Homoeopathic Society

Vol. 24 No. 1 February 2004

by Niri Pandit

Let us look at a few points regarding common problems with allergies and a few suggestions on how to deal with them. We all are aware that for a lot of people allergies are a part of life - they learn to live with them, work around them by avoiding allergens, and so on.

Most of us who are also well aware of the magic of homoeopathy know that it allows a person to reduce the intensity, frequency and duration of the allergic reactions - for some even cure. But how? It is often a hit and miss phenomenon rather than consistent results. Let us look at moving towards consistent results.

We will have a brief revision of the basics and what it is we are doing as a homoeopath - what is our aim in treating a patient? We will learn from the experience of those stalwarts who have walked before us on this path of trying to cure them, common pitfalls experienced by us when we try to do so and reach for the ideal - to have a strong positive influence in every case with the right approach and effort.

I would like to clarify at this stage that our objective is to treat the person having an allergy and not the allergy itself. So we need to keep in mind this subtle difference when we are dealing with various topics that seem clinical or scientific . For as we all agree we are dealing with a science and an art of healing.

I will try to outline the science part we need to remember while dealing with allergies. As with any scientific phenomenon, I have tried to relate it to the what, the why the how and the when to help us gain a perspective. Let us look at the whats, whys, whens etc . . . for three major phenomena:

• Normalcy
• Allergic systems
• Treatments

Normalcy

It is important to know what is normalcy when we look at anything abnormal. Why? To differentiate and recognise that which is abnormal. So what do we study? Do we study the local symptoms of the nose, lungs ,skin, eyes? As we all know, in the later part of last century immunology evolved as a science and a common thread was found putting together the common findings in all allergic reactions. The cells involved may be in any part of the body (though mostly skin or mucous membranes) but they all react in the same inappropriate pattern.

So to understand allergies we study the immune system now. In absolutely basic terms it is defined as an abnormal immune system reaction. Hence when we look for remedies, and we try to find one for the nose, one for the skin, etc . . . or look for the symptoms only in the eye or type of discharge, we often end up with partial cures. So as a homoeopath we do need to remember what is it exactly that we are trying to achieve in a person even if they have just redness of the eyes every time they go near a particular plant.

The immune system functions to keep the body healthy by protecting it - attacking potentially harmful infectious organisms, such as bacteria and viruses. When such an organism enters the body, it is detected by the immune system and a response is triggered. This response involves two steps:

1. Recognition of the antigen.

2. Immune response that destroys it.

How does the immune system work in allergies?

People often confuse hypersensitivity with allergy. The premise used here is that allergy usually means an over-reaction to a stimulus and hypersensitivity deals with any abnormal reaction including auto-immunity and a few others. So for the purposes of our focus today we work on the premise that hypersensitivity is divided into four types (Type I to IV) and allergies are usually covered by Type I. In allergies, the immune system thinks it is under attack all the time - it fights against common substances that normal people do not find the need to fight against - dust, strawberries, fish, eggs, cold etc . . . Immunologists say it can be anything and everything under the sun.

So when an antigen enters the system for the first time, it is identified as an enemy instead of just a passerby - and then what? It keeps the allergic fingerprint in mind and next time there is an exposure to that allergen, then it is a full fledged war. This process is called sensitisation.

Now what happens is that there is an excessive production of IgE in these people the next time they are exposed? These chemical weapons have the tendency to attach themselves to the mast cells and are ready to work like a snare or trap. They ensnare the threatening substance and then the mast cell breaks up. It releases substances that cause inflammation, vasodilatation and chemotaxis of the macrophages towards this antigen antibody complex. The macrophages and leukocytes immediately swallow this complex and dispose of it. As soon as the level of the allergen reduces, this reaction slows down until finally each and every invader is wiped out and the system is back to no allergen.

The crucial point to note for all physicians treating allergies is the size of the response to exposure to an allergen. This is the activity that is judged when we ask questions like How severe? How mild? How soon? How delayed? Answers can have an entire range from mild itching once or twice to the other end of the spectrum of life threatening anaphylactic shock, where in general at the cellular level there is massive release of vasodilatation-causing substances, blood pressure drops, there is bronchospasm, laryngeal oedema and grave danger to life in the form of anaphylactic shock or status asthmaticus.

Sensitivity to things that can make us allergic is a genetic predisposition. The level of the sensitivity is decided quite early by the human system - even in the uterus from as early as 22 weeks. Everything a mother eats during pregnancy, particularly in the last three months, and while she is breast-feeding, plus what a child eats or is exposed to in the early years, can have a huge impact on allergic sensitivity.

So this part of history taking has often been found to be of value especially in children.

What controls it? Have you ever wondered why is it that this time at the age of 25 years say this person became subject to allergies though there was a family history from the beginning for say asthma? Or out of all the allergens, why dust is more important for some and cold for others? This is because the psycho-neuro endocrine axis is the final action centre that decides what part of our body gives in to the struggle of survival against physical and mental adverse factors: So that is the one that decides what is the enemy and how much to consider it as a potential threat whether to go for a full fledged military attack or just think of it as a mild irritant and does not need anything more than a diplomatic pressure.

It is important to remember this as we as homoeopaths decide a medicine based on the characteristic reaction of the person. So though all allergics are generally disposed to react to cold or dust, only certain people will say they are better after a warm bath and a few others will say they feel like drinking really cold water. So our history taking has first the most crucial point of the degree of severity. We must assess that the patient first gets itching at the site, then gradual swelling of the entire arm, and then after an hour it settles down to mild redness. This happens every spring and of late there is also some itching in the legs. The next one is the details of the person and all the possible questions that Kent and other physicians suggest on the basis of their skills and training.

Depending on the sites affected we get symptoms and signs:

• A very severe allergy can cause an anaphylactic reaction, where the person can become very flushed, break out in hives, have itchy skin, stomach cramps, difficulty in breathing, a drop in blood pressure, and eventually lose consciousness. This is a lifethreatening situation and needs urgent medical attention (call an ambulance on 111 and tell them what is happening so they bring the appropriate drugs). We do have medicines in this situation but I have no personal experience in this situation.
• Hayfever: Affects the eyes and nose, causing runny nose, watery, itchy eyes, a red, sore, irritated and itchy throat and postnasal drip. We give the appropriate homoeopathic medications to prevent it and something acute for the symptoms. Often the medicine made out of the allergic substance is used as a drug to stop the symptoms as well as prevent recurrences. Sabadilla and Histaminum are two well known examples.
• There are two main types of allergic rhinitis, perennial allergic rhinitis and seasonal allergic rhinitis. Both respond well to the long acting chronic remedy. Sometimes they need Tuberculinum as at the cellular level the response is of a deviant immune response that is overreactive.
• Asthma affects the bronchii respiratory system causing wheezing and chronic cough needing an entire separate discussion in itself.
• Allergies to some foods, bites or stings can cause hives (raised, red, itchy bumps).
• Allergies in young babies may cause vomiting after a feed, excessive crying and fussing, red patches on the skin, colic, gastric reflux and recurrent ear infections.
• Allergic alveolitis: Affecting the alveoli as the name suggests it is quite a severe condition often occurring in people dealing with animals. The difficulties during homoeopathic treatments relate to the fact that the patient cannot safely discontinue relief measures and dropouts are many.
• Eczema affects the skin, causing itchy, red rashes, and contact dermatitis can look, and itch, very much like eczema. It usually presents as a rash of tiny blisters, inflamed reddened skin, sometimes dry, or sometimes moist and oozing.

We need to keep in mind that contact dermatitis is a nonimmunologic skin reaction that does not involve immune system sensitisation (previous exposure to the allergen ). It can occur in all members of the population depending on the “irritancy” of the chemical, the duration of contact and individual susceptibility. Atopics (who invariably have dry skin) are more prone to irritant dermatitis. Allergic contact dermatitis, on the other hand, is an immunologic skin reaction that occurs in allergic people.

• Contact urticaria is a hives-like reaction occurring at the site of contact of the skin product and usually occurring within 15 minutes of the product touching the skin.
• An experienced doctor’s help will be required to differentiate between allergic contact dermatitis and an irritant reaction on patch testing.

Treatment

As for treatment, how do you look at treating logically?

1. By controlling the reaction by giving an antiallergic substance as commonly used by modern medicine or an acute short-acting homoeopathic medication on the basis of the most acute symptoms.

2. By giving the same substance in small doses to make a person have a milder reaction. Sensitisation injections are a part of conventional treatments, or there is the tautopathic way in which we potentise the substance to which that person is allergic. Or the best royal route . . .

3. Cure: Stop letting the system go on reacting so aberrantly. The basis of greatest of homoeopathic cures to go to the root and stop the system from being deviant and abnormal - bring it back to a feeling of wellbeing with itself and the world around it. Meditation, psychotherapy, religious prayers, biofeedback, ayurveda etc . . . also try to deal with this aspect.

As homoeopaths we have some clue about the characteristics of the individual response system. We ask since when? Why does it not feel okay? What are the prime causative factors? What are the strange ameliorating factors? What are the food cravings? Dreams? Etc? We are matching the system at that level. The timing of giving the remedy is of paramount importance, the more severe the presentation, the more acute the situation, the greater the need to find a suitable timing when the system can tolerate the deepest acting and closest remedy. Never give a remedy at the aggravation time of the remedy.

Always go cautiously as these are the idiosyncratic diathesis people - I use the acronym SAP - Single dose, (minimum repetition).

Accurate observation and Patience is the golden rule. What to prescribe is a grey area for a lot of practitioners. A case can be made for prescribing the allergy-provoking substance in potentised form. But in general in our practical experience we go by looking at:

• Common remedies: Wyethia, Arsenicum album, Allium cepa, Sabadilla, Euphrasia, Arundo, Histaminum, Apis, Rhus tox, Solidago, Arsenicum iodatum, Antimonium arsenicum, Carbo vegetabilis.
• Deep acting simillimums often having longer lasting impact: Kali bichromicum, Natrum muriaticum, Calcarea carbonicum, Iodum, Sulphur, Kali iodatum, Magnesia muriaticum.
• Intercurrents often required: Thuja, Natrum sulphuricum, Tuberculinum, Medorrhinum, Psorinum.

Potency selection is another area full of controversies: but if we want a high rate of results - rather than dramatic results once and dramatic aggravations twice - start with 30-200c unless we find very strong similar mentals and intercurrent. I have also found that some patients react negatively to the lower doses of the drugs like Pulsatilla as they are allergic and idiosyncratic. At the same time a lot of physicians have used the tautopathic substance in the lower powers with good results in the relief of the symptoms.

The only guide that helped me go through this minefield was remembering: Be very sure what we are treating. If we are treating the acute, what is our goal? Is it to help them calm down only? Or is it to open the bronchospasm, or is it both? Are we remembering the importance of the concomitants or are we only looking at the sneezing? The more similar the remedy is to the entire person the deeper the cure. And the higher power is used. All the drugs used in the lower powers need to be really acting at a certain organ level with willingness to look at more chances of recurrences unless we go higher.

• Special note: Deviant responses at some or the other stage often require Tuberculinum - that is a experience of asthma clinics, skin as well as paediatrics.
• Another important point that is missed is that when we are at the close of treatment there may be a short period of flare up.
• You will often find Hering’s direction of cure coming up in practice especially regarding the order of symptoms, e.g. asthma improves and skin appears, etc.
• Pitfalls of high potencies are the highest in acute flare ups though it is tempting to treat severe attacks with higher powers. In such situations, the 50 millesimal scale and dilution methods are a saviour.

So to summarise, when we have a good clinical background in our mind, have a go at the thorough history taking and define the role of our remedy, a positive impact is possible for a dedicated homoeopath in each and every case provided the homoeopath is willing to logically look at experiences shared by Hahneman, Hering, Kent and others after them when they stumble.