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Introduction

Rhinitis is the inflammation of the nasal mucous membrane, and allergic rhinitis is a type 1 hypersensitivity inflammatory illness mediated by immunoglobulin E. Allergic rhinitis is an acute, recurrent, and episodic disease affecting over 20-30% of the global population, particularly prevalent among individuals in their twenties. In Ayurveda, Pratishyaya, described in the Uttaratantra by Acharya Sushruta, corresponds to allergic rhinitis. The signs, symptoms, and etiological factors of Vataja Pratishyaya are similar to allergic rhinitis, characterized by Nasasrava, Nasavarodha, Kshavathu, Shirashoola, and Swasavarodha. In Ayurveda, treatment strategies for Pratishyaya vary depending on the disease stage, including Snehapana, Swedana, and Shodhana. Nearly all Acharyas advocate Shirovirechana for Pratishyaya, except in Nava Pratishyaya. Treatment must consider the patient's physical condition, long-term medication use, and dietary restrictions.

This case report provides rational and scientific reasons to highlight the potential of Ayurveda, particularly Nasya Karma, in managing allergic rhinitis.

Methodology

Patient Profile

A 42-year-old female presented with a chief complaint of Nasavarodha (Nasal obstruction), Nasa srava (Nasal discharge), Kshavatu (Sneezing), Shira shoola (Headache), Kasa (coughing), Kandu (Itching in throat) and recurrent attack for last 13 years. Patient has Swarabheda, Jwara, Pandu, Aruchi, Mukhashosha, Shirogaurava as associated symptoms.

Physical examination with investigation reports:

A. Complaints:

1. Nasal obstruction: Unilateral (Right side), Aggravates at night

2. Nasal discharge:

a) Nature: Thick & Mucoid

b) Color: Transparent &White

c) Quantity: Mild

d) Smell: Foul smell

3. Sneezing: 5-6 times a day

a) Number of sneezing at a time: 16-20

b) Nature of sneezing: Early morning & evening

c) Season: Annual

d) Atmosphere: Cool, Moist & Smoky

4. Headache:

a) Site: Frontal & temporal region

b) Nature: Moderate

c) Rhythm: Continuous

6. Itching: Eyes/Nose & Throat

7. Frequency: Sudden onset relieved with medication

8. Coughing: Continuous (aggravates at night time)

B. Vitals:

a) Respiratory rate: 22/min, Regular

b) Temperature: 102” F

c) Blood pressure: 120/90 mm of Hg

d). Pulse: 98/min

A vegetarian, with regular menstrual period, having Madhur rasa in dominance, moderate appetite, Madhyam Kostha, regular bowel habits. Patient had disturbed sleep due to coughing and nasal blockage. She was doing house hold jobs with farming too.

C. Laboratory & Radiological Investigation:

a) Hb% - 11.8gm%

b) TLC – 5600/cu mm

c) DLC- Neutrophils - 62%, Lymphocytes - 28%, Monocytes - 3 %, Eosinophil - 4, Basophils - 0

d) Platelet count – 170 k/uL

e) ESR – 20 mm/hour

g) Absolute Eosinophil count – 670 /cu.mm

h) BS (Random) - 140 mg/dl.

i) IgE- 156 IU/ml

j) X-ray PNS (Water’s view) – Haziness in paranasal sinuses (bilateral maxillary sinus). Nasal cavity appears obliterated.

Local examination:

A. Examination of Nose:

a) Inspection: Swelling and congestion of the nasal mucosa, thin secretions.

b) Anterior Rhinoscopy – Lower and anterior part of septum, middle turbinate appears red, floor of the nose becomes red, mucosa red, septum normal.

B. Examination of sinus: Facial (maxillary area) tenderness on palpation of the sinuses

C. Examination of throat: Posterior oropharynx is moist, mucous accumulation in the back of the nose and throat, no sign of inflammation.

Treatment protocol:

Oral medication (for 30 days)

1. Laxmivilas Rasa- 125 mg/ tablet, 1 tablet twice daily with honey.

2.Haridra Khanda-5 gm twice daily with warm milk.

3.Chitrak Haritaki avaleha-5 gm twice daily with luke warm milk after food.

Therapeutic procedure (for 7 days)

Nasya Karma

1. Snehana – Mridu abhyanga with Ksheerbala Taila

2. Swedana –Vashpa Swedan for 3 minutes.

3. Pradhana karma -Nasya with Shadbindu Taila

Follow-up and Outcomes:

i. Intervention modification, interruption or discontinuation and the reasons: NIL

ii. Adherence to the intervention and how this was assessed: After completion of one-month treatment and follow up for 2 months clinical assessments were made from the interrogation with patient and assessment of objective parameters. as Table no. 2

Patient reported outcomes:

Headache reduced suddenly.

Dry coughing has stopped second day even.

Patients revealed the irritation due to itching, running nose and sneezing had stopped completely by 7th day of these treatments.

Discussion

Allergic rhinitis significantly hampers quality of life and daily activities, with its incidence rising due to environmental pollution, stress, and reduced immunity. In Ayurvedic classics, Vataja Pratishyaya, a Nasagata roga, is extensively described, marked by the vitiation of Vata and Kapha doshas, leading to symptoms like Kshawathu (sneezing), Nasaavarodha (nasal obstruction), Jalaja Nasa srava (watery nasal discharge), and Gala Talu Shushkata (dry throat). Nasya the administration of medicine through the nose, acts as Sravahara (removes secretions), Shothahara (reduces swelling), and Srothoshodana (cleanses channels). Purva karma practices like Snehana (oleation) and Swedana (sudation) help pacify Vata dosha. The use of Tila Taila (sesame oil) in Nasya, combined with Shadbindu taila components, forms a protective layer on the nasal mucosa, preventing allergen entry and strengthening nasal stamina. Shunti and Vidang, with their Tikshna (sharp) properties, act as Kaphanissaraka (expels Kapha) and Srotoshodaka (cleanses channels), while Tagara and Erand's Ushna Veerya (hot potency) pacifies Vata and Kapha doshas. Bringaraja, Madhuyashti, and Aja Ksheer, with their Rasayana (rejuvenate) properties, revitalize nasal tissues, providing anti-inflammatory and antimicrobial benefits, preventing infections and relieving headaches. Oral medications enhance immune response, with anti-histamine properties suppressing symptoms and antioxidant activity of Haridra boosting immunity. Laxmivilas Rasa's antibacterial quality prevents secondary infections, effective against pathogens like Streptococcus and Staphylococcus. Most treatment drugs, possessing Katu rasa (pungent taste), Ushna veerya, and Teeksha guna, facilitate liquefaction and expulsion of vitiated doshas, alleviating nasal obstruction and discharge. Absolute Eosinophil Count (AEC) is a more specific marker for allergic diseases, including allergic rhinitis. Elevated AEC reflects ongoing eosinophilic inflammation, a hallmark of allergic responses. A decrease in AEC after Ayurvedic treatment suggest a reduction in allergic inflammation, highlighting the efficacy of the therapeutic approach.

Immunoglobulin E (IgE) plays a central role in allergic reactions, with elevated serum IgE levels being indicative of allergic sensitization. Measuring IgE levels before and after treatment directly assess the impact of Ayurvedic drugs on allergic sensitization and the severity of allergic rhinitis. X-ray of the Paranasal Sinuses (PNS) reveal structural changes and the extent of sinus involvement in allergic rhinitis. Chronic inflammation can lead to mucosal thickening, sinus opacification, and other radiographic abnormalities. Evaluating PNS X-rays can provide objective evidence of the anatomical and functional improvements resulting from Ayurvedic treatments.

This case highlights Ayurveda's comprehensive approach in managing allergic rhinitis, focusing on long-term relief and overall health improvement, underscoring the need for integrating traditional and modern treatment methodologies in future research.

Conclusion

Allergic rhinitis is a prevalent condition that significantly affects quality of life. Its rising incidence is linked to environmental pollution, stress, and diminished immunity. Conventional treatments offer symptomatic relief but often do not address underlying causes. This case study illustrates the potential of Ayurvedic treatments, particularly Nasya Karma and herbo-mineral combinations, in providing comprehensive management by addressing root causes and enhancing immunity. Systematic assessment of these markers before and after Ayurvedic intervention can substantiate the therapeutic benefits and establish evidence-based support for the use of traditional medicine in managing allergic rhinitis.

The comprehensive evaluation of Total Leukocyte Count (TLC), Differential Leukocyte Count (DLC), Erythrocyte Sedimentation Rate (ESR), Platelet count, Absolute Eosinophil Count (AEC), Immunoglobulin E (IgE) levels, and X-ray of the Paranasal Sinuses (PNS) offers a robust framework for assessing the efficacy of Ayurvedic drugs in allergic rhinitis. These parameters provide critical insights into the immune response, inflammatory status, allergic sensitization, and anatomical changes associated with the condition. Systematic monitoring of these markers before and after Ayurvedic treatment can substantiate therapeutic benefits, thereby supporting the evidence-based integration of traditional medicine in managing allergic rhinitis.  Future research should focus on further validating these treatments through rigorous clinical trials. Additionally, understanding the molecular mechanisms behind Ayurvedic remedies could provide insights into their efficacy and potential integration into conventional treatment protocols. Recommendations include adopting a holistic approach that considers lifestyle and dietary modifications alongside traditional treatments. Healthcare providers should be trained in recognizing the benefits of Ayurvedic practices to offer a more integrative approach to managing allergic rhinitis. These steps could lead to improved patient outcomes and a reduction in disease recurrence.

Acknowledgement: We sincerely acknowledge the cooperation received from the GS Ayurveda Medical College Hospital management and staff for their administrative and technical supports in smoothly conducting this trial. We also express our gratitude to the patient for her cooperation throughout the follow-up period.

Images:

1. X ray (PNS) Pre

2. X ray (PNS) Post