|Year : 2019 | Volume
| Issue : 2 | Page : 47-50
Exploring the anti-allergic property of potentized sodium chloride using nasal eosinophil count as a criterion
Dania P Johnson1, K John Paul2
1 Final Year BHMS, Father Muller Homoeopathic Medical College, Mangalore, Karnataka, India
2 Department of Surgery, Father Muller Homoeopathic Medical College, Mangalore, Karnataka, India
|Date of Web Publication||24-Jan-2020|
Ms. Dania P Johnson
Father Muller Homoeopathic Medical College, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Nasal eosinophilia is a specific and valuable means for diagnosing and predicting the prognosis of allergic rhinitis (AR). Evidence-based recommendation for treating AR with homeopathic medicines is lacking. Symptomatology of Natrum Muriaticum (NM) derived from homeopathic pathogenetic trials and clinical proving aids its wide use in practice. Objective: The study aided in ascertaining the anti-allergic property of NM in lowering the nasal eosinophil count in patients with AR. Methods: This prospective, observational study included patients diagnosed with AR along with nasal eosinophilia, provided they received NM 30C homeopathic remedy. Written consent was obtained from 15 patients and then included in the study. Nasal smear was collected on the first visit before the treatment and at the end of 2 weeks after the treatment. Statistical Analysis and Results: Pre- and post-treatment nasal eosinophil counts were statistically analyzed using the paired t-test. The difference in mean eosinophil count (0.06333) was statistically significant, where P < 0.00000085. Results: From the study conducted, the eosinophil count was recorded before and after treatment [Figure 1]. Out of 15 participants, two had moderate eosinophilia and 13 had mild eosinophilia before treatment. There was no eosinophilia in any of the patients in the 2nd week after NM intake. Conclusions: It was evident that NM lowers the nasal eosinophil count when administered according to homeopathic principles. Nevertheless, it has opened new avenues to investigate the underlying mechanisms of the anti-allergic property possessed by NM through in vitro studies.
Keywords: Allergic rhinitis, eosinophils, homeopathy, nasal smear, Natrum Muriaticum, sodium chloride
|How to cite this article:|
Johnson DP, Paul K J. Exploring the anti-allergic property of potentized sodium chloride using nasal eosinophil count as a criterion. Muller J Med Sci Res 2019;10:47-50
|How to cite this URL:|
Johnson DP, Paul K J. Exploring the anti-allergic property of potentized sodium chloride using nasal eosinophil count as a criterion. Muller J Med Sci Res [serial online] 2019 [cited 2020 Apr 10];10:47-50. Available from: http://www.mjmsr.net/text.asp?2019/10/2/47/276683
| Introduction|| |
Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa, characterized by blood and tissue eosinophilia induced by an immunoglobulin E (IgE)-mediated reaction following exposure to an allergen. AR is one of the most common diseases in young people and is responsible for significant impairment in the quality of life (QOL). Its control is usually far from satisfactory. The prevalence of AR is increasing worldwide, affecting up to 40% of the global population. Despite its high prevalence, it is often undiagnosed. A definitive diagnosis is made by three symptoms, namely sneezing, itching of nose and nose block, together with positive nasal eosinophilia and identified causative allergens based on skin reactions or serum allergen-specific IgE antibody measurements. Anti-IgE administration shows better efficacy but very expensive. Anti-allergic immunotherapy is promising and new, however, well designed, long-term clinical trials are needed.
Nasal smear cytology is a simple, noninvasive, and cost-effective screening test done for rhinitis and other inflammatory diseases. Nasal smear examination for eosinophils is found to be specific and a valuable means of predicting the prognosis of AR.
The aim of any treatment is to lessen the symptoms of AR, improve the QOL, and to ensure that the therapy is economically feasible. Some meta-analyses provided positive results with homeopathy in the good-quality trials that were conducted in rhinitis. Coincidently, negative findings were also reported. A solid ground to provide an evidence-based recommendation for treating AR with homeopathic medicines is lacking.
An ample number of homeopathic remedies such as Sabadilla, Allium cepa, Natrum Muriaticum (NM), Ambrosia, Ammonium carb, Gelsemium, Bromium, Pulsatilla, Saponaria, Quillaya, and Pothos are widely used in clinical practice. Symptomatology of these remedies is derived from homeopathic pathogenetic trials and clinical proving, which correspond to the clinical features of AR.,,
NM is prepared by potentizing common salt, which has a marked action on the mucous membranes of the nose., Noted cures are cited in Boericke's Materia Medica with the use of NM in 30 centesimal potency., Although NM is empirically verified, there is no primary literature currently available to support NM for treating AR.
To make a factual statement on the effectiveness of NM in AR, this observational study was taken up. An objective was set to discover the role of NM in lowering the nasal eosinophil count in patients with AR, only when the remedy was selected and administered on an homeopathic basis. This would contribute scientific reasoning in the treatment of AR along with the curative effect of NM. Thus, this research sheds light on the anti-allergic effect of NM in AR.
| Methods|| |
This was a prospective, clinical observational study. Ethical clearance was obtained from the Institutional Ethics Committee (Protocol No: 08/18 dated 08.12.18). A sample size of 15 was calculated using a simple formulan = Zα2 P (1 − P)/e2, where the prevalence rate was 10% with Zα = 1.96 at 95% confidence interval and 15% precision. Purposive sampling was employed to recruit the patients. Sixteen patients were enrolled for the study and 15 completed the study. Written consent was obtained from all the participants. The remedy received by the participants was procured from a GMP certified Manufacturing unit that prepared homeopathic medicines as per the homeopathic pharmacopeia of India.
Participants consisted of adult patients reporting to a Homeopathic Medical College Hospital Outpatient Department. A pro forma containing the list of symptoms was used to screen patients for AR. The patients who received NM in the 30th centesimal potency and dosage according to the fifth inclusion criteria were observed. In addition, the focus was only on those patients where NM was selected as per the fourth inclusion criteria [Table 1]. If patients fulfilled the above-said, they were directed to the laboratory for the collection of nasal discharge. Nasal smears were prepared and checked for eosinophilia. Positive nasal eosinophilia patients who complied with the selection criteria were included in the study.,, The nasal discharge was collected once again during the first follow-up after 2 weeks of treatment and counted for eosinophils.
Nasal smear preparation and eosinophilia grading
Nasal smear was prepared by asking the patient to blow the nose on a tissue paper or scraping the mucosa over the inferior turbinate with a cotton applicator. As nasal discharge is a tissue fluid, it was centrifuged at the rate of 2500 rpm for 1 h to obtain cellularity. Resultant sediment was transferred to three glass slides for the preparation of smear. Once air-dried, they were fixed and stained using Leishman's stain for 2 min followed by a 5-min dilution with the buffer as per the procedure of blood smear preparation. Smears were rinsed immediately to avoid over staining. Eosinophils were counted under a high-power field using microscopy for every 100 white blood cells and were graded for eosinophilia before and after treatment [Table 2].
The quantitative data obtained from the pre- and post-treatment eosinophil count were statistically analyzed using the paired t-test in Gnu PSPP software v. 1.2.0-g0fb4db (Developed under GNU PROJECT-Richard Stallman, Massachusetts, USA) to determine whether the difference in mean was significant. The effectiveness of NM on individual symptoms was analyzed using online McNemar's Chi-square test C.I Calculator.
| Results|| |
From the study conducted, the eosinophil count was recorded before and after the treatment [Figure 1]. Out of 15 participants, two had moderate eosinophilia and 13 had mild eosinophilia before treatment. There was no eosinophilia in any of the patients in the 2nd week after NM intake. Statistical analysis of the data revealed that the administration of NM 30 had significantly reduced the eosinophil count within 2 weeks. The difference in mean eosinophil count (0.06333) was statistically significant, where P = 0.00000085 (P< 0.05).
At the symptomatic level, the following observations were made [Table 3]. There was improvement in the paroxysms of sneezing (26.67%), rhinorrhea (26.67%), nasal obstruction (30.76%), itching of eyes (57.14%), itching of nose (41.67%), itching of palate (50%), postnasal drip (27.27%), cough (33.33%), and fatigue (37.5%). No change in irritability was noted. The test for significance was analyzed through McNemar's Chi-Square test for paired counts on all the symptoms [Table 3]. Improvements noted in sneezing and rhinorrhea were statistically significant. As the probability value was much higher than the conventional significance on the rest of the symptoms, we could not validate the effectiveness of NM.
| Discussion|| |
An allergic inflammatory response is characterized by the presence of an increased number of eosinophils in the bone marrow, blood, and tissues. Dendritic cells are antigen-presenting cells strategically located in the nasal mucosal surface to capture allergens and present the allergenic peptides to T lymphocytes for sensitizing the allergen to elicit an IgE response. In sensitive individuals, the mast cells of the nasal mucosa and submucosa release preformed mediators such as histamine that cause the early symptoms of AR, namely rhinorrhea, nasal itching, and sneezing through IgE-dependent reactions which are capable of producing tissue edema and eosinophilic infiltration. In addition, histamine along with other mediators and selectins family results in the influx of inflammatory cells such as eosinophils, CD4+ T lymphocytes, and basophils. In contrast to the 2–5 day's normal life span of eosinophils, some mediators extend their survival to 14 days or more contributing to the increased eosinophil numbers at allergic sites.,
NM is chemically identified as sodium chloride (NaCl) and as an homeopathic remedy has a marked effect on the mucous membranes of the nose and a well-known remedy for treating AR. Although this remedy is extensively used, a systematic large-scale documentation on NM in homeopathic practice, particularly on AR is not available.In vitro exposure of human T-cells to increased salt concentrations reduces their suppressive capacity along with the higher expressions of proinflammatory cytokines leading to inflammation. A recently published study shows that TH2 cell differentiation is impaired in in vitro under high-salt conditions. NaCl has significantly reduced Th2 differentiation.
Potentized NM, when administered in patients suffering from AR based on the symptom similarity, has had a curtailing effect on the nasal eosinophil count. From a bird's-eye view, the possible action of NM in reducing the eosinophil levels can be explained in light of the aforementioned pathological mechanisms. NM probably hinders the action of histamine and other mediators, thereby reducing tissue edema, eosinophilic infiltration, and inhibiting the expressions of proinflammatory cytokines that lead to inflammation. However, this study has provided scientific evidence only on the property of NM to reduce eosinophil count and not on the actual underlying mechanisms. NM can be asserted to have an anti-allergic effect and considered a potential agent in tissue eosinophilia, provided the basis of prescription is individualized. At the symptomatic level, the statistical analysis clearly revealed the effectiveness of NM only on sneezing and rhinorrhea. Owing to the chronicity of AR, this study encourages large-sized long-term research on the remaining symptoms.
| Conclusions|| |
This observational study has ushered scientific comprehension on the anti-allergic effect of NM as one of the remedies that have a definitive action on nasal eosinophilia. Only prescriptions with respect to the homeopathic principles can achieve the intended outcome. Furthermore,in vitro studies on the effect of potentized NM in different potencies on the chemical mediators will establish a concrete idea on the underlying mechanism of NM in lowering eosinophil count.
We wish to acknowledge the support rendered by Dr KurianPJ, Research Coordinator, R&D Committee of Father Muller Homoeopathic Medical College, STSH-Central Council of Research in Homeopathy, Faculty & PG Scholars of Department of Pathology, Father Muller Medical College, the College Management to pursue this research study and for the financial support provided by the Father Muller Research Center, Father Muller Charitable Institutions, Kankanady, Mangalore.
Financial support and sponsorship
Grant: Father Muller Research Center, FMCI, Kankandy, Mangalore.
Drugs: Father Muller Homeopathic Pharmaceutical Division, Deralakatte, Mangalore.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dávila I, Mullol J, Ferrer M, Bartra J, del Cuvillo A, Montoro J, et al
. Genetic aspects of allergic rhinitis. J Investig Allergol Clin Immunol 2009;19 Suppl 1:25-31.
Izquierdo-Domínguez A, Valero AL, Mullol J. Comparative analysis of allergic rhinitis in children and adults. Curr Allergy Asthma Rep 2013;13:142-51.
Skoner DP. Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 2001;108:S2-8.
Okubo K, Kurono Y, Ichimura K, Enomoto T, Okamoto Y, Kawauchi H, et al
. Japanese guidelines for allergic rhinitis 2017. Allergol Int 2017;66:205-19.
Solelhac G, Charpin D. Management of allergic rhinitis. F1000Prime Rep 2014;6:94.
Vaidya KA, Sunil P, Nagaraj TS, Sukesh. A study on utility of nasal smear examination in diagnosing allergic rhinitis and its histopathological correlation in allergic nasal polyps. Int J Basic Appl Med Sci 2015;5:291-7. Available from: http://www.cibtech.org/jms.htm
[Last accessed on 2018 Dec 10].
Ahmadiafshar A, Taghiloo D, Esmailzadeh A, Falakaflaki B. Nasal eosinophilia as a marker for allergic rhinitis: A controlled study of 50 patients. Ear Nose Throat J 2012;91:122-4.
Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, et al
. ARIA update: I – Systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol 2006;117:1054-62.
Wallace KR. The homoeopathic treatment of asthma and allergies. Br Homoeopath J 1986;75:218-26.
Akhil BG. An observational study on usefulness of bromium 30c in atopic respiratory complaints by assessing serum immunoglobulin E levels. Indian J Res Homoeopathy 2017;11:177-83. [Full text]
William B. Pocket Manual of Homoeopathic Materia Medica. Reprint Edition. 9th
ed. New Delhi: IBPP; 2015. p. 460.
Herring C. The Guiding Symptoms of our Materia Medica. Vol. 7. Reprint edition NewDelhi: Pratap Medical Publishers; 2003. p. 556.
William B. Physiological Materia Medica. Reprint Edition. New Delhi: B Jain Publishers; 1995. p. 630-1.
Boericke W, Dewey WA. The Twelve Tissue Remedies of Schussler. Reprint Edition. New Delhi: IBPP; 2008. p. 115.
Kapoor MC. Types of studies and research design. Indian J Anaesth 2016;60:626-30.
] [Full text]
Daniel WW, editor. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th
ed. New York: John Wiley and Sons; 1999.
Syamalan K. Statistics in Medicine. 2nd
ed. Trivandrum: Global education bureau publishers; 2012. p. 50.
Hahnemann S. Organon of Medicine. Reprint Edition. NewDelhi: IBPP; 2016. p. 204.
Venkateshwarlu V, Murali Mohan KV. A comparative study of nasal smear eosinophilia vs absolute eosinophil count in patients with allergic rhinitis. MRIMS J Health Sci 2015;3:36-8.
Das B, Basumatari S. Cytological study of nasal smear in allergic rhinitis. J Evol Med Dent Sci 2017;6:4222-6.
Holgate S, Church M, Broide D, Martinez F. Allergy. 4th
ed. Philadelphia: Saunders; 2012: p. 16, 206.
Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL. Harrison's Principles of Internal Medicine. 17th
ed., Part. 14. Vol. 2. New York: Mcgraw-Hill Professional; 2008. p. 2069.
Willebrand R, Kleinewietfeld M. The role of salt for immune cell function and disease. Immunology 2018;154:346-53.
Hammer A, Schliep A, Jörg S, Haghikia A, Gold R, Kleinewietfeld M, et al
. Impact of combined sodium chloride and saturated long-chain fatty acid challenge on the differentiation of T helper cells in neuroinflammation. J Neuroinflammation 2017;14:184.
[Table 1], [Table 2], [Table 3]