Allergic fungal sinusitis – how homoeopathy can help?
Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the para nasal sinuses. It is one of the very common chronic illnesses with a substantial health care impact. As per reports, approximately 20% of patients visit to specialists in allergy and immunology (AI) are related to sinusitis but unfortunately it is very difficult to treat by conventional treatment.[1] Allergic fungal sinusitis (AFS) is relatively new term. Its clinical features, radiological and histopathological findings are not fully understood. In this condition, antibiotics and conventional topical nasal preparations are not much useful. Conventional therapy largely depends on surgical intervention and corticosteroids with adverse effects.[2] On the other side, homoeopathy, known for its role in allergic conditions and fungal infections, can help in AFS without surgical invasion. In this article, AFS and its homoeopathic approach are discussed.
Allergic fungal sinusitis and its causative factors
Allergic fungal sinusitis was first reported as a separate clinical entity in 1976.[3] It is an allergic reaction to aerosolized environmental fungi, usually of the dematiaceous species, in an immunocompetent host. This is in contrast to invasive fungal infections that affect immunocompromised hosts, such as patients with diabetes mellitus and patients with AIDS. Most patients with AFS have a history of allergic rhinitis, and the exact timing of AFS development is difficult to assess. Thick fungal debris and mucinare developed in the sinus cavities.[4]
As per modern view, AFS is an allergic reaction to fungi, in which fungal debris, allergic mucin, and nasal polyposes are formed in the nasal cavity and paranasal sinuses. The causative fungi in AFS are usually dematiaceous fungi, consisting of the genera Bipolaris, Curvularia, Exserohilum, Alternaria, Drechslera, Helminthosporium, and Fusarium, with a small component of AFS caused by Aspergillus. However, as per homoeopathic view point, AFS affects the people with weak immunity since it does not affect all the people who are in touch with those fungi.4
Prolonged allergic rhinitis/sinusitis is observed with allergic asthma. However, a study found that AFS is not significantly associated with asthma.[5]
Efficacy of homoeopathy in sinusitis in general
A multicentre observational study was conducted by Central Council for Research in Homoeopathy to assess the usefulness of homoeopathy in chronic sinusitis (CS). 628 patients suffering from CS were enrolled for the study. On the basis of pathological symptoms 17 pre defined homoeopathic remedies were short listed for the prescription. The follow-up period was for 6 months. Statistical analysis was done using SPSS version 16. There were significant reduction of chronic sinusitis assessment score (CSAS) after 3 and 6 months of treatment in 550 patients with at least one follow-up. Radiological appearances also improved. Lycopodium clavatum, Calcarea carbonica, Phosphorus, Kali iodatum and Silicea were the most indicated remedies. There were no complications during the treatment. [6]
In another large prospective multicentre observational study, 134 adult cases suffering from chronic sinusitis for 10.7 ± 9.8 years were studied. Most of them had previously treated with the conventional medicine. Consecutive patients presenting for homeopathic treatment were followed-up for 2 years, and complaint severity, health-related quality of life (QoL), and medication use were regularly recorded. The complaint severity 1.58, 2.15, and 2.43 at 3, 12, and 24 months respectively after receiving homoeopathic medicine. It is observed that QoL also improved in these cases. Then effect were still present after 8 years with SF-36 physical component score 0.38 and mental component score 0.74.[7]
Frequently used homoeopathic medicines for the management of fungal sinusitis[8],[9],[10],[11]
Homoeopathy medicines are found effective and gives long term solution for fungal or non fungal chronic sinusitis in all ages and other respiratory complaints related to it. Homoeopathic similimum should be selected focusing on the probable causative factor it could be mental as well as physical. Some of the frequently indicated remedies with indications are discussed below.
Allium cepa: Very melancholic, anxious with catarrh. Dullness of intellect. Coryza, with copious acrid nasal discharge and laryngeal symptoms, eye secretion bland. Coryza worse in warm room and toward evening; better in open air. Specially adapted to phlegmatic patients; colds in damp cold weather. Sneezing, especially when entering a warm room. Fluent coryza with headache, cough, and hoarseness.
Arsenicum album: Anxiety, fear and mental restlessness along with physical restlessness. Thin, watery, excoriating discharge. Nose feels stopped up. Sneezing without relief.Hay-fever and coryza; worse in open air; better indoors. Burning and bleeding. Among these the all-prevailing debility, exhaustion, and restlessness, with nightly aggravation.Great exhaustion after the slightest exertion. Great thirst; drinks much, but little at a time.
Arsenicum iodatum:Anger and irritability during all complaints; aversion to answering questions; extreme anxiety, restlessness and fear; worse in a warm bed; confusion of mind morning and evening; delirium during the night; illusions of fancy and delusions about dead people.Allergic rhinitis with thin, watery, irritating, excoriating discharge from anterior and posterior nares. Irritation and tingling of nose constant desire to sneeze. Chronic nasal catarrh; swollen nose; profuse, thick, yellow discharge; ulcers; membrane sore and excoriated.Aggravation by sneezing.
Arundo mauritanica: Lascivious ideas.Laughs easily, a stupid hilarity.Anxiety diminished in open air.Hay-fever begins with burning and itching of palate and conjunctiva. Annoying itching in the nostrils and roof of the mouth. Sneezing, itching of nostrils.
Arum triphyllum:Unconscious of what he is doing or what is said to him. Forgetful.Absence of mind ; giddy.Soreness of nostrils. Acrid, excoriating discharge, producing raw sores. Nose obstructed; must breathe through mouth. Boring in the nose.Coryza; discharge blood-streaked, watery. Nose completely stopped, with fluent, acrid discharge. Hay-fever, with pain over root of nose. Face feels chapped, as if from cold wind; feels hot. Constant picking at nose until it bleeds.
Bromium:Delusion that strange persons are looking over patient’s shoulder and that she would see some one on turning. Quarrelsome.Coryza, with corrosive soreness of nose. Stoppage of right nostril.Pressure at root of nose. Tickling, smarting, as from cobwebs. Fan-like motion of alae.Bleeding from nose relieving the chest.
Calcarea carbonica: Dryness of the nose. Nostrils are sore ulcerated. Stoppage of nose, also with fetid, yellow discharge. Offensive odor in nose. Polypi; swelling at root of nose.Takes cold at every change of weather. Catarrhal symptoms with hunger; coryza alternates with colic. Sense of weight on top of head. Headache, with cold hands and feet. Headache from overlifting, from mental exertion, with nausea. Head feels hot and heavy, with pale face. Patient develops jaded state, mental or physical, due to overwork. Feels better while constipated. Desire for salt, sweet, and egg.
Dulcamara:Mental confusion. Rejects things asked for. Complete stoppage of nose. Stuffs up when there is a cold rain. Thick, yellow mucus, bloody crusts.Profuse coryza. Wants nose kept warm, least cold air stops the nose.
Gelsemium sempervirens: Desire to be quiet, to be left alone. Dullness, languor, listless. “Discernings are lethargied. “Apathy regarding his illness.Absolute lack of fear.Delirious on falling to sleep. Emotional excitement, fear, etc, lead to bodily ailments. Sneezing followed by tingling and fullness in the nose. Early morning sneezing; streaming of water from nose. Sneezing with fluent coryza; profuse watery discharge excoriates the nostrils. Dizziness, drowsiness, dullness, and trembling during coryza. Thirst poor.
Hepar sulphur: Soreness of nostrils, with catarrhal troubles. Sneezes every time he goes into a cold, dry wind, with running from nose, later, thick, offensive discharge. Stopped up every time he goes out into cold air. Smell like old cheese. Boring pain in the right temple and in root of nose every morning. Great sensitiveness to all impressions. Sweating patient pulling blanket around him. Very much sensitive to cold air. Sore throat from cold food and drinks. Desire for sour but aggravates.
Kali bichromicum: Pressure and pain at root of nose, and sticking pain in nose. Septum ulcerated; round ulcer. Fetid smell. Discharge thick, ropy, greenish-yellow. Tough, elastic plugs from nose; leave a raw surface. Inflammation extends to frontal sinuses, with distress and fullness at root of nose. Aching and fullness in glabella. Semilateral headache in small spots, and from suppressed catarrh. Frontal pain; usually over one eye.
Kali iodatum: Tip of nose red; profuse, acrid, hot, watery, thin discharge. Ozena, with perforated septum. Sneezing. Nasal catarrh, involving frontal sinus. Stuffiness and dryness of nose, without discharge. Profuse, cool, greenish, unirritating discharges. Pain through sides of head. Violent headache. Cranium swells up in hard lump. Pain intense over eyes and root of nose. Tea-taster’s cough due to inhaling the fungus.
Lycopodium clavatum: Scanty excoriating, discharge anteriorly. Ulcerated nostrils. Crusts and elastic plugs. Snuffles; child starts from sleep rubbing nose. Fan-like motion of aloe nasi. Pressing headache on vertex; worse from 4 to 8 pm, and from lying down or stooping, if not eating regularly. Deep furrows on forehead. Premature baldness and gray hair.
Mercurius solubilis: Sneezing in sunshine. Nostrils raw, ulcerated; nasal bones swollen. Yellow-green, fetid, pus-like discharge. Coryza; acrid discharge, but too thick to run down the lip; worse, warm room. Pain and swelling of nasal bones, and caries, with greenish fetid ulceration. Salivary secretions greatly increased. Intense thirst for cold drinks. Breath, excretions and body smell foul. Tendency to formation of pus, which is thin, greenish, putrid; streaked with thin blood.
Nux vomica: Stuffed up, at night especially. Stuffy colds, snuffles, after exposure to dry, cold atmosphere; worse, in warm room.Intoxicated feeling; worse, morning, mental exertion, tobacco, alcohol, coffee, open air. In general patient is very irritable. Cannot bear noises, odors, light, etc. Constipation, with frequent ineffectual urging, incomplete and unsatisfactory; feeling as if part remained unexpelled.
Phosphorus: Chronic congestion of head. Fan-like motion of nostrils. Bleeding; epistaxis instead of menses. Chronic catarrh, with small hæmorrhages; handkerchief is always bloody. Polypi; bleeding easily.
Pulsatilla: Melancholia, sadness, weeping, despair, religious despair, fanatical; full of notions and whims; imaginative; extremely excitable.Obstruction of nose and dry coryza, principally in evening and in the heat of a room. Coryza with loss of taste and smell, or with discharge of thick (yellowish green) and fetid mucus.Tickling in nose and frequent sneezing, principally in morning and evening.The patient seeks the open air; always feels better there, even though he is chilly. Symptoms ever changing.Thirstless, peevish, and chilly.
Psorinum: Hopeless; despairs of recovery. Melancholy, deep and persistent; religious.Suicidal tendency.Sticking in left nostril when boring in with finger. Clear, watery fluid pours out from nose. Offensive discharge from nose in chilly individual, wants the head kept warm, wants warm clothing even in summer.
Sabadilla: Nervous, timid, easily startled. Has erroneous notions about himself. Imagines that he is very sick; that parts are shrunken; that she is pregnant; that she has cancer; delirium during intermittents.Spasmodic sneezing, with running nose.Coryza, with severe frontal pains and redness of eyes and lachrymation. Sore; begins on left side Warm food and drink relieve. Empty swallowing is most painful.
Sangunaria Canadensis: Profuse, offensive yellowish discharges. Nasal polypi. Coryza, followed by diarrhœa. Chronic rhinitis; membrane dry and congested. Periodical sick headache; pain begins in occiput, spreads upwards, and settles over eyes, especially right. Pain in the back of head “like a flash of lightning”.
Silicea: Itching at point of nose. Dry, hard crusts form, bleeding when loosened. Nasal bones sensitive. Sneezing in morning. Obstructed and loss of smell. Sinus headache better, wrapping up warmly; when lying on left side. Profuse sweat of head, offensive, and extends to neck. Pain begins at occiput, and spreads over head and settles over eyes. Swelling in the glabella. Ill effects of vaccination. Great sensitiveness to taking cold. Intolerance of alcoholic stimulants. Ailments attended with pus formation.
Rarely used homoeopathic remedies for allergic rhinitis in lower potencies
Ammonium muriaticum: It suits to fat and sluggish people, and who have small, thin legs. They are prone to suffer from catarrhal conditions, and as a result it is indicated in cases of coryza that is watery and acrid and corrodes the lips. It covers sneezing and crawling in the throat, with extreme soreness and tenderness of the nose.
Aralia racemosa: It is also useful in hay-fever with frequent sneezing.
Euphrasia officinalis: Profuse, bland, fluent coryza and excoriating lacrimation.
Helianthus annus: It is used in old cases of intermittent fevers, coryza, catarrh, nasal haemorrhage and thick scabs in nose.
Justicia adhatoda: It is useful for curing many catarrhal conditions of the respiratory system. It is a great expectorant and soothes teasing cough in coryza, pneumonea, bronchitis, phthisis and clears the lungs. It is also beneficial in the first stage of phthisis and all kinds of pulmonary diseases with discharge of blood in the phlegm.
Mimosa pudica: Homoeopathically used for feeling of large body, headache over the eyes, sinusitis, coryza, blepharitis, influenza, acute otitis, and acute enterocolitis. In lower potencies it is used for stones and urinary troubles, for purification of blood.
Narcissus pseudonarcissus: It is a remedy for cough and bronchitis. It is also used in cases of coryza, frontal headache, and convulsive stages of whooping cough.
Quillayasaponaria: It produces and cures symptoms of acute catarrh, sneezing and sore throat. It is most effective in the beginning of coryza, frequently checking its further development; colds with sore throat; heat and dryness of throat and cough with difficult expectoration.
Sambucus nigra: It acts specially on the respiratory organs. Dry coryza of infants, snuffles, oedematous swellings.
Sticta pulmonaria: It offers a set of symptoms like coryza, bronchial catarrh, asthma and influenza, together with nervous and rheumatic disturbances.
Teucrium marum verum: This remedy is indicated in polypi of the nose and vagina. There is frequent sneezing with a sensation of crawling in the nose without coryza.
References
[1] Hamilos, D. L. (2000). Chronic sinusitis. Journal of Allergy and Clinical Immunology, 106(2), 213–227. doi:10.1067/mai.2000.109269.
[2] Glass D, Amedee RG. Allergic fungal rhinosinusitis: a review. Ochsner J. 2011;11(3):271-275.
[3] Safirstein B. Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract. Chest. 1976;70:788–790.
[4] John E McClay. Allergic Fungal Sinusitis. Available from: https://emedicine.medscape.com/article/834401-overview
[5] Telmesani LM. Prevalence of allergic fungal sinusitis among patients with nasal polyps. Ann Saudi Med. 2009;29(3):212-214. doi:10.5144/0256-4947.2009.212
[6] Chaturbhuja Nayak, Vikram Singh, V.P. Singh, Praveen Oberai, Varanasi Roja, Shashi Shekhar Shitanshu, M.N. Sinha, Deepti Deewan, B.C. Lakhera, Sunil Ramteke, Subhash Kaushik, Sarabjit Sarkar, N.R. Mandal, P.G. Mohanan, J.R. Singh, Sabyasachi Biswas, Georgekutty Mathew, Homeopathy in chronic sinusitis: a prospective multi-centric observational study, Homeopathy, Volume 101, Issue 2, 2012, Pages 84-91, ISSN 1475-4916, https://doi.org/10.1016/j.homp.2012.02.002. (https://www.sciencedirect.com/science/article/pii/S1475491612000033)
[7] Witt, C.M., Lüdtke, R. & Willich, S.N. Homeopathic treatment of patients with chronic sinusitis: A prospective observational study with 8 years follow-up. BMC Ear Nose Throat Disord 9, 7 (2009). https://doi.org/10.1186/1472-6815-9-7
[8]Hering’s guiding symptoms of our Materia Medica By Calvin B. Knerr, M. D. B Jain Publishers Pvt Ltd; New Delhi.
[9] J. H. Clarke, Dictionary of Practical Materia Medica, Reprint Edition 1992, B. Jain Publishers, New Delhi.
[10] W. Boericke, New Manual of Homoeopathic Materia Medica& Repertory [with Relationship of Remedies], Second Re-Augmented & Revised Edition Based on Ninth Edition, Reprint Edition 2002, B. Jain Publishers, New Delhi.
[11]Dr. P. N. Varma, KusumYadav,RamachandranValavan, A Compendium of Rare and Clinically Established Mother Tinctures, 4th Edition, Dr. Willmar Schwabe India Pvt. Ltd., A-36, Sector 60, Noida.
Note: This article is based on the below publication:
Valavan R, Sharma N. Allergic fungal sinusitis – How homoeopathy can help? Homoeopathy for All. 2021 Jun Volume 23(6).