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Case Study

Case of Recurrent Allergic Rhinitis
Dr Prasad H Saundankar

Understanding the child through various available expressions
Experiencing the role of environment on the growing child’s psyche and its repercussion in the behavior.
Learning to differentiate similar Materia Medica images with the help of above.

The patient was a 12 yr-boy, 7th Std in a convent, was brought for treatment.
Mother, B-com, was a housewife. Father, M Sc, worked in the production dept in a factory.
Sister: 5 yr, senior K G, Grandmother: HW
Grandfather: died. Veg.


Sensation & pathology

A F < >

Strict time relation

Respiratory system
Since age 1 year


1st acute episode



Now usual episode:
duration 8-10 days

Coryza, Cough,
Increase in Resp rate. Fever
P/h/o primary complex (in infancy)
Coryza followed by dry2 cough within ½ hour

Chest pain
Fever mild

Anti-tubercular Rx for 1 year


AF C of Weather3
< Tomato sauce
< Jams
< Cold-drinks
< Candy
< Rasna
< Drinks with added preservative
< Monsoon+++
> Summer
< HS before sleep
< Morning, 15 min after sleep

Appetite decreases

Physical characteristics:
Appearance: thin extremities, wheatish complexion, slightly curly hair
weat: Scanty Appetite: Good
Stool / urine: Normal functioning
Cravings: spicy vegetable++, palak paneer++, groundnuts, milk
version: cauliflower, karela
Developmental landmarks and problems:
Head-holding-3rd month; Dentition-diarrhoea with every tooth. Crawling-7th month
Babbling 9th month. Talking 1st year. Walking with support 9th month; without support 10th month. Bowel & urine control- by 1st year
Sleep during: movement of limbs, intermittently through night. Occasionally talks.
Dream: once shouted loudly and trembled for ½ hour.
Also refer life space).
Thermal: Hot. Weight 26 kg.
O/E one cervical gland on left side, CVS/RS/PA-NAD
Nails- white spots ++. Tonsils: hypertrophy +.
Nose- hypertrophied turbinate ++
Tongue- large posterior papillae.

P/h/o all molar teeth had caries [not permanent teeth]
Recently had Urticaria rash with allopathic drugs
F/h/O Mother: allergic recurrent bronchitis
Grandmother: hypertension & cervical spondylosis
Grandfather died in 3rd myocardial infarction

Life space: Data from mother:
He is the elder son, 12 yr, studying in 7th std in a convent school, with a younger sister of 5 years. His family includes mother, father and grandmother. He was born in 2nd year after marriage. When mother was pregnant, there was stress and pressure from mother-in-law. The elder co-sister, poorly educated, used to be the source of quarrel, she would influence MIL to scold her. She wanted to work after marriage but in-laws did not allow. All this created tension throughout pregnancy. Constantly broods "though I work sincerely, why these people scold me?".
Even now she is an anxious Mother, constantly admonishing "Nikhil don’t do this and don’t do that" but he is out of her control. Patient listens only to father, who has control over him. Since 3-4 y, there is change in his behavior- very irritable, shouts, doesn’t listen. Very strong sibling rivalry with younger sister- in eating, drinking, objects, care and attention. He even feels he is getting less food or drink!. He takes away her toys. Even if sister is ill and cared for, he cannot tolerate it. Though he beats sister, he can’t tolerate another child beating his sister, then he beats that other child. If she is ill, he behaves well with her. His sister is more affectionate than him; though she is also irritable by nature, she submits; she understands him. When he was the lone child, all pampered him. This changed after sister’s birth. To worsen matters, sister resembles paternal relatives while patient is more like maternal relatives. So the grandparents compare and the partiality started without heeding that it could affect patient. Then again, sister is intelligent, fair, smart and good looking while patient has wheatish complexion. Naturally sister is more appreciated, He feels bad about it and whenever goes to maternal grandmother, he complains about paternal relatives.

Basically, he is an affectionate child and if anybody is ill, he gives tablets, water etc. But his loving nature is over-shadowed by his behavior. If he is prevented from watching TV, and asked to study he gets angry and throws things. He needs TV even at mealtimes. Takes frequent breaks in study- for bathroom or gets hungry! TV has contributed to his poor academic performance. Everybody now teaches him about behavior. He breaks toys and games. If he is made to study, he demands his sister should also be asked to study; he concentrates more in things happening around than in study. He is a restless boy, constantly moving hands and legs. He likes to play cricket. Schoolteacher reports him as talkative and naughty child and so asks him to sit in first row. At home too, he is talkative.

He was attached to grandfather who died of Myocardial infarction [1½ year back]. His behavior worsened since then. He dreams of grandfather [twice] that "grandfather came, feed him & went but when grandfather was going he said "don’t go, don’t go". He gets frightful dreams intermittently. During sleep, he moves limbs through out night. Sometimes he starts or gets frightened in sleep. He has fear of dark. Wants company, very restless even during interview.

Case analysis:
Clinical Diagnosis: 
Recurrent allergic rhinitis along with hypertrophied nasal turbinates
Understanding Patient:
 From birth, he had been pampered. Sister’s birth created a problem, when attention of everybody shifted to this newcomer. This sudden shift of center of attention started affecting him, and resulted in sibling rivalry. Of course sibling rivalries do arise in children but pass off with time. But here it is persisting. It is important to note how this works in the patient. This child has shown self-centeredness as a prominent behavior, which is his way of adaptive behavior. He still wants to be center of attention and therefore shows irritation over others, so much so that family criticize his behavior: this vicious cycle goes on and problem is increasing instead of getting solved. This disequilibrium is affecting his health and negative behavior is also persisting, as too the tendency to destroy things.
On the other hand, he is affectionate and attached to family members. This is evident when his grandfather died, he got dreams of grandfather.
Other attributes:
activity++, restless++, talkative++, irritable+++ . Milestones early
Fundamental miasm
Dominant miasm
Materia Medica Images
=Phosphorus, Tarentula, Iodine, Kali Group, Calc-iod, Tuberculinum.

: Center of attention along with activity in the behavior, tubercular miasm and the naughty, talkative behavior. But the irritating and destructive behavior and absence of sweetness of Phos rules it out. Also Patient is hot.

Tarentula-Lot of resemblance. But the finer shades like affection and care eg when anybody is ill in the home, though overshadowed by negative behavior. Then again his core problem is with attention [pampering] receiving concurrent with sharing of affection, which is not seen in Tarentula.
activity, tubercular nature of case, destructiveness [due to iod element] brings case near to Calc-iod but patients problem differentiates calcarea nucleus
Kali group: 
self-centeredness, attachment with family, affectionate nature brings Kali in the picture.
The other qualities like activity++, restlessness++, destructiveness, thermal-hot, tubercular miasm are well covered by the iod element.






Cough+ with yellowish expectoration; weakness+; fever =0

Kali-iod 30 3 hs


Cough=0; appetite improved. eats maggi



Coryza+; c/o sometimes swelling around eyes in morning

Kali-iod 30 3 Hs

19/9/- 3/10/01-18d

No c/o; eats jam



Cough 2 ds; expectoration + occ sneezing

Kali-iod 30 3 Hs


No c/o. Eats everything



Cough++, breathless +, weakness, thirst decreased+, sleepiness, fever=0

Kali-iod 200
1 Hs





Cough-mild. tonsils size+ nasal turbinates size > +

Kali-iod 200 1 Hs

17-31/12/01-14 d

No c/o



Thick yellow nasal discharge, expectoration -thick white; headache< rt. forehead

Kali-iod 200
1 Hs

3/01/02 evening

Shivering++, nose block, coryza, forehead aching. Appetite-normal; thirst- normal

Hepar-sul 30
Tds x 2 days


Felt better. Coryza +

Kali-iod 200 1 Hs

18-01-02 to
22-01 02

In these 5 days he had an acute episode that responded to Ars-alb 200. Plus the response in these 5 months was not up to expected level [acutes were recurring & hence need of medicine]. Parents first time mentioned "patient had primary complex in infancy"

1M 1Hs
 200 3 Hs

28-1-02 4-2-02

Cough+, nose watering+, white expectoration+
A.F missal pav-Nausea, vomiting [once] headache, coryza+, cough+ , weakness++

Kali-iod 200 1 Hs
1M 1 Hs http://www.njhonline.com/images/rtarrow.gif
 200 1 Hs

11-2-02 to 23-8-02
{6 ½ month} 24-8-02

No c/o inspite of eating everything including preservative. No < change of weather
Nose block++, sneezing+, throat pain+, coryza++, thirstless+; o/e throat-normal


Kali-iod 200
1 Hs


> ; Expectoration-yellow






Tuberculinum 1M 1 Hs à Kali-iod 200 1 Hs


Till 9-10-02

No complaints.


(Editor: Conclusion: This case graphically demonstrates that even the completely well-indicated similimum could not bring the case to complete cure, until the underlying miasm was tackled and the strongly indicated anti-miasmatic remedy, Tuberculinum given. Only 2 doses were sufficient to bring about a complete cure. Just for this demonstration, we should be thankful to the parents for not revealing this important data right in the beginning of the case. If this history of primary complex had been obtained at the start, then certainly Tub would have been given much earlier and we would not have got this proof, so to speak, of the importance of the anti-miasmatic theory of Master Hahnemann and especially of the effects of Tuberculinum, the anti-tubercular remedy.