Running head: ALTERNATIVE MEDICINE FOR ALLERGIES AND RHINITIS IN ADULTS

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Alternative medicine for allergies and rhinitis in adults Bernice .J. Edwin Temple University

Author Note Bernice .J. Edwin, Department of Kinesiology, Temple University. Correspondence concerning this Alternative medicine for allergies and rhinitis for adults paper should be addressed to Bernice .J. Edwin, Department of Kinesiology, 1801 N. Broad Street, Philadelphia, PA- 19122. E-mail: tud45169@temple.edu

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Abstract The nose is one of the defensive organs of the body that helps in maintaining the homeostasis of the body. The nerves in the nasal mucosa and paranasal sinuses contribute to their function. If the nose or the sinuses gets disturbed, the nerve also gets affected thus affecting the nervous system. There is a serious of events that happen when the nasal mucosa encounters with an allergen. Certain symptoms of the allergic rhinitis are the self defense mechanism of the nose, but some are due to the interference in the nerves between the nervous system and the nose. Alternative medicine encompasses acupuncture, homeopathy, phytotherapy, chiropractic, and several others. They all help in restoring the balance in the body and the connection between the nervous system and the nose. By clearing out the disturbances in the body, the body can heal on its own through its healing power. The feedback from alternative treatment for allergic rhinitis is solely depended on the individual. Keywords: nasal mucosa, alternative medicine, nervous system, sinuses.

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Complementary treatments for Allergies and Rhinitis Rhinitis and rhinosinusitis happen due to two main reasons such hypersensitivity to certain substances or non- hypersensitivity route. There is a correlation between the nervous system and sinus problems related to allergy. The peripheral nervous system plays a major role in the wellness and function of the nasal mucosa and the paranasal sinuses. Rhinitis Rhinitis is defined as the inflammation of the nasal mucosa. Rhinosinusitis or Sinusitis is the inflammation of the sinuses of the nose (Volcheck, 2009). According to Volcheck (2009), “The term rhinosinusitis has been suggested to replace sinusitis because sinusitis is almost always accompanied by nasal airway inflammation. In addition, rhinitis and sinusitis frequently occur together, and the symptoms of nasal discharge and nasal obstruction are prominent in sinusitis” (Volcheck, 2009, p.117). The four paranasal sinuses are maxillary sinus, sphenoidal sinus, etmoidal sinus and frontal bone (Volcheck, 2009). According to Waugh and Grant (2001), “The paranasal sinuses are cavities in the bones of the face and the cranium which contain air (p. 241). Rhinitis is classified into four different categories such as allergic rhinitis, infectious rhinitis, non-allergic rhinitis and others (Scadding, 2009). The common symptoms of rhinitis are nasal running, itching, sneezing and blocking of the nose (Scadding, 2009). Allergic rhinitis. Allergic rhinitis is commonly known as hay fever. It consists of seasonal and perennial allergic rhinitis (Scadding, 2009). In this case when exposed to various foreign particles, the body develops hypersensitivity towards that foreign particle (Scadding, 2009). There is a

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production of Ig-E antibodies occur along with mast cell degranulation and inflammation (Scadding, 2009). According to Waugh and Grant (2001), “Irritation of the nasal mucosa results in sneezing, a reflex action that forcibly expels an irritant” (p. 242). Symptoms of allergic rhinitis include nasal blockage with decreased olfaction, hypersensitivity of mucosa and vasodilatation (Scadding, 2009). Non-allergic rhinitis. Non- allergic rhinitis with eosinophilia syndrome (NARES) is a common non-allergic rhinitis (Scadding, 2009). NARES is a type of rhinitis that is similar to perennial allergic rhinitis but without any known hypersensitivity to foreign particles (Scadding, 2009). There is no clear evidence of Ig E mediated inflammatory mechanism in a non-allergic rhinitis (Scadding, 2009). NARES is found to be the early stage of aspirin intolerance (Scadding, 2009). The symptoms of a non- allergic rhinitis include sneezing, itching, nasal blockage, rhinorrhea and occasional hyposmia (Scadding, 2009). Infectious rhinitis. An infectious rhinitis can be acute or chronic (specific and non-specific) (Scadding, 2009). The three major infective agents that cause rhinitis are virus, bacteria and fungi (Scadding, 2009). Virus such as rhinovirus, influenza virus and para influenza virus are the major cause of common cold causing edema of the nasal mucosa leading to sinusitis (Scadding, 2009). Acute bacterial infection cause nasal obstruction, facial pain, and crusting (Scadding, 2009). Fungi are found in noses from expired air (Scadding, 2009). Immunodeficient patients are prone to fungal infection that can cause rhinitis and sinusitis (Scadding, 2009). Others.

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The other types of rhinitis are as follows: occupational rhinitis which is caused by airborne agents, geriatric rhinitis which is prevalent in the elderly population, gustatory rhinitis which is caused by spicy food and preservatives, drug-induced rhinitis which is caused by betablockers drugs ,ACE inhibitors drugs and chloropromazine, hormonal rhinitis which is caused by increased levels of estrogen, atrophic rhinitis causes atrophy in the underlying bone of the turbinated and nasal mucosa, and idiopathic or vasomotor rhinitis which is caused by the nasal hyperresponsiveness to non specific stimulus (Scadding, 2009). Nervous System The nervous system is composed of a central nervous system and peripheral nervous system. The central nervous system includes the brain and the spinal cord. The brain includes the cerebrum, midbrain and cerebellum. The functions of cerebrum include sensory perception, mental activities, initiation and control of muscle work (Waugh &Grant, 2001). The brain stem helps in the coordination of skeletal muscle, coordination of the autonomic nervous system activity such as cardiovascular, respiratory and gastrointestional functioning and selective awareness (Waugh &Grant, 2001). Spinal cord is composed of the gray matter and white matter. Sensory nerve tract (afferent) and motor nerve tract (efferent) are the two ways of transmitting senses to the brain through the spinal cord (Waugh &Grant, 2001). Peripheral nervous system is composed of the spinal nerves, cranial nerves and the autonomic nervous system (Waugh &Grant, 2001). Spinal nerves The thirty pairs of spinal nerves includes eight cervical nerves, twelve thoracic nerves, five lumbar nerves, five sacral nerves and one coccygeal nerve (Waugh &Grant, 2001). These nerves are made up of both motor and sensory nerve united together (Waugh &Grant, 2001).

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Preganglionic fiber of the sympathetic nervous system of the autonomic nervous system is a major part of the spinal nerve (Waugh &Grant, 2001). The spinal nerve comes from both sides of the spinal cord and emerges through intervertebral foramen (Waugh &Grant, 2001). Anterior nerve root consists of motor nerve fibers and the posterior nerve consists of sensory nerve fibers (Waugh &Grant, 2001). After emerging from the intervertebral foramen each nerve divides into a ramus communians, which are part of the preganglionic neurons of the sympathetic nervous system (Waugh &Grant, 2001). The anterior rami provide communication to skin, muscles and posterior part of the head, neck and truck (Waugh &Grant, 2001). The posterior rami provide communication to the anterior and lateral part of the head, neck and truck (Waugh &Grant, 2001). The anterior ramus of the cervical, lumbar and sacral nerves unites and form plexuses (Waugh &Grant, 2001). The cervical nerve of the spinal cord supports the head and is known as the master controller of the nervous system (Waugh &Grant, 2001). This region plays a major role in the function of both nose and sinuses. Cranial nerves. There are twelve pairs of cranial nerves found on the inferior surface of the brain (Waugh &Grant, 2001). Each of the cranial nerve have a both a central and peripheral connection (Waugh &Grant, 2001). The olfactory nerve of the cranial nerve has a central connection at the temporal lobe of the cerebrum via olfactory bulb and a peripheral connection at the mucous membrane of the nose (Waugh &Grant, 2001). Autonomic nervous system. Autonomic nervous system is the involuntary part of the nervous system. The two divisions of the autonomic nervous system are the sympathetic and parasympathetic nervous system. Both the sympathetic and parasympathetic nervous system has two efferent neurons in

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their peripheral pathway between the central nervous system and the effector organs are the preganglonic and postganglonic neuron (Waugh &Grant, 2001). Cell body of the pre ganglonic is in the brain or spinal cord and their axon terminal synapses with cell body of the post ganglonic neuron which communicates with the effector organ (Waugh &Grant, 2001). The sympathetic nervous system prepares the body to get ready for a stressful situation while parasympathetic nervous system tends to slow the body down (Waugh &Grant, 2001). In the respiratory system, the sympathetic nervous system causes dilatation of the lungs, increase in respiratory rate and heart rate, increase in oxygen intake and carbon dioxide output and the parasympathetic nervous system causes constriction of the lungs (Waugh &Grant, 2001). Apart from the common allopathic medicine, rhinitis can be treated through alternative medicine (Resnick, Bielory,E, & Bielory,B., 2008). . According to Resnick et al., (2008), “CAM therapies are largely used to treat chronic diseases such as neuropsychiatric disorders (headache and depression); musculoskeletal disorders (arthritis, lower back pain); and allergies (allergic rhinoconjunctivitis, urticaria, and asthma) (p. 118). The alternative medicine includes acupuncture, homeopathy, chiropractic and various other non-allopathic therapies (Resnick et al., 2008). Besides the fact that there is a relationship between nervous system and rhinitis, rhinitis can be treated with alternative medicine. These alternative ways of treatment help in correcting any disturbances or interruptions in the connection between the nervous system and the nasal membrane. These alternative medicines can be helpful in making the nervous system clear from any interruptions with its communication with the nasal membrane and thus the nervous system can work at it normal optimal level. The alternative way of treatment promote the body to heal on its own using its healing power.

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Mechanism of Allergic Rhinitis. When the nasal mucosa is exposed to allergens or irritants, there is a serious of reactions that occur as an immune response to that allergen or irritant. As soon as the allergen attacks the nasal mucosa, there is an immediate response resulting in the production of Ig E and mast cell degranulation (*Baraniuk, 2001). These mast cell degranulation causes itching, sneezing, nasal discharge and mucosal swelling with increased nasal airways resistance (*Baraniuk, 2001). Histamine plays a prominent role in the immediate of phase of the mechanism of allergic rhinitis (*Baraniuk, 2001). The three receptors of histamine are responsible for the itching sensation, acid production in the stomach, vasodilatation, anaphylaxis, and causes reduction in neural activity (*Baraniuk, 2001).Followed by the immediate phase is the late phase, where infiltration of eosinophils, basophils, and TH 2 lymphocytes are recruited and activation of these cells along with other mediators occur during the last phase (*Baraniuk, 2001). When compared to the immediate phase, the activity of histamine is low in the late phase (*Baraniuk, 2001). Cytokines and other mediators are released from infiltrating eosinophils when exposed to chronic allergens (*Baraniuk, 2001). Inflammation develops after prolonged exposure to a particular allergen (*Baraniuk, 2001). Hyperresponsiveness is a characteristic of mucosal surfaces during inflammation and indicates an increased mucosal response to various irritants (*Baraniuk, 2001). ). Epithelial cells of the nasal mucosa get activated in the case of allergic rhinitis (*Baraniuk, 2001). These cells are regulated by the cytokines and eosinophils (*Baraniuk, 2001).

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Normal nasal mucosa (*Baraniuk, 2001, p.209). Nervous system and Rhinitis. Nerves in the nasal mucosa have neurotransmitters that contribute to the function of the nose (Canning, 2002). Dysfunction of the nerves in the upper airways contributes to the pathogenesis of rhinitis (Canning, 2002). According to Canning (2002), “Neuronal reflexes play a prominent role in the pathogenesis of allergic rhinitis and the response to mast-cell and basophil- derived mediators” (p. 210). Autonomic nerves of the nasal mucosa. Afferent autonomic nerves that innervate the nose are derived from the sympathetic and parasympathetic ganglia (Canning, 2002). These nerves are unmyleinated C- fibers, and they innervate the epithelium cells, blood vessels and glands of the nasal mucosa (Canning, 2002). The C-fibers can be antidromically stimulated which results in the release of inflammatory neuropeptides (Sarin, Undem, Sanico & Togias, 2002). The neurotransmitters released by the afferent nerves cause vasodilatation, plasma exudation, mucus secretion and inflammatory cell recruitment (Canning, 2002).

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Autonomic nerves secrete acetylcholine, nitric oxide, vasodilators and vasoconstrictors (Canning, 2002). Stimulation of the parasympathetic nerves of the nasal mucosa causes increase in mucus secretion and vasodilatation (Canning, 2002). The neurotransmitters released by the parasympathetic nerves are acetylcholine, vasoactive intestinal peptide, peptide histidine methionine and peptide histidine valine which causes glandular discharge, vasodilatation and sinusoida engorgement (Sarin et al., 2002). Stimulation of the sympathetic nerves of the nasal mucosa causes vasoconstriction and increased nasal airway patency (Sarin et al., 2002). The neurotransmitter released by the sympathetic nerves is the norepinephrine which causes vasoconstriction (Canning, 2002). Sensory nerves of the nasal mucosa According to Sarin et al., (2002), “The nose provides defensive and homeostatic functions requiring rapid responses to physical and chemical stimuli. As a result, it is armed with a complex nervous system that includes sensory, parasympathetic and sympathetic nerves (Sarin et al., 2002, p. 999). Symptoms of rhinitis are found to be caused due to the defensive mechanism of the nose, but some symptoms are caused by the nervous system (Sarin et al., 2002). The olfactory, ophthalmic and maxillary of the trigeminal nerve together make up the sensory nerves of the nose (Sarin et al., 2002). The ophthalmic division is composed of the lacrimal, frontal and nasociliary branches (Baraniuk, 2001). The lacrimal branch has the parasympathetic neurons of the lacrimal gland and the sympathetic neurons (Baraniuk, 2001). The frontal branch becomes the supraorbital nerve innervating the upper eyelid, frontal sinus mucosa and anterior scalp (Baraniuk, 2001). The maxillary division is completely sensory that divides into the infraorbital branch innervating the lower eyelid, frontal, ethmoid and sphenoid sinus mucosae and lateral facial skin (Baraniuk, 2001).

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The cell bodies of the sensory nerves of the nose are located in the trigeminal ganglion of the sympathetic and parasympathetic nervous system (Sarin et al., 2002). The neuropeptides of the sensory nerves are tachykinis and calcitonin, when released causes neurogenic inflammation which includes vasodilatation and increased vascular permeability (Sarin et al., 2002). These neuropeptides also cause glandular activation, cyte recruitment and activation of lymphocytes, eosinophils, mast cells and macrophages (Sarin et al., 2002). Autonomic nervous system and allergic rhinitis A study conducted by Ishman, Martin, Hambrook, Smith, Jaradeh and Loehrl (2007) found that there is a relationship between the autonomic nervous system and allergic rhinitis. There were two groups of people one being the control group and the others were patients with allergic rhinitis (Ishman, Martin, Hambrook, Smith, Jaradeh & Loehrl, 2007). There were 10 patients with allergic rhinitis, eight of which were women and the other two were men of ages ranging from 21 to 45 years (Ishman et al., 2007). The control group consisted of twelve females and four male of ages ranging from 18 to 45 (Ishman et al., 2007). According to Ishman et al., (2007), “An imbalance in the sinonasal cavity input levels from the PNS and SNS is thought to play a role in the inflammatory nasal and sinus disorder (Ishman et al., 2007, p. 56). It was found that autonomic nervous system is a contributor to the pathogenesis of allergic disorders (Ishman et al., 2007). It was also reported that the sympathetic nervous system causes vasoconstriction of the nasal mucosa and the parasympathetic nervous system causes vasodilatation of the nasal mucosa (Ishman et al., 2007). Ishman et al., (2007), “ANS dysfunction, specifically sympathetic hypofunction, was identified in all of the allergic rhinitis patients studied (Ishman et al., 2007, p.55). Alternative Medicine

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According to Resnick et al.,(2008), “The term complementary/ alternative medicine (CAM) refers to those therapeutic and diagnostic approaches different from conventional allopathic medicine” (p. 118). Nearly 50% of Americans with asthma and rhinosinusitis have used alternative medicine to help them combat their illness (Resnick et al.,2008). Acupuncture In acupuncture needles are inserted at points on the skin stimulating specific sites of the body which help restore the balance in the vital flows (Resnick et al.,2008). Acupuncture is found to improve circulation through autonomic nervous system (Bettschart et al., 1998). Acupuncture can be referred to as neuromodulation performed with needles, which means stimulation of the nervous system with neddles to affect or restore the functioning of the nervous system (Dung, Clogston & Dunn, 2004). The exact points where these needles are inserted are called acupoints (Dung et al., 2004). Acupoints run over the sensory nerves of the peripheral nervous system (Dung et al., 2004). The type of stimulus used to effect acupuncture treatment is determined by the individual (Bettschart, Glaeske, Langbein, Saller and Skalnik, 1998). If excess which means feel fullness, hotness or have blockage, then a strong stimulus is used where it is inserted slowly and withdrawn quickly by drawing out the excess (Bettschart et al., 1998). This gives a soothing and cooling effect (Bettschart et al., 1998). If deficit which means feel emptiness, coldness or fragility, then a warm stimulus is used where it is inserted quickly and withdrawn slowly by imparting fullness (Dung et al., 2004). The numbers of treatments vary according to the degree of the disorder. For an acute disorder, an average of 5 to 10 treatments while for a chronic disorder, an average of 15 to 20 treatments (Bettschart et al.,1998). Unsterilized neddles,

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careless insertion and desertion of neddles and improper technique can cause side effects in an acupuncture treatment (Bettschart et al.,1998). Types and variants of acupuncture. There are two types of acupuncture namely the TSM style acupuncture and Western acupuncture. The TSM style acupuncture believes that illness is considered as a discrete process which can be influenced by encouraging the body to heal itself (Bettschart et al.,1998). The western acupuncture is a blend between Chinese and techniques developed for western patients (Bettschart et al.,1998). The acupuncture concepts and techniques along with the notions of disease and diagnosis accepted in modern medicine makes up the western acupuncture (Bettschart et al.,1998). The different variants of acupuncture are moxibustion, ear acupuncture, electroacupuncture, transcutaneous electric nerve stimulation (TENS) and injection acupuncture (Bettschart et al.,1998). Moxibustion is a combination of heat and aromatic substances applied to specific areas (Bettschart et al.,1998). It penetrates deep into the body and produces refreshing and warming effect (Bettschart et al.,1998). It is used to treat bronchioles and bronchial asthma (Bettschart et al.,1998). Ear acupuncture is beneficial in the treatment of psychological problems and addictions (Bettschart et al.,1998). Electroacupuncture is where a very small current is given through a electrical device to help point stimulation through needle and is used to treat chronic pain (Bettschart et al.,1998). In TENS a very small amount of currents are given to the patients (Bettschart et al.,1998). Injection acupuncture uses products from local anesthetics to patient’s own urine which is injected into the acupuncture points to modulate the immune system and lessen the pain (Bettschart et al.,1998). Acupuncture for allergies and sinus problems.

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Acupuncture treatment of sinus allergy involves 5 cranial nerves (Dung et al., 2004). According to Dung et al., (2004), “Another important application of acupuncture in the face and head is the treatment of sinus allergy and asthma; this gratifying successfully in approximately 75% of patients regardless of pain sensitivity level (p.88). Parasympathetic fibers from the superior salivatory nucleus of the brain regulates the secretion of the sinus cavity (Dung et al., 2004). Patient’s response to treatment does not depend on the pain-sensitivity level (Dung et al., 2004). The basic rule of acupuncture is that the sensitive areas of the body such as the face, hands and feet must be needled last (Dung et al., 2004). Supraorbital, infraorbital and mental points are the paranasal points and when needles are inserted into these points, it causes an effect on the post ganglonic parasympathetic fibers (Dung et al., 2004). These paranasal points are sensitive to needles and have to be handled carefully (Dung et al., 2004). Paravertebral points are inserted with needles when the patient is in prone position (Dung et al., 2004). The primary points are the acupoints from the maxillary division which includes the infraorbital, zygomaticofacial, zygomaticotemporal and paranasal (Dung et al., 2004). The interconnection between the maxillary division and the parasympathetic nervous system is the reason for the success in controlling sinus allergy by stimulating the acupoints of the face and nose and thus control the secretion in the nasal cavity and sinuses (Dung et al., 2004). The regular first three acupuncture treatments are as follows: During the first treatment, needles are inserted into primary points in a supine position (Dung et al., 2004). At the second treatment, needles are inserted into both primary points and Paravertebral points in a prone position (Dung et al., 2004). And finally during the third treatment, needles are inserted into accessible primary and secondary plus couple of other points such as bregma and plerion in

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a sitting position (Dung et al., 2004). When patients continue to have symptoms or develop other symptoms, treatments are extended and the accupoints are dependent on the symptoms of the patient It was found that sinusitis can be treated in 3 to 6 sessions where the effect of the treatment can last for few years. The treatment sessions can increase depending on the individual if he/she has hyperresponsiveness to more than one allergen (Dung et al., 2004). Response to an acupuncture treatment is dependent on each individual, where in some people will require 1 or 2 additional treatments along with acupuncture and some others will feel better with just the acupuncture treatment (Dung et al., 2004).

Pterion and Bregma points. (Dung et al., 2004, p.89)

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Paranasal points.(Dung et al., 2004 p.91)

Mental point. (Dung et al., 2004, p. 93)

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Homeopathy The word homeopathy is derived from the Greek words homeo which means like and pathos which means suffering (Bettschart et. al., 1998). Homeopathy believes in treating the symptoms by using the substances that caused it (Resnick et al., 2008). Before being used for treatment, these substances are ultra- diluted and potentiated with proper manipulation (Resnick et al., 2008). The homeopathic preparation determines its form of administration namely the high potency ones are given in the form of small sugar pills or globuli and the low potency ones are administered as tablets (Bettschart et al., 1998). Homeopathy concentrates on helping the body to realize its potential to heal on its own (Bettschart et al., 1998). Before finding the best remedy, the patient will be treated for several times. The sign of initial aggravation indicates the right preparation for the patient (Bettschart et al., 1998). The substances used in homeopathic remedy can sometimes trigger allergies and cause intoxication (Bettschart et al., 1998). Treatment depends on the disease, form of treatment, remedy potency and person’s efficacy to treatment which can take months and even years (Bettschart et al., 1998). The variants of homeopathy. The four variants of homeopathy are organotrophic and functiotropic, nosodes, homotoxicology and spagyric (Bettschart et al., 1998). In organotrophic and functiotrophic homeopathy, treatment is selected according to patient’s symptoms (Bettschart et al., 1998). Organotrophic means directed toward specific organ or organ system, and functiotrophic means directed toward a functional system (Bettschart et al., 1998). Nosodes encourages the body’s defense system to heal any disease and clear out the poisons (Bettschart et al., 1998). A nasode is referred to the product of the disease used to treat which can include blood, pus, pathogenic organism or cancer cells (Bettschart et al., 1998).

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Homotoxicology believe that disease is the sign that the body is protecting itself from both exogenous and endogenous poisons (Bettschart et al., 1998). Diseases develop in a six stage of process and reversal can occur at all the stages except the 6th stage (Bettschart et al., 1998). Spagyric is the combination of homeopathic principles and vital energy released by humans (Bettschart et al., 1998). This encourages the body to use its power of self-healing and eliminate harmful substances (Bettschart et al., 1998). Homeopathy remedy for allergies and sinus problem According to Bettschart et al., (1998), “Homeopathic remedies are more frequently given in chronic diseases, lowered resistance, allergies and psychomotor disorders (p. 835). According to a study conducted patients with allergic rhinitis who chose homeopathic reported greater improvements in their overall health when compared to patients who chose other treatments (Resnick et al., 2008). Studies have also found that homeopathic grass, trees, weeds mix, 30 ml dilution of grass pollen and 30 ml dilution of allergens showed a significant improvement in symptoms of allergic rhinitis (Resnick et al., 2008). Phytotherapy Phytotherapy is commonly known as the herbal remedy or medical herbalism (Bettschart et al., 1998). Phytotherapy is the use of plants or certain parts of it such as barks, roots, seeds, flowers, leaves and fruits for remedy purposes (Bettschart et al., 1998). Chinese, Japanese and Ayurvedic medicines use herbs in fixed mixtures to treat allergic rhinitis (Resnick et al., 2008). Bettschart et al., (1998), says “More than three-quarters of the world’s population uses herbal remedies as a significant or exclusive way of treating disease” (Bettschart et al., 1998, p.854). Facts about Phytotherapy.

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The important principle of medical herbalism is synergism which means the strength of the herbal remedy is greater than the strength of its individual parts (Bettschart et al., 1998). Phytotherapist believe that each element plays a role in the body besides the active ingredient, and also working in combination reduces the harmful side effect (Bettschart et al., 1998). From animal experiments, it was found that some elements of plants regulate blood pressure, lower cholesterol levels, and stimulate immune system, while some others give antiinflammatory, anti-bacterial and anti-cancerous effect (Bettschart et al., 1998). Herbal remedies are used on its own to treat a disease or at times it is used along with other naturopathic techniques (Bettschart et al., 1998). Side effects are possible when handmade mixtures are used or when herbs are used in combination with other alternative therapies (Resnick et al., 2008). Side effects can occur due to over dosage or when used without the guidance of a phytotherapist (Bettschart et al., 1998). Certain plants such as golden seal, juniper, marjoram, mugwort, pennyroyal, pokeroot and sage must be avoided by women who are pregnant or breastfeeding (Bettschart et al., 1998). Duration of the treatment depends on the type of disease and the benefits that are attained from the treatment (Bettschart et al., 1998). Phytotherapy for allergic rhinitis. A mixture of 18 traditional Chinese herbs known as RCM 101 was found to have improved the quality of life and caused changes in various actions of the inflammatory mediators (Resnick et al., 2008). Studies have found that RCM 101 has inhibited the synthesis and release of histamine, leukotriene B4 and prostaglandin E2 which plays a role in allergic rhinitis (Resnick et al., 2008). Bimmine, an herbal remedy in a tablet form seemed to have reduced the sneezing in allergic rhinitis patients (Resnick et al., 2008). Urtica dioica, an ingredient of homeopathic had showed significant improvements in the symptoms of allergic rhinitis (Resnick et al., 2008).

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Lycopus lucidus has both anti-oxidative and anti-inflammatory effects (Resnick et al., 2008). They cause an inhibition of mast cell mediated immediate phase and down regulation of cytokines (Resnick et al., 2008). Shu-bi-lin, a six herb Chinese herbal remedy when compared to anti-histamines had significantly causes a decrease in sneezing and nasal scratching (Resnick et al., 2008). When tested on animals, shu-bu-lin was found to decrease eosinophils infiltration and endothelial nitric oxide synthase activity (Resnick et al., 2008). Petasites hybridus commonly known as the butterbur is a shrub found in Europe, parts of Asia and North America (Resnick et al., 2008). Petasins from butterbur was used to treat asthma and allergic rhinitis (Resnick et al., 2008). About 90% of the patients who used butterbur have showed improvement in the symptoms of allergic rhinitis (Resnick et al., 2008). Spirulina from Arthrospira platensis which is found in fresh and salt water is used as a protein food (Resnick et al., 2008). Spirulina was found to inhibit histamine release and other inflammatory mediators (Resnick et al., 2008). A study showed that spirulina users had a significant drop in their interleukotriene 4 (an inflammatory mediator) levels (Resnick et al., 2008). Because of the lack of knowledge about the mechanism of herbal remedy, there is a possibility of an existence of drug-interaction between traditional and conventional medicine when used simultaneously (Resnick et al., 2008). Glycyrrhizin, a chinese herbal medicine for allergic rhinitis was found to interact with angiotension-converting enzyme inhibitors and pseudoaldosteronism (Resnick et al., 2008). Herbs and herbal mixtures seem to have impact on cytochrome P 450 enzymes (CYP) (Resnick et al., 2008). Sho-seiryo-to, a Japanese 8- herb medicine which is used to treat allergic rhinitis had a minimal effect on CYP enzymes and many others. Chiropractic care

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The purpose of a chiropractic care is to correct any nerve interference which is also referred to as subluxation (Rodberg. 1998). These nerve interference causes sickness and disease by weakening the immune system (Rodberg. 1998). The spinal column has 24 small bones called the vertebrae which includes 7 cervical, 12 thoracic and 5 lumbar vertebrae (Rodberg. 1998). Misalignment of the vertebrae interrupts the communication between the nervous system and the other parts of the body (Rodberg. 1998). According to Rondberg (1998), “…that disease is a lack of comfort, a loss of harmony in the system” (p.22). Nerve interference is known as the silent killer because the onset of symptoms does not mark the beginning of the nerve interference which means that the symptoms do not show up for years after the actual start of the nerve interference (Rodberg. 1998). Innate Intelligence Chiropractors believe that people are born with an Innate Intelligence that controls and runs the body properly when regularly fueled and maintained (Rodberg. 1998). These misalignments can interrupt the instructions sent by the Innate Intelligence to the cells of the body, thus causing dis-ease (Rodberg. 1998). Chiropractors believe in correcting any disturbances of the body and allow them to heal on their own by using their own healing wisdom and power (Rodberg. 1998). According to Palmer, “Chiropractors adjust subluxations, relieving pressure from the nerves so that they can perform their functions in a normal manner. The innate can and will do the rest (Rodberg. 1998, p. 33). The Innate Intelligence sends messages to the cells of the body via nerves directing them to perform their functions. These nerves can run into interference at any point down, but most of it occurs at the spinal column which is considered as the headquarters of the nervous system (Rodberg. 1998). Misalignment of the vertebrae causes the nerves projecting from it to be disturbed causing discomfort.

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Cervical nerves Cervical nerves play a role in the function of the sinuses and the nose. The cervical nerves are the main nerves used by the nervous system to communicate with the sinuses and nose. These five cervical nerves project out from the five cervical vertebrae of the spinal column. Any misalignment in these vertebrae can cause nerve interference in the cervical nerves. When these nerves are disturbed, they can cause sinus problems and allergies.

(http://www.beamsvillechiropractic.com/spinal.html) Chirotherapy for allergies and rhinitis.

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Chirotherapy is a manual therapy involving the adjustment of misaligned vertebrae to reduce pain, relax muscles, and mobilize joints (Bettschart et al., 1998). Chiropractors use their hands to adjust misaligned vertebrae and joints back to their place thus removing the cause of the muscle spasm and nerve irritation (Bettschart et al., 1998). Improper use of techniques can result in fractured bones or injured blood vessels (Bettschart et al., 1998). A recommended duration of chirotherapy is five to ten sessions (Bettschart et al., 1998). Others Neural therapy is a therapy used widely in Germany, in which anesthetic injections are given to various sites such as nerves, acupuncture points, glands, scars and trigger points (Cassileth, 1998). The trigger points are the points that produce a sharp pain when pressed (Cassileth, 1998). These injections are found to remove blockages, interference fields thus restoring the electrical conductivity throughout the body and enabling healing to occur (Cassileth, 1998). Neural therapists believe that the interruptions in the body’s electrical system is the cause for illness, and so these injections clears the communication disturbances and hence restoring health (Cassileth, 1998). Antioxidants are things that counteract with the oxidants. The oxidative stress is an imbalance between reactive oxygen species and is caused by environmental factors and inflammation (Resnick, 2008). It plays a role in the development and exacerbation of allergic diseases such as allergic rhinitis (Resnick, 2008). Vitamin E, an antioxidant plays a role in the reducing oxidative damage (Resnick, 2008). A study found that vitamin E helps in lowering Ig E levels and frequency of allergen stimulation (Resnick, 2008). Studies show that rosmarinic acid was found to decrease symptoms of allergic rhinoconjuctivitis, decrease number of neutrophils and eosinophils in the nasal fluid and decrease the production of reactive oxygen radical

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(Resnick, 2008). Rosmarinic acid has an anti-inflammatory and antioxidant effects (Resnick, 2008). Aller-7/NR-A2, a seven herbal medicine was found to reduce the symptoms of allergic rhinitis acting in an anti-inflammatory and antioxidant pathways (Resnick, 2008). Kebimin, a Chinese medicine when tested on rats showed a significant alternation in nasal mucosa, decreased serum levels of Ig E and circulation cytokines (Resnick, 2008). Quercetin is found in vegetable, fruits and herbs and is a flavonoid agylcone of rutin. (Resnick, 2008). It has an anti-inflammatory and antioxidant effects (Resnick, 2008). It was found to inhibit inflammatory process by stabilizing the activated neutrophils and inhibiting hyaluronidase, which prevents breakdown of collagen matrix proteins (Resnick, 2008). These function help quercetin to prevent degranulation of the mast cell and the basophil, secretion of neutrophil lysosomal enzyme and production of leukotriene (Resnick, 2008). A study had found that quercetin inhibit antigen-stimulated histamine release (Resnick, 2008). Artemisia abrotaum L. which contains quercetin was found to produce relief when compared to antihistamine nasal spray (Resnick, 2008). There are several other alternative medicines used to treat allergies and rhinitis such as enzyme therapy, nutritional therapy, physical therapy, reflex therapy, probiotics, cell therapy, eliminative methods, flower remedies, bioresonance therapy, acupressure and aromatherapy (Bettschart et al., 1998). These therapies and remedies have shown very low success rate (Bettschart et al., 1998). Conclusion The nose is the organ that is constantly exposed to both physical and chemical stimulus and it rapidly fights to defend and maintain the homeostasis of the body. The symptoms of allergic rhinitis are mostly the defensive mechanism of the nose and some are due to the

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disturbances in the nervous system. The relationship between the nervous system and allergic rhinitis creates the pathway for these alternative medicines. The body can properly function when they are nurtured and maintained properly. Most of the alternative medicines work on treating the disturbances in the natural body and interruptions in the communication between the nervous system and the cells of the body. Alternative medicines aim in correcting the disturbances and let the body heal with its own healing power. These natural alternative way of treating allergies and rhinitis can help people from getting affected by the side effects of the allopathic way of treating allergies and rhinitis. Even though there is few side effects involved in the alternative medicine, there are mostly due to improve use of techniques. It is important to note that the alternative medicine may not work for all people. For instance some people might respond to acupuncture better than homeopathy. Thus the type of alternative medicine used to treat allergies and rhinitis depends solely on each individual. The alternative medicine could be a way for adults who want to treat their allergies and rhinitis in a non allopathic way. As a conclusion, the alternative medicine can help treat adults who are suffering from allergies and rhinitis with less or no side effects.

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References
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Baraniuk, J.N. (2001). Mechanisms of Allergic Rhinitis. Current allergy and asthma reports 1, 207-217. doi: 10.1007/s11882-001-0007-5

Baraniuk, J.N. (2001). Neurogenic mechanisms in rhinosinusitis. Current allergy and asthma reports 1, 252-261. doi: 10.1007/s11882-001-0016-4 Bettschart, R., Glaeske, G.,Langbein, K., Saller, R., & Skalnik, C. (1998). The complete book of symptoms & treatments: Your comprehensive guide to the safety and effectiveness of alternative and complementary medicine for common ailments. Ernest, E. (Ed.). Boston, MA: Element books. Canning, B.J. (2002). Neurology of Allergic Inflammation and Rhinitis. Current allergy and asthma reports 2, 210-215. doi: 10.1007/s11882-002-0021-2 Cassileth, B. R. (1998). Neural therapy. The alternative medicine handbook: The complete reference guide to alternative and complementary therapies. New York, NY: W.W. Norton & Company. Dung, H., Clogston. C.P., & Dunn, J.W. (2004). Conditions of the face and head. Acupuncture: An anatomical approach. Boca Raton, FL: CRC press. Resnick, E.S., Bielory, B.P., & Bielory, L. (2008). Complementary Therapy in Allergic Rhinitis. Current allergy and asthma reports. 8, 118-125. doi: 10.1007/s11882-008-0021-y Rondberg, T.A. (1998). Chiropractic first: The fastest growing healthcare choice…before drugs and surgery. The chiropractic journal. Sarin, S., Undem, B., Sanico, A., & Togias, A. (November 2006). The role of the nervous system in rhinitis. Journal of allergy and clinical immunology 118 (5). doi: 10.1016/j.jaci.2006.09.013

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Scadding, G.K.(2009). Non allergic rhinitis. Allergy frontiers: Clinical manifestations. Pawankar, R., et.al. (Eds). doi: 10.1007/978-4-431-88317-3_3 Waugh, A., & Grant, A. (2001). The nervous system. Anatomy and physiology in health and illness. Ross & Wilson, (Eds.). London, UK: Churchill Livingstone. (2005). Spinal nerve/ condition chart. Beaavillechiropractic.com. Retrieved from http://www.beamsvillechiropractic.com/spinal.html