Transcript rhinitisx20cambridge2010x1x_Jackie_Mardon

Rhinitis in children
Jacqueline M Mardon
A collaborative model
retrospective review
47 children referred by ENT
allergic or non-specific rhinitis
ineffective conventional therapy
assessed by homeopathic practitioner
treated with homeopathy ± isopathy
follow-up and outcomes
The integrity of the child
What is rhinitis and what is it an
expression of in the child’s being?
What is the significance?
(different levels this can be approached)
A very visible manifestation:
flowing, sticky
lurid green, yellow, clear burny
blood
Face full, tender, squeaky, stuffedup
Unseen pain, itch - nose rub, palate
scratch
Eyes water, stick, searing tears
Ears fuzzy, bubble
Skin prickles and flakes
Hard to breathe - the night is not
peaceful, disturbed with grunts,
snorts and gasps
 An assault to the dignity of the
young individual and their integrity
 Affects concentration, distorts the
face. Hard to gaze outwardly.
 There may be shame, mute misery
 Can experience being shunned,
bullied
Conventional approaches
 History, examination ±
investigation (skin prick tests,
RAST)
 Associated asthma, eczema,
foods?
 Treatment nasal corticosteroids,
anti-histamines
Self-help approaches
 Allergen avoidance/reduction
 Saline nasal washes
 Light impulse probes?
Homeopathic “holistic”
approach
 The child first and always
 Welcome the family
 Symptoms
 Maternal history, birth
 Early life, breathing, feeding and
weaning
 FHx
Onset allergy - eczema,asthma, rashes,
food
Homeopathic “holistic”
approach (2)
 Movement
 Physical, social and emotional
development
 Sleeping
 Day rhythms
 Temperature
Observations; significance of ages
Review of cases(1)
 47 children: 18 girls, 29 boys
 Age range: 1 - 16 years
Review of cases (2)
ENT referral/diagnosis
 Non-specific rhinitis - 8 children
 Allergic rhinitis/multiple allergies -
37
 Other - 2 children
Review of cases (3)
other medical
problems/Hx
A hetereogeneous group
Congenital heart disease
Tonsils, adenoids
Cleft lip and palate
Nasal intubations/feeding, surgery
Grommet insertions, ear problems
Review of cases (4)
medical hx cont
 Asthma (11 children)
 Eczema (13 children), 5 with both
 “ALLERGY MARCH”
 Urticaria/rashes
 Food allergies: milk protein, fish,
egg, dairy
 Chest and respiratory tract
infections - multiple antibiotics
Review of cases (5)
 Allergy tests
 RAST - 2 children
 Skin prick tests - 39 children
(9 negative results;
30 positive for one or more allergen)
Review of cases (6)
Family history
 Siblings with congenital heart
disease (2)
 30 children with family hx of atopy
Review of cases (7)
Maternal hx/birth
33 children recorded details
7 Caesarean Section births
5 births by Forceps delivery - SCBU with
bruising to head/face in 2 babies
Individual experiences eg “stuck”, purple
large baby with excess mucus, lasted
several months
Review of cases (8)
Conventional medication:
- one child parents declined nasal spray
- one child spray effective but parents
concerned re side-effects
- In most cases the tx
(steroids,antihistamines) ineffective or
limited effect
- Also bronchoinhalers and antibiotics
Review of cases (9)
 Previous homeopathy - one patient
visited homeopath in Pakistan;
another previous patient GHH
Review of cases (10)
Homeopathy/Isopathy Tx
 Many different remedies, first
consultation and beyond
 No treatment (1)
 Single (constitutional) remedy (17)
 Single (local)remedy (1)
 Miasmatic nosode and
constitutional (3)
 Isopathy and constitutional (23)
Review of cases (11)
Follow-up
 11 children attended one appointment
only- 1 was planned
 Further ENT assessment/treatment?
(10/46 is DNA rate of 21.7%)
36 children attended at least one followup (range 1 to 14 months from first
seen - patient-led!)
Review of cases (12)Outcome
 Reduction/cessation conventional Tx
 No response at follow-up - 5 children (1
did not like powders): 5/36 (14%)
 Partial response - 9/39 (25%)
 Good response with significant
improvement - 22/36 (61%)
 31/36 children (86%) of those seen
more than once have either partial or
good response - some follow-up and Tx
ongoing
Review of cases (13)
Discussion
 Rhinitis is a symptom - complexity of
individual’s history and circumstances
 Many of these children had heavy load
of interventions and Tx
 Allergies on many levels
 Can treating early in holistic way affect
longer-term outcome?
Collaborative model
 Child at centre
 Family
 General Practitioner
 Specialists - ENT surgeon,
Homeopathic/holistic practitioner
 Community/environment
Thanks
 Mr HA Sadiq ENT Surgeon, Royal
Hospital for Sick Children, Glasgow
 Elaine Hamilton, Nadja Gunneburg,
Kamal Ohri, Bridie O’Dowd, Robert
Leckridge
 Linda and administrative staff
 Betty and pharmacy staff