Allergic Rhinitis Under Individualised Homoeopathic Care: OPD Case Series with TNSS, Mini-RQLQ and MONARCH

Allergic rhinitis is one of the commonest chronic conditions seen in Indian OPDs — sneezing, watery rhinorrhoea, nasal obstruction and itching triggered by dust mites, pollen or seasonal change — and many patients seek homoeopathic care for it. Homoeopathic teaching hospitals record hundreds of such cases every year, but most case notes are unstructured, outcomes are described in words rather than scores, and the question of whether improvement can reasonably be attributed to the prescription is rarely examined systematically.

This project is an observational, prospective case series of twelve consecutive patients with allergic rhinitis in the OPD of a homoeopathic teaching hospital. The student does not select or change any remedy; prescriptions are made by the treating physician through individualised case-taking and repertorisation, as in routine practice. The student documents each case with a standardised case-record form, classifies severity using ARIA, and records outcomes with two validated tools — the Total Nasal Symptom Score (TNSS) and the Mini-RQLQ — at baseline, week 4 and week 8.

For each case, the Modified Naranjo Criteria for Homeopathy (MONARCH) is applied to score the likelihood that the observed change is attributable to the homoeopathic intervention, and the series is written up using the HOM-CASE extension of the CARE guidelines. The project trains the student in rigorous case documentation and in honest interpretation: a case series describes and generates hypotheses; it does not establish efficacy.

Abstract

A prospective observational case series of twelve consecutive adults with allergic rhinitis attending the OPD of a homoeopathic medical college hospital. Each case will be documented on a standardised case-record form capturing history, totality of symptoms, repertorisation, remedy, potency and repetition as prescribed by the treating physician, along with ARIA classification. TNSS and Mini-RQLQ will be recorded at baseline, four and eight weeks. MONARCH scores will be assigned to each case at eight weeks. Results will be summarised descriptively and reported using HOM-CASE guidance.

Introduction

Allergic rhinitis affects a large proportion of Indian adults, particularly in cities with high dust and pollen exposure, and considerably reduces sleep, work and school performance. Homoeopathic management is individualised: two patients with the same diagnosis may receive different remedies according to their totality of symptoms. This individualisation makes case documentation central to the discipline, and the Organon itself sets out detailed rules for case-taking.

Literature gap

Published homoeopathic case reports on allergic rhinitis are numerous but vary widely in quality. Many do not use validated outcome scales, and few assess causal attribution using a structured tool. MONARCH and HOM-CASE were developed precisely to improve this, but they are rarely used in undergraduate projects.

Proposed work

• Design a CRF integrating homoeopathic case-taking with ARIA classification and validated scales.
• Enrol consecutive eligible patients after IEC approval and written informed consent.
• Record outcomes at three visits without influencing prescribing.
• Apply MONARCH to each case and report as per HOM-CASE.

Feasibility

• Operational: the OPD sees allergic rhinitis cases daily; twelve can be enrolled within three weeks.
• Technical: TNSS and Mini-RQLQ take about ten minutes per visit.
• Economic: printing costs only.
• Ethical: IEC approval, written consent, confidentiality, and continuation of any conventional medicine the patient already takes.

Patients with allergic rhinitis form a large part of the OPD load in homoeopathic teaching hospitals, yet their cases are commonly documented in free-text notes without standard severity classification, without validated symptom or quality-of-life scores, and without any structured assessment of whether a change in symptoms can reasonably be linked to the prescription. As a result, the hospital's own clinical experience cannot be summarised, compared with the literature or used to design controlled studies.

Undergraduate BHMS students learn case-taking in detail but seldom practise prospective documentation with validated outcomes or tools such as MONARCH. There is a need for a standardised, ethically approved observational case series that documents allergic rhinitis patients under routine individualised homoeopathic care, measures outcomes with validated scales, scores causal attribution transparently, and reports the findings without overstating what a case series can show.

In scope

• Adults aged 18–55 with a clinical diagnosis of allergic rhinitis in the college hospital OPD.
• Documentation of individualised prescriptions made by treating physicians.
• TNSS, Mini-RQLQ and MONARCH over eight weeks.
• Descriptive and exploratory statistics.

Out of scope

• Selecting, changing or comparing remedies (no intervention by the student).
• Control group or randomisation.
• Laboratory allergy testing (IgE, skin-prick) beyond records already available.
• Children and patients with asthma exacerbations.

Study design: prospective, observational, single-centre case series.

Setting: Department of Practice of Medicine OPD, a homoeopathic medical college hospital (fictional: Dr Hahnemann Memorial Homoeopathic Medical College Hospital), under a faculty guide.

Sample size justification: as a descriptive series without hypothesis testing, no power calculation applies; twelve consecutive patients are feasible in the enrolment window, allow individual case summaries in the report and are sufficient to pilot the CRF.

Inclusion criteria: age 18–55, either sex; symptoms of allergic rhinitis (at least two of sneezing, rhinorrhoea, nasal obstruction, nasal itching) for ≥ 1 hour on most days; ARIA-classified intermittent or persistent disease; baseline TNSS ≥ 5; written informed consent.

Exclusion criteria: nasal polyps or marked septal deviation, acute sinusitis, asthma requiring rescue medication more than twice a week, systemic corticosteroids in the last four weeks, pregnancy or lactation, serious systemic illness.

Instruments: CRF (demographics, presenting complaints with location–sensation–modalities–concomitants, past and family history, physical generals, mental generals, totality, repertorisation summary, remedy, potency, repetition); ARIA classification; TNSS (0–12); Mini-RQLQ (14 items, 0–6); MONARCH (10 items; total −4 to +13).

Procedure: screen with the physician; consent; baseline CRF and scales; record prescription as made; follow-up at week 4 and week 8 (± 5 days); record any change in conventional medicines, aggravations and adverse events; apply MONARCH at week 8 for each case, independently by the student and the guide, and resolve differences by discussion.

Statistical analysis: SPSS/Excel; descriptive statistics; exploratory Wilcoxon signed-rank test for baseline vs week 8 TNSS and Mini-RQLQ, explicitly interpreted as non-causal; MONARCH scores summarised as median and categories.

Ethics: IEC approval before enrolment; written informed consent in the patient's preferred language; patients continue any conventional medicine already prescribed and are free to withdraw; confidentiality by study codes; conduct as per ICMR National Ethical Guidelines (2017).