Allergic Rhinitis Tocopherol Therapy

Six cases of allergic rhinitis in which dl-alpha tocopherol relieved the edema and exudation are presented. The edema and exudation returned when tocopherol was withdrawn; they disappeared again when the patients resumed taking tocopherol. DI-alpha-tocopherol acetate, the preparation used in this series, is an E vitamin. lt causes diuresis in certain cases of water retention.^1,2

How this tocopherol rids the body of edema and relieves allergic rhinitis is not known but several factors that influence its action can be described.

Factors Influencing Vitamin E Deficiency Edema

Soluble salts, histamine, cholesterol, unsaturated fats, and carbohydrate increase the edema of vitamin E deficiency.^3-6 Lipocaic, inositol, and ascorbic acid decrease this edema.^6-7

The following reports give the pharmacological actions of vitamin E and help to analyze the experimental work presented here.

Actions of Vitamin E

Vitamin E increases the effectiveness of vitamin A and increases the storage of this vitamin in the liver.^8-20

Vitamin E aids fat metabolism. It makes unsaturated fatty acids more effective in relieving dry skin that comes from a deficiency of these fats. This disease is similar to atopic eczema. Vitamin E protects unsaturated fats against destruction by oxidation.^22,23 Dam²⁴ believes that peroxidation of certain unsaturated fatty acids in the absence of vitamin E may be partly responsible for the associated sterility.

Vitamin E prevents excessive lipid accumulations in muscle and brain. It raises the ratio ol phospholipids to other lipid fractions in the blood.²⁶

E helps protein metabolism. It prolongs the lives of rats on a diet fatally low in protein.²⁷ It prevents stomach lesions resulting from diets deficient in several factors that interfere with protein metabolism.²⁸ It relieves cystine deficiency.²⁹

E controls excessive oxidation. It lowers the oxygen consumption of brain homogenates from animals deficient in vitamin E. It stops cytochrome-C from being reduced and thereby slows oxidation of proteins, carbohydrates, and fats.³⁰ This helps animals to survive anoxia that would kill them if they had less vitamin E.³¹

Vitamin A,³² unsaturated fats,²¹ and ferric chloride,³³ increases the requirement for vitamin E. It is not known if these substances destroy vitamin E, increase its excretion, or use it up in some reaction. But a high intake of A, unsaturated fats, or iron can cause a vitamin E deficiency.

Experimental Cases

All patients took a diet consisting of:

1. 4,500 calories for adults, 2,500 calories for children.
2. Calories distributed as follows: 30 to 40 per cent fat, little or no carbohydrate, balance in protein.
3. Soy-bean lecithin, one teaspoon with each meal.
4. B-complex vitamin concentrate derived from rice bran, one teaspoon daily.
5. Raw liver, one tablespoon daily.
6. Salt mixture, one to two teaspoons daily (50 per cent of the cations being sodium)

Case 1

On May 7, 1951 this 51-year-old white man had allergic rhinitis, rheumatoid arthritis, paradentosis, atherosclerosis and hypertension. He was sensitive to wheat flour and for 15 years had worked in a flour mill. All this time he had nasal congestion, coryza and sneezing.

June 11, 1951 he started to take 100 mg. tocopherol daily.

June 21, 1951 he noticed that coryza and sneezing had stopped and nasal congestion was gone for the first time in 15 years.

July 1, 1951 he noticed that pain was gone from left knee for the first time in many years.

July 23, 1951 he stopped taking tocopherol.

July 26, 1951 coryza began again and his nose became congested again. His left knee also hurt again.

August 6, 1954 he started to take 50 mg. tocopherol daily.

August 21, 1951, the nasal congestion reduced, but not as much as when he was taking 100 mg. tocopherol.

August 21, 1951, the daily dose of tocopherol was increased to 100 mg.

September 18, 1951, the nose is free from congestion and coryza, although he inhales wheat flour daily. Sneezing has stopped.

Case 2

On February 25, 1950 this 9-year-old white boy came to us suffering from continuous allergic rhinitis of 5½ years’ duration. He suffered from abdominal pain which we found by fluoroscopy to be the result of pylorospasm. The pain and gastric function responded to belladonna. He had hepatitis with hypercholesterolemia of 197 mg. (140 to 180 mg.% normal), icteric index of 9.6. His hemoglobin was 13 gm. The following notes show how his allergic rhinitis responded to tocopherol.

June 7, 1951 he started to take 50 mg. tocopherol daily.

June 21, 1951 he was breathing through nose more easily and sneezing less than at any time in the past 5 years.

July 5, 1951 he reported that formerly if he went out in the night air, he would sneeze all night. He was out last night, and he has not sneezed at all.

On July 5, 1951 he began taking an increased daily dose of tocopherol (100 mg.).

Nose was free from edema and exudation, on July 24, 1951, at which time he stopped taking tocopherol.

July 26, 1951 his nose had been congested, exudative and itchy since July 25, 1951.

July 26, 1951 he started to take 100 mg. daily.

August 4, 1951 his nose was free of edema, exudation and sneezing since the patient started to take tocopherol again. So we stopped tocopherol.

August 7, 1951, the nose was still clear.

August 7, 1951 he started to take 100 mg. tocopherol daily.

August 17, 1951, nose had been free from edema, exudation and sneezing, and he stopped taking tocopherol.

August 23, 1951 the nose of the patient has been congested since he stopped taking tocopherol. The patient wakes up at night crying because of difficult breathing. This was a usual occurrence before he started to take tocopherol. He slept well when he took tocopherol.

August 23, 1951 he started to take 100 mg. tocopherol daily.

September 6, 1951 his nose was still congested. The tocopherol was increased to 200 mg. daily.

October 8, 1951, nose is free from exudation, edema and sneezing. Still taking 200 mg. daily.

Case 3

This 51-year-old white woman came to us May 10, 1951 with a history of asthma, allergic rhinitis, and eczema of 40 years’ duration. Eosinophil count was 13 per cent and blood cholesterol 190 mg.% (140 to 180 mg.% normal). For the past three years she had also suffered from migraine. She had menopausal syndrome, and we gave her 0.3 mg. of diethylstilbestrol daily beginning on July 23, 1951. This relieved her menopausal hot flashes. Pyribenzamine^Ⓡ had given her temporary relief from nasal congestion. The following reports indicate how her allergic rhinitis re­sponded to tocopherol therapy:

August 9, 1951 she started to take 200 mg. tocopherol daily.

August 23, 1951, the nose was less edematous. She could breathe easily, but could not breathe through her nose when she was first examined here. She was not taking pyribenzamine.^Ⓡ

August 23, 1951 we increased tocopherol to 400 mg. daily.

The patient on August 27, 1951 got exhausted at a rodeo, and started wheezing. Her nose usually becomes congested under these circumstances so that she cannot breathe through it. Pyribenzamine^Ⓡ usually gives some relief. She took no pyribenzamine^Ⓡ this time: she continued with the tocopherol, Her nose stayed clear, and she was able to breathe even more easily than when she takes pyribenzamine.^Ⓡ

On September 7, 1951 she stopped taking tocopherol.

At her call September 21, 1951 she said her nose started to be congested one week ago. She cannot breathe through her nose now. The patient says the weather got warm a week ago and this usually makes her nose congested. Her nose is congested continuously now. On this date she started tocopherol 400 mg. daily.

October 19, 1951 it was found that the congestion disappeared from her nose a few days after she started tocopherol. She was able to breathe through her nose easily while she was taking tocopherol except on a few hot days when she had some congestion. She used up her supply of tocopherol one week ago, but her nose has stayed clear.

Case 4

On March 6, 1951 this 30-year-old white man came to us complaining ol epigastric pain. He had a history of allergic rhinitis of over ten years’ duration. He had also suffered from eczema on the arms and legs for several weeks. His allergic rhinitis was worse in the spring and fall; cold air made it worse. When we examined him, he sneezed continually.

August 6, 1951 he started to take 400 mg. tocopherol daily.

August 24, 1951 his nose had become less congested ten days after he started to take tocopherol. A few days ago he developed an upper respiratory infection and he had green pus exuding from his nose, The mucosa was inflamed but only slightly edematous. He breathed more easily through his nose now than before we started treating him with tocopherol. Penicillin was given.

September 17, 1951 the nasal discharge was clear in color and less in quantity. Congestion was disappearing.

October 15, 1951 the congestion was gone from his nose. He breathed freely through the nose. He reported he felt well. He stopped taking tocopherol.

The congestion was returning to the nasal mucosa on October 19, 1951.

On October 23, 1951 the nose was much more congested, and he couldn’t breathe through it. He started to take 200 mg. tocopherol daily. The next day the congestion was disappearing from his nose. sneezing.

October 25, 1951 his nose was free from congestion. No sneezing.

Case 5

On July 25, 1944 this 52-year-old white man had a history of allergic rhinitis of several years’ duration. He also suffered from shortness of breath on slight exertion. His nasal mucosa was pale and edematous, and he could not inhale air through his nose.

July 5, 1951 he started to take 200 mg. tocopherol daily.

He could breathe through his nose for the first time in years, according to his statement on July 13, 1951. No dyspnea was experienced on mild exertion for the first time in a long time.

July 27, 1951 the nasal congestion was gone; he was breathing well through the nose. On this date he stopped taking tocopherol.

August 17, 1951 he said his nose stayed free of congestion for two weeks. Then the patient developed nasal edema. He started to take 400 mg. tocopherol daily.

On October 10, 1951 the edema began to disappear from his nose two days after he began taking tocopherol. The nose has been getting gradually more clear every day. He now breathes easily through his nose.

Case 6

This 4-year-old white boy came to us February 21, 1951, with a history of allergic edema of the nose, mouth, and trachea since birth. He had also suffered from eczema during this time. We found his nasal mucosa to be edematous and pale and exudative. He could never breathe through his nose. His eczema was minimal at this time. His blood cholesterol level was 212 mg. per cent (normal 40 to 180), his eosinophil count was 22 per cent. His symptoms became worse if he ate certain foods or if he came in contact with wool. The following reports show how his allergic rhinitis responded to tocopherol therapy.

On August 4, 1951 he started to take 10 mg. tocopherol daily.

August 9, 1951 congestion was beginning to disappear from nose.

On September 8, 1951 congestion was gone from nose. He could breathe through his nose for the first time in his life. He stopped taking tocopherol.

September 21, 1951 the patient said the edema was gradually returning to the nose since he stopped taking tocopherol.

October 8, 1951 nasal congestion had grown severe. The patient could not breathe through his nose.

October 10, 1951 he started to take 100 mg. tocopherol daily.

On October 20, 1951 edema of nose had gradually subsided since he started taking tocopherol again, The breathing through his nose is better.

Discussion

We have observed that tocopherol relieved the edema, exudation, and sneezing of allergic rhinitis. However, tocopherol is not a specific cure for allergies. Although it has succeeded in all cases in which we used it to treat allergic rhinitis, it failed more than it succeeded when we used it in other allergies. At this time we can only consider vitamin E to be one of several factors that promote normal lipid and water metabolism.

We have observed diuresis in a few patients following tocopherol therapy, but it was not observed in the cases presented here.

The diet which these six patients followed was probably important in relieving their allergies. No attempt was made to avoid any allergens to which the patients were sensitive. But the diet contained several factors that aid lipid metabolism, namely, lecithin,^34-37 unsaturated fats,³⁸ B vitamins,^39-41 and protein.^29,42 The diet in itself could not relieve their allergies: the edema, exudation and sneezing returned when the patients stopped taking the tocopherol, although they continued the same diet. But the diet may have helped us to relieve allergic rhinitis with this tocopherol where Dam and Glaser failed.⁴³

Summary

1. Six patients who had suffered from allergic rhinitis for several years were selected. They all had continuous nasal edema and exudation with sneezing. None of them could breathe through the nose.
2. They took dl-alpha-tocopherol and found that the edema, exudation and sneezing disappeared; they were able to breathe through the nose.
3. They stopped taking tocopherol and their symptoms returned.
4. They resumed taking tocopherol and their symptoms disappeared again. Their symptoms did not come back while they continued taking the tocopherol.
5. These patients took a diet aimed to help fat and water metabolism. This probably helped the tocopherol to relieve the edema, exudation and sneezing.

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