavanprasha

Varunaadi ghrit                                        Shadbindu tail                          Guduchi rasayana

Vyoshaadi vati                                          Guda nagar nasya

Trayodashaanga kwath with                   Pradmana(triphala+

sahapana of madhu                                  trikatu churna)

After meal  urad+saindhava                     Rasaanjanaaadi tail

Conclusion

 Over all conclusion is that Ayurveda works in these condition as a preventive manner and also work on curatives. Nasya karma and Rasayan therapy give a milestone in the treatment of above diseases. Now we can say that acceptance of Ayurvedic methods and Pathya  manner  noticed as  useful in this fast life during living.

Refrences

1. Acharya Charak charak smhita chapter 1 chikitsa sthan pad 1
2. Acharya Charak charak smhita chapter 1 chikitsa sthan pad 2
3. Acharya Charak charak smhita chapter 1 chikitsa sthan pad 2
4. Acharya Shushrut Sushrut samhita uttar tantra
5. Acharya Charak charak smhita chapter 5 sutra sthan.