Lecture IV

-Rhinitis Alergi-

dr. Lukman Rivai Sp.THT-KL

Tujuan

Mengetahui patofisiologi rhinitis alergi

Mengenali variasi gejala rhinitis alergi

Mampu memilih manajemen terbaik untuk

menangani rhinitis alergi

• Definisi dan Klasifikasi

Rinitis alergi: kelainan hidung karena proses inflamasi mukosa hidung yang di mediasi oleh hipersensitifitas tipe I, dgn gejala hidung gatal, bersin-bersin,rinore dan hidung tersumbat

PatofisiologiPatofisiologi

Cellular interactions pada Rhinitis alergi

ANAMNESIS

Anamnesis dimulai dengan pertanyaan yang meliputi gejala di hidung Gejala rinitis alergi yang perlu ditanyakan adalah : Bersin-bersin (lebih dari 5 kali setiap kali serangan) Rinore (ingus bening encer) Hidung tersumbat ( menetap/ berganti-ganti) Gatal di hidung, tenggorok, langit-langit atau telinga

Selain itu perlu ditanyakan : Frekuensi serangan, beratnya penyakit, lama sakit, intermiten atau persisten. . Manifestasi penyakit alergi lain sebelum atau bersamaan dengan timbulnya rinitis Riwayat atopi di keluarga Faktor pemicu timbulnya gejala rinitis alergi

Pemeriksaan penunjang : Tes alergi Naso endoskopi Pemeriksaan IgE spesifik

Metoda diagnostik Rinitis AlergiMetoda diagnostik Rinitis Alergi

History

Onset of symptomsInfant less than 3 years oldOlder child

SymptomsHeadache - OcularNasal - Oral○ Pruritis○ Sneezing○ Congestion○ Postnasal drip○ Rhinorrhea

History

FrequencyPerennial (cat, dog, dust mite, cockroach, molds)Seasonal (trees, grass, weeds)

SeveritySchool absenceLoss of smellBehavioral changesComorbid conditions

Physical Exam

• Eyes

• Ears

• Nose

• Oropharynx

• Lungs

Differential Diagnosis

• Upper respiratory infection

• Chronic sinusitis

• Anatomical nasal obstruction

– Concha bullosa - Nasal polyps

– Deviated nasal septum - Adenoidal hypertrophy

• GERD

Should you refer for skin testing?

YES Poor response to

therapeutic trial Drastic environmental

changes are considered

Strong desire for immunotherapy

NO• Hx suggestive for AR• Trial of appropriate

therapy successful• Symptoms mild and

easily managed• Mechanical,

anatomical, or infectious causes

Guideline Penatalaksanaan Rinitis Alergi dari ARIA WHO

Antihistamines

• 1st generation: Hydroxyzine (Atarax®)

Diphenhydramine

(Benadryl®) Chlorphenarimine

(CTM®)

• 2nd generation: Cetirizine (Zyrtec®)

Loratadine (Claritin®)

Fexofenadine (Allergra®)

Desloratadine (Clarinex®)

Nasal sprays

• Nasal steroids

• Cromolyn (Nasocrom®)

• Oxymetolazone (Afrin®)

• Nasal saline (Ocean®)

Nasal steroids

• Mometasone (Nasonex®)

• Fluticasone (Flonase®)

• Budesonide (Rhinocort®)

• Vancenase (Beclomethasone®)

• Flunisolide (Nasalide®)0

5

1 0

1 5

2 0

2 5

M o m e ta F lu tic B u d e s B e c lo F lu n iso l

% B io a va il

Immunotherapy

• Rise in IgG “blocking” antibodies

• Reserved for patients who find it difficult to avoid

allergens but do not respond adequately to

pharmacologic therapy

• Children > 7 years old

Allergist Referral

• Symptoms should exceed 6 weeks and present for at least 2 years in a row

• Inadequate relief after one month of continuous treatment

• Intolerable side effects• Complications of allergy• Patients moving into the area already on

immunotherapy

Terima KasihTerima Kasih