Management of Nasal Allergies in Ayurveda: A Successful Case Study

According to a survey report of pan India in 2020, nearly 18% of respondents below 19 years of age are down with allergies. There is a rapid increase in the number of individuals who have allergies from 13% in 2018 to around 15% in 2020 throughout the nation. The stats are even more alarming for the U.S. as it has been reported that over 100 million of the U.S. population experience some form of allergies every year and allergies rank at the sixth place for the leading reason behind the chronic illness in the country. The burden of nasal allergies is between $ 3 billion to $4 billion per year. In the year 2021, around 81 million of the U.S. population received a diagnosis of seasonal allergic rhinitis which makes around 26% of adults and 19% of children. The condition not only impacts the quality of life but is also responsible for significant loss of productivity. Asthma and other allergic conditions often coexist, and the comorbidities are hard to manage. The modern interventions are effective yet incomplete symptom relief, cost of medications, and side effects highlight the need for a natural and holistic management of nasal allergies. The current case study aims to highlight the efficacy of natural and herbal management for the patients with Allergic Rhinitis and foster a treatment module that significantly reduces the symptoms and also enhances the quality of life. A 29-year-old female patient was presented with the chief complaints of repeated bouts of sneezing, nasal and throat irritation, runny nose, nasal itching, post-nasal drip, nasal congestion and chest congestion. The ayurvedic diagnosis, clinical findings, and symptoms pointed towards a condition known as Vata-kaphaj Pratishyay a or Allergic Rhinitis. The patient was advised to follow an ayurvedic management including a combination of classical ayurvedic formulas and patent combinations along with diet and lifestyle modifications. After the complete course of treatment, there was a significant relief from the symptoms and the quality of life of the patient improved significantly.


Introduction
Allergic rhinitis or nasal allergies is a condition in which there is an inflammation of the nasal cavity on the exposure of allergens like pollen, dust, mold, or animal fur.Inflammation occurs due to the immunological inflammatory response of the nasal mucosa on exposure to allergens.The symptoms of nasal allergy are repeated sneezing, blocked nose, runny nose, itching sensation and redness in the eyes.The symptoms usually appear right after exposure to an allergen.• Email: editor@ijfmr.com

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Volume 6, Issue 1, January-February 2024 2 When a sensitive individual has an exposure to allergens, depending upon the time sequence, two types of allergic reactions develop.The first one is early response which develops within 30 minutes of exposure and manifests as sneezing and rhinorrhea.The second one is late response which develops around 6 hours of exposure to allergens and expresses nasal congestion and subsides slowly.The early response is mediated by mast cells towards allergens and is type 1 hypersensitivity.The mast cells trigger the secretion of chemical mediators like histamines, leukotrienes and prostaglandins and give rise to nasal symptoms.While the late reaction is mediated by eosinophil chemotaxis which is due to the chemical mediators of the first initial response.Now various inflammatory cells along with mast cells, eosinophils, and T cells reach the nasal mucosa, disintegrate and restructure the nasal tissue and cause nasal obstruction as one of the primary symptoms of allergic rhinitis.
Earlier Allergic Rhinitis was differentiated into two subtypes namely seasonal and perennial allergic rhinitis depending upon the type of allergens.Perennial allergic rhinitis is due to house dust mites, cockroaches, animal fur and seasonal allergic rhinitis is due to environmental pollen.However, the two types can overlap when perennial allergic rhinitis can be triggered by pollen grains when the patients get exposure to pollen sticking to indoor carpets, bedding or wooden goods after the pollen season.Furthermore, the symptoms of perennial allergic rhinitis do not last year long while seasonal allergic rhinitis patients can show symptoms in all the seasons due to multiple allergens.Lately allergic rhinitis is divided into two types namely intermittent and persistent allergic rhinitis.
The condition not only impacts the quality of life but is also responsible for significant loss of productivity.Asthma and other allergic conditions often coexist, and the comorbidities are hard to manage.The modern interventions are effective yet incomplete symptom relief, cost of medications, and side effects highlight the need for a natural and holistic management of nasal allergies.Ayurveda the science of life has explained a condition called Pratishyaya which is a broad term that covers all the types of common cold.

Literature Review
Ayurvedic texts have given detailed description about a condition called as "Pratishyaya" (rhinitis) and allergic rhinitis can be correlated with "Vata-Kaphaj Pratishyaya".The oldest healing system or Ayurveda include "virudha aahar" (inappropriate food combinations), "asatmaya" (incompatible food item), and "ama" (Body toxins) are responsible for allergic conditions."Virudh Aahar" refers to wrong food combinations like milk and sour fruits like orange, and others."Asatmaya" refers to incompatible food items like dry food items are incompatible for individuals having Vata-dominant unique constitution."Ama" is the biproduct of improper digestion of food which negatively impacts rasa (food extract), and rakta dhatu(blood cells) and gives rise to "Pratishayaya".

Symptoms of Vata-Kaphaj Pratishyaya
"Vata-kaphaj pratishyaya" manifests different symptoms such as sneezing, nasal congestion, headache, runny nose, itchiness in and around the nose and mouth, fatigue, fever, and dryness of throat, palate and lips, and loss of taste.

Similarities between Allergic Rhinitis and Vata-kaphaj Pratishyaya
Patients with intermittent or seasonal allergic rhinitis have symptoms of sneezing, rhinorrhea, and watery eyes, while patients with chronic Allergic Rhinitis often complain of postnasal drip, chronic nasal congestion and obstruction.

Nadi Pariksha (Pulse examination):
In this examination, radial pulse of the individual is examined to understand the current state of the individual's physical, mental, emotional, and spiritual well-being, extent of vitiation of doshas (elemental energies Vata, pitta, and kapha) and disease reaction in the human body.
In case of allergic rhinitis the rate, rhythm, volume, and force of the pulse feels like that of a snake and swan.
Mutra Pariksha (Urine Examination): visual examination the urine of the individual is performed, and it has been observed that the urine appears pandu (Pale), and phenayukta (foamy) in case of Vata-kapha pratishyaya or Allergic Rhinitis.

Mala Pariksha (Stool examination):
The color and consistency of the stool is monitored to understand the dosha's dominance and it appears hard and kapisha (brown colored).
Jihwa Pariksha (Tongue Examination): the tongue appears to be cold, rough, coated, whitish, and sticky in case of vata-kapha pratishyaya.

Pathogenesis of Vata-Kaphaj Pratishyaya (Samprapti)
Due to different causative factors Vata dosha along with others including rakta dosha accumulate separately as well as comprehensively inside the head and give rise to a condition known as Pratishyaya.

Ayurvedic Treatment of Vata-kaphaja Pratishyaya
The ayurvedic treatment of vata-kaphaja pratishyaya includes external medication that involves nasya treatment that refers to putting medicated oil inside both the nostrils.The internal medications are advised to maintain the doshas balance and to restore the state of health and well-being.

Diet Recommendation (Pathya)
Light and easily digestible food • Frequent intake of small amounts of lukewarm water More fiber containing fruits and vegetables • Take green food stuff once a day • Curd in mid noon only with black pepper • Take herbs like fennel, cumin and curry leaves regularly.This will improve your agni as well as enhance absorption also that will stimulate digestive enzyme secretions which will further improve digestion, absorption and clear away the accumulated toxins out of the body.• Fresh fruits of pomegranate and apple on a daily basis.
• Use of Garlic, Turmeric, Ginger, Black pepper

Don'ts (Apathya)
• High fat foods: butter, margarine, and cream, as well as fatty, fried, or greasy food, spicy and sour food.• High Lactose containing food products • Avoid milk and milk products • Packaged food that contains food additives, dye and artificial sweeteners.
• Fruits: Avocado, banana • Heavy, cold diet • Avoid direct exposure to allergens like perfumes, smoke, chemical fumes which cause inflammation and irritation of the nasal passage

Results and follow-up 1st Follow-up Result (After -30 days)
The patient said that she was feeling a lot better with a significant relief in the symptoms.She has occasional throat irritation, and she reported that there is 30% On examination S.No.Symptom Score 1.
Shwas or difficulty in breathing 1

nd Follow-up (After 3 months)
Patient reported that now even on exposure to AC air there are no symptoms and her quality of life improved significantly.S.No.Symptom Score 1.

Discussion
Acute rhinitis is an allergic disorder in which the immune system shows a hypersensitive reaction and manifests as recurrent bouts of sneezing and runny nose.The defense mechanism of the body produces an overreaction to fight allergies like dust, pollen, and results in the symptoms of allergic rhinitis.There are certain limitations of the modern treatment of allergic rhinitis like incomplete symptom relief, cost of medicines, and side effects.These challenges present the need for a natural and holistic management of the disease.
Pratishyaya is a nasaroga that involves the upper respiratory tract and is more observed amongst children.
The condition is categorized into different types based on the dosha involvement and Vata-kaphaja Pratishyaya can be correlated with Allergic Rhinitis.The chronic stage of the cold is described as jirna Pratishayaya and it is due to long standing and repeated episodes of Pratishyaya.Pratishyaya indifferent stages are regarded as Pakwa and Apakwa awastha which reflect infective and non-infective stages respectively.
Allergic rhinitis can be correlated with Vata-kaphaj Pratishyaya.Pratishyaya refers to a broad spectrum disease that involves nasal and para nasal inflammation.The etilological factors of the condition are agnimandhyakara nidana ( low digestive fire) and strotovrodha (blockage in the microchannels) which forms Ama ras (toxin) at rasavaha and pranavaha strotas which results in vata-kaphaj pratishayaya.
Ayurveda has emphasized langhana, deepana, and pachana medicines in alliance with detoxification therapies like vaman, virechan, nasya, and others.There are some classical ayurvedic formulations like sitopladi churnam for internal use, and anu tailam for nasya.The above-mentioned patent formulations fulfil the criteria of langhana, deepana, and pachana medicines.Samana chikitsa, nasya chikitsa, and implementing the principles of pathya-apathya are crucial in the management of Vata-kaphaj Pratishayay.
The herbal formulations are immuno-modulaory, immune-boosting, anti-inflammatory, anti-allergic in nature and also work to pacify the vitiated Vata and Kapha dosha and aid in the effective management of the condition.
The present case study is of a female patient suffering from Vata-Kaphaj Pratishayaya and the condition can be linked to allergic rhinitis.The nasya karma with Nasa Yoga Ghrutham helps to relieve nasal congestion and obstruction and Nasal All clear X drops help to reduce the inflammation in the nasal mucosa.The internal medicines included Total Care 3X Rasa which is effective in controlling repeated sneezing by reducing nasal irritation and also supports the well-being of the respiratory system.Respiratory Detox tablet helps to alleviate the toxins accumulated inside the body and helps to treat the amavastha of the condition.Sitopaladi churna is a classical ayurvedic medicine that helps as a mast cell inhibitor and reduces the symptoms.IAFA Res Chai-7 provides a supportive treatment and helps to remove the mucus from the passages.The different herbal formulations work on the principles of rasa, guna, veerya, vipaka, and prabhava.The chief modality that enables a herb to perform its function is Veerya.It is the veerya of different herbal combinations that helps to break the pathogenesis of a disease and provide relief from the symptoms.The polyherbal combinations have overall tikta rasa and ushana veerya that is responsible for pacifying Vata and kapha dosha vitiation which is the main cause of Vatakaphaj Pratishyaya or Allergic rhinitis.Moreover, the implementation of pathya-apathya helps to make the body more receptive and works in a synergistic manner.The patient was advised to stay away from the allergens that trigger her condition, and the first follow-up was conducted after 30 days of the treatment.The patient reported significant relief in her symptoms as measured by a scale.The relief in symptoms and no recurrences validated the effectiveness of ayurvedic management of the condition.To support the evidence, more such research will be conducted in future to provide effective and sustainable solutions to common issues such as Vata-kaphaj Pratishyaya or allergic rhinitis.

Patient's testimonial
Initially, the patient was irritated with her symptoms and reported that it largely impacted her quality of life as she could not stay in an A.C room even during summers.She also felt embarrassed by her repeated bouts of sneezing and was tired of wiping her nose constantly.However, she reported that after 1 month of the treatment, she started feeling a lot better with a significant relief in her symptoms.She also said that she is very happy with her progress and has developed faith in the traditional healing practice of Ayurveda.

Informed consent
The patient agreed to provide written consent to publish the results for the benefit of society and research purposes.

Conclusion
A common condition such as Vata-kaphaj Pratishyaya or Allergic Rhinitis significantly reduces the quality of life of the patient.The condition also greatly impacts productivity and puts a tremendous financial burden across the globe.The need for natural and holistic management of the condition is highlighted by the incomplete symptom relief and significant side effects of modern medicine.Ayurveda can manage long standing allergies by balancing the doshas as is evident by the present case study where the patient got significant relief through a combination of different herbal formulations.

Vata Pratishyaya Kapha Pratishyaya Allergic Rhinitis
August 2023, Babita, a 29-year-old female patient, consulted at IAFA Ayurveda Outpatient Department (OPD).The patient was presented with nasal irritation, sneezing, throat irritation, runny nose, post-nasal drip, watery eyes, and shortness of breath from the last 1 year.The patient has identified sitting in an A.C room and banana intake as the trigger factors that aggravated her condition.She undertook allopathic medicine that includes oral antihistamines, decongestants, and occasional nasal sprays with steroids, but the symptoms reappeared after the completion of her medicine course.The chief complaints of the patient at the time of consultation included IAFA Res Chai-7 and for external application Pratimarsha nasya karma with nasa yoga ghrutam and IAFA Nasal All Clear X drops.FOR NASAL: Pratimarsha Nasya Karma: with 1. Nasa Yoga Ghrutam-4-6 drops of lukewarm Grutham in bilateral nostrils and 2-4 drops in navel area twice in a day at early morning and at bed time.