imunologi pada rhinitis alergi

7/25/2019 imunologi pada rhinitis alergi

1/24

Rhinitis Alergik

TUGAS IMMUNOBIOLOGI

Prof. Dr. YOES PRIJATNA DACHLAN, dr, M.SC

Disusun oleh:

A.ZAKARIA AMIEN: 09152435300

!R"#RAM $%&DI $2 IM&N"'"#I

!A$(A$AR)ANA &NI*ER$I%A$ AIR'AN##A

$&RA+A,A

201


2/24

+A+ I

!ENDA-&'&AN

1.1 'tr +elkng

Rinitis didefinisi!n se"!#!i $er!d!n#!n d!ri %e%"r!n &id'n#

(!n# dit!nd!i den#!n #e)!*! o%$*es (!n# terdiri d!ri o%"in!si "e"er!$!

#e)!*! "eri't + "ersin, &id'n# ters'%"!t, &id'n# #!t!* d!n rinore. M!t!,

te*in#!, sin's d!n ten##oro!n )'#! d!$!t ter*i"!t. Rinitis !*er#i %er'$!!n

$en(e"!" terserin# d!ri rinitis.

Rinitis !*er#i !d!*!& $er!d!n#!n $!d! %e%"r!n %'os! &id'n#,

re!si $er!d!n#!n (!n# di$er!nt!r!i I#E, dit!nd!i den#!n o"str'si &id'n#,

seret &id'n# !ir, "ersin-"ersin, d!n #!t!* $!d! &id'n# d!n %!t!. Rinitis

!*er#i %e!i*i $er%!s!*!&!n ese&!t!n d'ni! %en#en!i seit!r /0 1 234

$o$'*!si d'ni!, den#!n $enin#!t!n $re5!*ensi se*!%! de!de ter!&ir.

Rinitis !*er#i %er'$!!n ondisi roni terserin# $!d! !n! d!n

di$erir!!n %e%$en#!r'&i 604 !n!-!n!. Se"!#!i onse'ensin(!,

rinitis !*er#i "er$en#!r'& $!d! '!*it!s &id'$, "ers!%!-s!%! den#!n

o%or"idit!s "er!#!% d!n $erti%"!n#!n "e"!n sosi!*-eono%i, rinitis

!*er#i di!n##!$ se"!#!i #!n##'!n $ern!f!s!n 't!%!. Tin#!t e$!r!&!n

rinitis !*er#i di*!sifi!si!n "erd!s!r!n $en#!r'& $en(!it ter&!d!$

'!*it!s &id'$ seseor!n#. Di!#nosis rinitis !*er#i %e*i"!t!n !n!%nes! d!n

$e%eris!!n *inis (!n# er%!t, *o!* d!n siste%i &'s'sn(! s!*'r!n n!f!s

"!!&.


3/24

1.2 Ru/usn Mslh

/.2./ B!#!i%!n! definisi r&initis !*er#i 7

/.2.2 B!#!i%!n! etio*o#i r&initis !*er#i 7

/.2.8 B!#!i%!n! *!sifi!si r&initis !*er#i 7

/.2.6 B!#!i%!n! P!tofisio*o#i r&initis !*er#i 7

/.2.3 B!#!i%!n! M!nifest!si r&initis !*er#i 7

/.2.9 B!#!i%!n! insiden r&initis !*er#i ter)!di 7

/.2.: B!#!i%!n! e5!*'!si di!#nosti rinitis7

/.2.; B!#!i%!n! $en!t!*!s!n!!n r&initis !*er#i 7

/.2.< B!#!i%!n! o%$*i!si r&initis !*er#i 7

/.8 T')'!n

/.8./ T')'!n U%'%

Unt' %en#et!&'i r&initis !*er#i

/.8.2 T')'!n =&'s's

!. Unt' %en#et!&'i definisi r&initis !*er#i

". Unt' %en#et!&'i etio*o#i r&initis !*er#i

. Unt' %en#et!&'i *!sifi!si r&initis !*er#i

d. Unt' %en#et!&'i $!tofisio*o#i r&initis !*er#i


4/24

e. Unt' %en#et!&'i %!nifest!si r&initis !*er#i

f. Unt' %en#et!&'i insiden r&initis !*er#i ter)!di

#. Unt' %en#et!&'i e5!*'!si di!#nosti !*er#i rinitis

&. Unt' %en#et!&'i $en!t!*!s!n!!n r&initis !*er#i

i. Unt' %en#et!&'i o%$*i!si r&initis !*er#i

). Unt' %en#et!&'i !s'&!n e$er!!t!n $!d! $!sien r&initis !*er#i


5/24

+A+ II

!EM+A-A$AN

2.1 Deinisi Rhinitis Alergi

R&initis !*er#i %er'$!!n "ent' !*er#i res$ir!tori's (!n# $!*in#

serin# dite%'!n d!n di$erir!!n di!nt!r!i o*e& re!si i%'no*o#i e$!t

>&i$ersensiti5e I?. R&initis !d!*!& s'!t' inf*!%!si > $er!d!n#!n ? $!d!

%e%"r!n %'os! di &id'n#. >Di$iro, 2003 ?. R&initis !d!*!& $er!d!n#!n

se*!$'t *endir &id'n#. > Dor*!nd, 2002 ?

Sed!n#!n %en'r't @HO ARIA 200/!d!*!& e*!in!n $!d! &id'n#

den#!n #e)!*! "ersin-"ersin, r&inore, r!s! #!t!*, d!n ters'%"!t sete*!& %'os!

&id'n# ter$!$!r !*er#en (!n# di$er!nt!ri o*e& I#E.

2.2 Etiologi

2.2./ Rinitis A*er#i

Rinitis !*er#i d!n !to$i se!r! '%'% dise"!"!n o*e& inter!si d!ri

$!sien (!n# se!r! #eneti %e%i*ii $otensi !*er#i den#!n *in#'n#!n.

Geneti se!r! )e*!s %e%i*ii $er!n $entin#. P!d! 20 1 80 4 se%'! $o$'*!si

d!n $!d! /0 1 /3 4 !n! se%'!n(! !to$i. A$!"i*! ed'! or!n# t'! !to$i,

%!! risio !to$i %en)!di 6 !*i *e"i& "es!r !t!' %en!$!i 30 4. Per!n

*in#'n#!n d!*!% d!*!% rinitis !*er#i (!it' !*er#en, (!n# terd!$!t di se*'r'&

*in#'n#!n, ter$!$!r d!n %er!n#s!n# res$on i%'n (!n# se!r! #eneti te*!&

%e%i*ii eender'n#!n !*er#i.


6/24

Ad!$'n !*er#en (!n# "i!s! di)'%$!i "er'$! !*er#en in&!*!n (!n#

%!s' "ers!%! 'd!r! $ern!$!s!n (!it' de"' r'%!&, t'n#!', otor!n

ser!n##!, 't' "in!t!n#, )!%'r, ser"' s!ri, d!n *!in-*!in.

R&initis !*er#i !d!*!& $en(!it $er!d!n#!n (!n# di!!*i o*e& d'!

t!&!$ sensitis!si (!n# dii'ti o*e& re!si !*er#i. Re!si !*er#i terdiri d!ri d'!

f!se (!it' +

I%%edi!te P&!se A**er#i Re!tion, Ber*!n#s'n# se)! ont!

den#!n !**er#en &in##! / )!% sete*!&n(! L!te P&!se A**er#i Re!tion,

Re!si (!n# "er*!n#s'n# $!d! d'! &in##! e%$!t )!% den#!n $'n! 9-; )!%

sete*!& $e%!$!r!n d!n d!$!t "er*!n#s'n# &in##! 26 )!%.

!. Berd!s!r!n !r! %!s'n(! !**er#en di"!#i !t!s +

/? A*er#en In&!*!n, (!n# %!s' "ers!%! den#!n 'd!r! $ern!f!s!n,

%is!*n(! de"' r'%!&, t'n#!', ser$i&!n e$ite* d!ri "'*' "in!t!n# sert!

)!%'r.

2? A*er#en In#est!n, (!n# %!s' e s!*'r!n ern!, "er'$! %!!n!n,

%is!*n(! s's', te*'r, o*!t, i!n d!n 'd!n#

8? A*er#en In)et!n, (!n# %!s' %e*!*'i s'nti!n !t!' t's'!n, %is!*n(!

$enisi*in !t!' sen#!t!n *e"!&

6? A*er#en =ont!t!n, (!n# %!s' %e*!*'i ont! den#!n '*it !t!'

)!rin#!n %'os!, %is!*n(! "!&!n os%eti !t!' $er&i!s!n

". Den#!n %!s'n(! !**er#en e d!*!% t'"'&, re!si !*er#i di"!#i %en)!di

ti#! t!&!$ "es!r +

/. Res$on Pri%er, ter)!di e*i%in!si d!n $e%!!n!n !nti#en, re!si non

s$esifi


7/24

2. Res$on Se'nder, re!si (!n# ter)!di s$esifi, (!n# %e%"!n#it!n

s(ste% &'%or!*, s(ste% se*'*!r s!)! !t!' "is! %e%"!n#it!n ed'!

s(ste% tere"'t, )i! !nti#en "er&!si* di&i*!n#!n %!! "er&enti $!d!

t!&!$ ini, )i! !nti#en %!si& !d!, !ren! defe d!ri eti#! %e!nis%e

s(ste% terse"'t %!! "er*!n)'t e res$on tersier

8. Res$on Tersier , Re!si i%'no*o#i (!n# tid! %e#'nt'n#!n

. Sed!n#!n *!sifi!si (!n# *e"i& "!r' %en'r't #'ide*ine d!ri ARIA, 200/

>A**er#i R&initis !nd its I%$!t on Ast&%!? disd!s!r!n $!d! !t'

ter)!din(! #e)!*! d!n e$!r!&!nn(! !d!*!&+

+ersrkn '/n %eri #el

=*!sifi!si Ge)!*! di!*!%i se*!%!

Inter%itten ='r!n# d!ri 6 &!ri se%in##', !t!'

'r!n# d!ri 6 %in##' seti!$ s!!t

!%"'&.

Persisten Le"i& d!ri 6 &!ri se%in##', !t!'

*e"i& d!ri 6 %in##' seti!$ s!!t

!%"'&.

Berd!s!r!n =e$!r!&!n d!n ='!*it!s Hid'$

Rin#!n Tid! %en##!n##' tid'r, !ti5it!s

&!ri!n, o*!&r!#!, seo*!& !t!'

$eer)!!n. Tid! !d! #e)!*! (!n#


8/24

%en##!n##'.

Sed!n# s!%$!i Ber!t Ter)!di s!t' !t!' *e"i& e)!di!n di "!!&

ini+

/. G!n##'!n tid'r

2. G!n##'!n !ti5it!s &!ri!n,

esen!n#!n, !t!' o*!& r!#!

8. #!n##'!n $!d! seo*!& !t!'

$eer)!!n

6. #e)!*! (!n# %en##!n##'

!. Rinitis Non!*er#i

/. Rinitis 5!so%otor

=esei%"!n#n 5!so%otor ini di$en#!r'&i "er"!#!i &!* +

!? O"!t-o"!t!n (!n# %ene!n d!n %en#&!%"!t er)! s!r!f si%$!tis,

se$erti+ er#ot!%in, *or$ro%!in, o"!t !nti&i$ertensi, d!n o"!t

5!soontritor *o!*.

"? !tor fisi, se$erti irit!si !s!$ roo, 'd!r! din#in, e*e%"!$!n

'd!r! (!n# tin##i, d!n "!' (!n# %er!n#s!n#

? !tor endorin, se$erti + e&!%i*!n, $'"ert!s, d!n &i$otiroidis%e

d? !tor $siis, se$erti + e%!s d!n te#!n# > !$it! se*et!?

2. Rinitis Medi!%entos!


9/24

Rinitis Medi!%entos! %er'$!!n !i"!t $e%!!i!n 5!soonstritor

to$i!* >o"!t tetes &id'n# !t!' o"!t se%$rot &id'n#? d!*!% !t'

*!%! d!n "er*e"i&!n, se&in##! %en(e"!"!n s'%"!t!n &id'n# (!n#

%enet!$. D!$!t di!t!!n &!* ini dise"!"!n o*e& $e%!!i!n o"!t

(!n# "er*e"i&!n >Dr'# A"'se?.

8. Rinitis Atrofi

Be*'% )e*!s, "e"er!$! &!* (!n# di!n##!$ se"!#!i $en(e"!"n(! se$erti

infesi o*e& '%!n s$esifi, (!it' s$esies =*e"sie**!, (!n# serin#

=*e"sie**! o!n!e, e%'di!n st!fi*oo, sre$too, Pse'do%on!s

!er'#inos!, defisiensi e, defisiensi 5it!%in A, sin'sitis roni,

e*!in!n &or%on!*, d!n $en(!it o*!#en. M'n#in "er&'"'n#!n

den#!n tr!'%! !t!' ter!$i r!di!si.

2.8 =*!sifi!si r&initis !*er#i

2.8./ Men'r't sif!tn(! d!$!t di"ed!!n %en)!di d'!+

!. R&initis !'t >or(!, o%%ond o*d? %er'$!!n $er!d!n#!n

%e%"r!n %'os! &id'n# d!n sin's-sin's !sesoris (!n#

dise"!"!n o*e& s'!t' 5ir's d!n "!teri. Pen(!it ini d!$!t

%en#en!i &!%$ir seti!$ or!n# $!d! s'!t' !t' d!n serin# !*i

ter)!di $!d! %'si% din#in den#!n insidensi tertin##i $!d! !!*

%'si% &')!n d!n %'si% se%i.


10/24

". R&initis ronis !d!*!& s'!t' $er!d!n#!n ronis $!d! %e%"r!n

%'os! (!n# dise"!"!n o*e& infesi (!n# "er'*!n#, !ren! !*er#i,

!t!' !ren! rinitis 5!so%otor.

2.8.2 R&initis "erd!s!r!n $en(e"!"!nn(! di"ed!!n %en)!di +

!. R&initis !*er#i

Rinitis !*er#i !d!*!& $en(!it '%'% (!n# $!*in# "!n(! di

derit! o*e& $ere%$'!n d!n *!i-*!i (!n# "er'si! 80 t!&'n!n.

Mer'$!!n inf*!%!si %'os! s!*'r!n &id'n# (!n# dise"!"!n o*e&

!*er#i ter&!d!$ $!rtie*, se$erti+ de"', !s!$, ser"'te$'n# s!ri

(!n# !d! di 'd!r!. Mesi$'n "'!n $en(!it "er"!&!(! (!n#

%e%!ti!n, rinitis !*er#i &!r's di!n##!$ $en(!it (!n# seri's

!ren! !ren! d!$!t %e%$en#!r'&i '!*it!s &id'$ $enderit!n(!.

T! &!n(! !ti5it!s se&!ri-&!ri (!n# %en)!di ter#!n##', "i!(! (!n#

!!n die*'!r!n 'nt' %en#o"!tin(! $'n !!n se%!in %!&!*

!$!"i*! $en(!it ini tid! se#er! di!t!si !ren! te*!& %en)!di

ronis. R&initis !*er#i Ad!*!& isti*!& '%'% (!n# di#'n!!n 'nt'

%en'n)'!n seti!$ re!si !*er#i %'os! &id'n#, d!$!t ter)!di

"ert!&'n-t!&'n !t!' %'si%!n.

Berd!s!r!n !t'n(!, R&initis A*er#i d!$!t di #o*on#!n %en)!di+

/. Rinitis !*er#i %'si%!n >H!( e5er?

Bi!s!n(! ter)!di $!d! %'si% se%i. U%'%n(! dise"!"!n ont!

den#!n !**er#en d!ri *'!r r'%!&, se$erti "en!n# s!ri d!ri t'%"'&!n


11/24

(!n# %en##'n!!n !n#in 'nt' $en(er"'!nn(!, de"' d!n $o*'si

'd!r! !t!' !s!$.

2. Rinitis !*er#i (!n# ter)!di ter's %ener's >$erenni!*?

Dise"!"!n "'!n !ren! %'si% tertent' > ser!n#!n (!n# ter)!di

se$!n)!n# %!s! >t!&'n!n?? di!i"!t!n !ren! ont! den#!n !**er#en

(!n# serin# "er!d! di r'%!& %is!*n(! 't' de"' r'%!&, "'*' "in!t!n#

$e*i&!r!!n sert! "!'-"!'!n (!n# %en(en#!t

". R&initis Non A*er#i

R&initis non !**er#i dise"!"!n o*e& infesi s!*'r!n n!$!s >r&initis

5ir!* d!n r&initis "!teri!*, %!s'n(! "end! !sin# ed!*!% &id'n#,

defor%it!s str't'r!*, neo$*!s%!, d!n %!ss!, $en##'n!!n roni

deon#est!n n!s!*, $en##'n!!n ontr!se$si or!*, o!in d!n !nti

&i$ertensif. Berd!s!r!n $en(e"!"n(!, r&initis non !*er#i di

#o*on#!n se"!#!i "eri't+

Ti$e-ti$e rinitis non !*er#i !d!*!&+

/. Rinitis Infesios!

Rinitis infesios! "i!s!n(! dise"!"!n o*e& infesi $!d!

s!*'r!n $ern!f!s!n B!#i!n !t!s, "!i o*e& "!teri %!'$'n 5ir's.

Ciri &!s d!ri rinitis infesios! !d!*!& *endir &id'n# (!n# "ern!n!&,

(!n# disert!i den#!n n(eri d!n te!n!n $!d! !)!&, $en'r'n!n

f'n#si inder! $eni'%!n sert! "!t'.


12/24

2. Rinitis Non-A*er#i! Den#!n Sindro%! Eosinofi*i!

Pen(!it ini did'#! "er&'"'n#!n den#!n e*!in!n %et!"o*is%e

$rost!#*!ndin. P!d! &!si* $e%eris!!n !$'s &id'n# $enderit!n(!,

dite%'!n eosinofi* se"!n(! /0-204. Ge)!*!n(! "er'$! &id'n#

ters'%"!t, "ersin, &id'n# %e*er, &id'n# ter!s! #!t!* d!n

$en'r'n!n f'n#si inder! $eni'%!n >&i$os%i!?.

8. Rinitis O'$!sion!*

Ge)!*!-#e)!*! rinitis &!n(! ti%"'* di te%$!t $enderit! "eer)!.

Ge)!*!-#e)!*! rinitis "i!s!n(! ter)!di !i"!t %en#&ir'$ "!&!n-

"!&!n irit!n >%is!*n(! de"' !(', "!&!n i%i!?. Penderit! )'#!

serin# %en#!*!%i !s%! !ren! $eer)!!n.

6. Rinitis Hor%on!*

Be"er!$! $enderit! %en#!*!%i #e)!*! rinitis $!d! s!!t ter)!di

#!n##'!n esei%"!n#!n &or%on >%is!*n(! se*!%! e&!%i*!n,

&i$otiroid, $'"ert!s, $e%!!i!n $i* =B?. Estro#en did'#!

%en(e"!"!n $enin#!t!n !d!r !s!% &i!*'ron!t di se*!$'t &id'n#.

Ge)!*! rinitis $!d! e&!%i*!n "i!s!n(! %'*!i ti%"'* $!d!

"'*!n ed'!, ter's "er*!n#s'n# se*!%! e&!%i*!n d!n !!n

%en#&i*!n# $!d! s!!t $ers!*in!n ti"!. Ge)!*! 't!%!n(! !d!*!&

&id'n# ters'%"!t d!n &id'n# "er!ir.


13/24

3. Rinitis =!ren! O"!t-o"!t!n >rinitis %edi!%entos!?

O"!t-o"!t!n (!n# "er&'"'n#!n den#!n ter)!din(! rinitis !d!*!&

deon#est!n to$i!*, ACE in&i"itor, reser$in, #'!netidin,

fento*!%in, %eti*do$!, "et!-"*oer, *or$ro%!in,#!"!$entin,

$enisi*!%in, !s$irin, NSAID, o!in, estro#en eso#en, $i* =B.

9. Rinitis G'st!tori's

Rinitis #'st!tori's ter)!di sete*!& %en#ons'%si %!!n!n

tertent', ter't!%! %!!n!n (!n# $!n!s d!n $ed!s.

:. Rinitis !so%otor

Rinitis 5!so%otor di(!ini %er'$!!n !i"!t d!ri ter#!n##'n(!

esei%"!n#!n siste% $!r!si%$!tis d!n si%$!tis. P!r!si%$!tis

%en)!di *e"i& do%in!n se&in##! ter)!di $e*e"!r!n d!n

$e%"en#!!n $e%"'*'& d!r!& di &id'n#. Ge)!*! (!n# ti%"'*

"er'$! &id'n# ters'%"!t, "ersin-"ersin d!n &id'n# "er!ir.

G!n##'!n 5!so%otor &id'n# !d!*!& terd!$!tn(! #!n##'!n

fisio*o#i *!$is!n %'os! &id'n# (!n# dise"!"!n o*e&

"ert!%"!&n(! !ti5it!s $!r!si%$!tis. Rinitis 5!so%otor !d!*!&

#!n##'!n $!d! %'os! &id'n# (!n# dit!nd!i den#!n !d!n(!

ede%! (!n# $ersisten d!n &i$erseresi e*en)!r $!d! %'os!

&id'n# !$!"i*! ter$!$!r o*e& irit!n s$esifi. Etio*o#i (!n# $!sti

"e*'% diet!&'i, tet!$i did'#! se"!#!i !i"!t #!n##'!n


14/24

esei%"!n#!n f'n#si 5!so%otor di%!n! siste% s!r!f

$!r!si%$!tis re*!tif *e"i& do%in!n. =esei%"!n#!n 5!so%otor ini

di$en#!r'&i o*e& "er"!#!i f!tor (!n# "er*!n#s'n# te%$orer,

se$erti e%osi, $osisi t'"'&, e*e%"!"!n 'd!r!, $er'"!&!n s'&'

*'!r, *!ti&!n )!s%!ni d!n se"!#!in(!, (!n# $!d! e!d!!n nor%!*

f!tor-f!tor t!di tid! dir!s!!n se"!#!i #!n##'!n o*e& indi5id'

terse"'t. Mer'$!!n res$on non s$esifi ter&!d!$ $er'"!&!n

$er'"!&!n *in#'n#!nn(!, "er"ed! den#!n rinitis !*er#i (!n#

%!n! %er'$!!n res$on ter&!d!$ $rotein s$esifi $!d! !t

!**er#enn(!. !tor $e%i'n(! !nt!r! *!in !*o&o*, $er'"!&!n

te%$er!t'r e*e%"!$!n, %!!n!n (!n# $!n!s d!n $ed!s, "!' 1

"!'!n (!n# %en(en#!t > stron# odor ?, !s!$ roo !t!' $o*'si 'd!r!

*!inn(!, f!tor 1 f!tor $siis se$erti + stress, !nsiet!s, $en(!it 1

$en(!it endorin, o"!t-o"!t!n se$erti !nti &i$ertensi, ontr!se$si

or!*.

2.4 !toisiologi

Te$'n# s!ri (!n# di&ir'$, s$or! )!%'r, d!n !nti#en &e!n di

end!$!n $!d! %'os! &id'n#. A*er#en (!n# *!r't d!*!% !ir "erdif'si e

d!*!% e$ite*, d!n $!d! indi5id' indi5id' (!n# eender'n#!n !to$i

se!r! #eneti, %e%'*!i $rod'si i%'no#*o"'*in *o!* >I# ? E. Pe*e$!s!n

%edi!tor se* %!st (!n# "!r', d!n se*!n)'tn(!, $en!ri!n ne'trofi*,

eosinofi*, "!sofi*, sert! *i%fosit "ert!n##'n# )!!" !t!s ter)!din(! re!si

!!* d!n re!si f!se *!%"!t ter&!d!$ !*er#en &ir'$!n. Re!si ini

%en#&!si*!n %''s, ede%!, r!d!n#, #!t!*, d!n 5!sodi*!t!si. Per!d!n#!n


15/24

(!n# *!%"!t d!$!t t'r't sert! %en(e"!"!n &i$erres$onsi5it!s &id'n#

ter&!d!$ r!n#s!n#!n nons$esifi s'!t' $en#!r'& $ersi!$!n. >Be&r%!n,

2000?.

2.5 Mniestsi Klinis

/? Bersin "er'*!n#-'*!n#, ter't!%! sete*!& "!n#'n tid'r $!d! $!#i &!ri

>'%'%n(! "ersin *e"i& d!ri 9 !*i?.

2? Berd!s!r!n #e)!*! (!n# %enon)o*, di"ed!!n !t!s #o*on#!n (!n#

o"str'si d!n rinore!. Pe%eris!!n rinoso$i !nterior %en'n)'!n

#!%"!r!n *!si "er'$! ede%! %'os! &id'n#, on! "er!rn! %er!&

#e*!$ !t!' %er!& t'!, d!$!t $'*! $'!t. Per%'!!n(! d!$!t *iin !t!'

"er"en)o*. P!d! ron##! &id'n# terd!$!t seret %'oid, "i!s!n(! sediit,

n!%'n $!d! #o*on#!n rinore!, seret (!n# dite%'!n "i!s!n(! seros!

d!n d!*!% )'%*!& "!n(!.

8? Hid'n# %e*er. C!ir!n (!n# e*'!r d!ri &id'n# %e*er (!n# dise"!"!n

!*er#i "i!s!n(! "enin# d!n ener, tet!$i d!$!t %en)!di ent!* d!n $'ti&

er'& !t!' e'nin#-'nin#!n )i! "ere%"!n# %en)!di infesi &id'n#

!t!' infesi sin's.

6? Hid'n# #!t!* d!n )'#! serin# disert!i #!t!* $!d! %!t!, te*in#! d!n

ten##oro.

3? B!d!n %en)!di *e%!& d!n t! "erse%!n#!t.

9? Ge)!*! %e%"'r' $!d! $!#i &!ri !t' "!n#'n tid'r !ren! $er'"!&!n

s'&' (!n# estri%, 'd!r! *e%"!", )'#! !ren! !s!$ roo d!n

se"!#!in(!.

:? =e*'&!n s'"(etif (!n# serin# dite%'!n $!d! $!sien "i!s!n(! n!$!s

"er"!' >se%ent!r! $!sien sendiri %enderit! !nos%i!?, in#'s ent!*

&i)!', r'st! &i)!', #!n##'!n $eni'%!n, s!it e$!*!, d!n &id'n#

ters'%"!t.


16/24

;? P!d! $enderit! THT dite%'!n ronn#! &id'n# s!n#!t *!$!n#, in!

inferiord!n %edi! &i$otrofi !t!' !trofi, seret $'r'*en &i)!', d!n r'st!

"er!rn! &i)!'

2.9 Insiden R&initis A*er#i

Rinitis terse"!r di se*'r'& d'ni!, "!i "ersif!t ende%is %!'$'n

%'n'* se"!#!i =LB. Di d!er!& "eri*i% sed!n#, insidensi $en(!it ini

%enin#!t di %'si% #'#'r, %'si% din#in, d!n %'si% se%i. Di d!er!&

tro$is, insidensi $en(!it tin##i $!d! %'si% &')!n. Se"!#i!n "es!r or!n#,

e'!*i %ere! (!n# tin##!* di d!er!& den#!n )'%*!& $end'd' sediit d!n

teriso*!si, "is! terser!n# s!t' &in##! 9 !*i seti!$ t!&'nn(!. Insidensi

$en(!it tin##i $!d! !n!-!n! di "!!& 3 t!&'n d!n !!n %en'r'n se!r!

"ert!&!$ ses'!i den#!n "ert!%"!&n(! '%'r.

Rinitis %er'$!!n s!*!& s!t' $en(!it $!*in# '%'% (!n# terd!$!t

di !%eri! Seri!t, %e%$en#!r'&i *e"i& d!ri 30 )'t! or!n#. =e!d!!n ini

serin# "er&'"'n#!n den#!n e*!in!n $ern!$!s!n *!inn(!, se$erti !s%!.

R&initis %e%"eri!n $en#!r'& (!n# si#nifi!n $!d! '!*it!s &id'$. P!d!

"e"er!$! !s's, d!$!t %en(e"!"!n ondisi *!inn(! se$erti %!s!*!& $!d!

sin's, %!s!*!& $!d! te*in#!, #!n##'!n tid'r, d!n #!n##'!n 'nt' "e*!)!r.

P!d! $!sien den#!n !s%!, rinitis (# tid! terontro* d!$!t %e%$er"'r'

ondisi !s%!n(!.

=!ren! rinitis !*er#i diti%"'*!n o*e& te$'n# s!ri !t!' !$!n# >%o*d? (!n#

ter"!! !n#in, e!d!!n ini ddit!nd!i o*e& insiden %'si%!n di Ne#!r! e%$!t

%'si% +


17/24

!? A!* %'si% se%i- te'n# s!ri > $o**en? $o&on >o!, e*%,$o$*!r?

"? A!* %'si% $!n!s >rose fe5er? 1 te$'n# s!ri rer'%$'t!n>Ti%ot&(,

red-to$?

? A!* %'si% #'#'r 1 te$'n# s!ri #'*%! >r!#eed?d? Seti!$ t!&'n(!, ser!n#!n di%'*!i d!n "er!&ir $!d! !t' (!n#

'r!n#-*e"i& s!%!.

S$or! !$!n# (!n# &!n#!t d!n *e%"!". Mesi$'n $o*! %'si%!n (!n# !'

tid! terd!$!t, s$or! ini %'n'* $!d! !!* %'si% se%i, "ert!%"!& "!n(!

se*!%! %'si% $!n!s d!n "er'r!n# sert! %en#&i*!n# %en)e*!n# t'r'nn(!

s!*)' (!n# $ert!%!.

2. E*A'&A$I DIA#N"$I$

2.:./ An!%nesis

An!%nesis s!n#!t $entin#, !ren! serin#!*i ser!n#!n tid! ter)!di

di&!d!$!n $e%eris!. H!%$ir 304 di!#nosis d!$!t dite#!!n d!ri

!n!%nesis s!)!. Ge)!*! rinitis !*er#i (!n# &!s !d!*!& terd!$!tn(! ser!n#!n

"ersin "er'*!n#. Se"et'*n(! "ersin %er'$!!n #e)!*! (!n# nor%!*, ter't!%!

$!d! $!#i &!ri !t!' "i*! terd!$!t ont! den#!n se)'%*!& "es!r de"'. H!* ini

%er'$!!n %e!nis%e fisio*o#i, (!it' $roses %e%"ersi&!n sendiri >se*f

*e!nin# $roess?. Bersin di!n##!$ $!to*o#i, "i*! ter)!din(! *e"i& d!ri *i%!

!*i seti!$ ser!n#!n, ter't!%! %er'$!!n #e)!*! $!d! RAC d!n !d!n#-

!d!n# $!d! RAL se"!#!i !i"!t di*e$!s!nn(! &ist!%in. /

Ge)!*! *!in i!*!& e*'!r in#'s >rinore? (!n# ener d!n "!n(!, &id'n#

ters'%"!t, &id'n# d!n %!t! #!t!*, (!n# !d!n#-!d!n# disert!i den#!n

"!n(! !ir %!t! e*'!r >*!ri%!si?. Rinitis !*er#i serin# disert!i o*e& #e)!*!


18/24

on)'n#ti5itis !*er#i. Serin# !*i #e)!*! (!n# ti%"'* tid! *en#!$, ter't!%!

$!d! !n!. =!d!n#-!d!n# e*'&!n &id'n# ters'%"!t %er'$!!n e*'&!n

't!%! !t!' s!t'-s!t'n(! #e)!*! (!n# di't!r!!n o*e& $!sien./ Ge)!*! *inis

*!inn(! d!$!t "er'$! F$o$$in# of t&e e!rs, "erde&!%, d!n "!t'-"!t' *e"i&

)!r!n# die*'&!n.6

2.:.2 Pe%eris!!n isi

P!d! rinoso$i !nterior t!%$! %'os! ede%!, "!s!&, "er!rn! $'!t

!t!' *i5id disert!i !d!n(! seret ener (!n# "!n(!. Bi*! #e)!*! $ersisten,

%'os! inferior t!%$! &i$ertrofi. Pe%eris!!n n!soendoso$i d!$!t

di*!'!n "i*! f!si*it!s tersedi!. Ge)!*! s$esifi *!in $!d! !n! !d!*!&

terd!$!tn(! "!(!n#!n #e*!$ di d!er!& "!!& %!t! (!n# ter)!di !ren! st!sis

5en! se'nder !i"!t o"str'si &id'n#. Ge)!*! ini dise"'t !**er#i s&iner./

Se*!in d!ri it' serin# )'#! t!%$! !n! %en##oso-#oso &id'n#,

!ren! #!t!*, den#!n $'n##'n# t!n#!n. =e!d!!n ini dise"'t se"!#!i !**er#i

s!*'te. =e!d!!n %en##oso ini *!%! e*!%!!n !!n %en#!i"!t!n

ti%"'*n(! #!ris %e*int!n# di dors'%n!si "!#i!n se$erti#! "!!&, (!n#

dise"'t se"!#!i !**er#i re!se./

M'*'t serin# ter"'! den#!n *en#'n# *!n#it-*!n#it (!n# tin##i,

se&in##! !!n %en(e"!"!n #!n##'!n $ert'%"'&!n #i#i #e*i#i >f!ies

!denoid?. Dindin# $osterior f!rin# t!%$! #r!n'*er d!n ede%! >o""*estone

!$$e!r!ne?, sert! dindin# *!ter!* f!rin# %ene"!*. Lid!& t!%$! se$erti

#!%"!r!n $et! >#eo#r!$&i ton#'e?.

2.:.8 Pe%eris!!n Pen'n)!n#


19/24

!. In 5itro

Hit'n# eosinofi* d!*!% d!r!& te$i d!$!t nor%!* !t!' %enin#!t.

De%ii!n $'*! $e%eris!!n I#E tot!* >$rist-$!$er r!dio i%'nosor"ent

test? serin# !*i %en'n)'!n ni*!i nor%!*, e'!*i "i*! t!nd! !*er#i

$!d! $!sien *e"i& d!ri s!t' %!!% $en(!it, %is!*n(! se*!in rinitis

!*er#i )'#! %enderit! !s%! "roni!* !t!' 'rti!ri!. Pe%eris!!n ini

"er#'n! 'nt' $redisi e%'n#in!n !*er#i $!d! "!(i !t!' !n! ei*

d!ri s'!t' e*'!r#! den#!n der!)!t !*er#i (!n# tin##i. Le"i& "er%!n!

!d!*!& den#!n RAST >R!dio I%%'no Sor"ent Test? !t!' ELISA

>En(%e Lined I%%'no Sor"entAss!( Test?.

Pe%eris!!n sito*o#i &id'n#, !*!'$'n tid! d!$!t %e%!sti!n

di!#nosis, tet!$ "er#'n! se"!#!i $e%eris!!n $e*en#!$.

Dite%'!nn(! eosinofi* d!*!% )'%*!& "!n(! %en'n)'!n

e%'n#in!n !*er#i in&!*!n. Ji! "!sofi* >3 se**!$? %'n#in

dise"!"!n !*er#i %!!n!n, sed!n#!n )i! dite%'!n se* PMN

%en'n)'!n !d!n(! infesi "!teri./

". In 5i5o

A*er#en $en(e"!" d!$!t di!ri den#!n !r! $e%eris!!n tes 'it

'*it, ')i intr!'t!n !t!' intr!der%!* (!n# t'n##!* !t!' "erseri >Sin

End-$oint Titr!tionSET?. SET di*!'!n 'nt' !*er#en in&!*!n den#!n

%en('nti!n !*er#en d!*!% "er"!#!i onsentr!si (!n# "ertin#!t

e$e!t!nn(!. =e'nt'n#!n SET, se*!in !*er#en $en(e"!" )'#! der!)!t

!*er#i sert! dosis inisi!* 'nt' desensitis!si d!$!t diet!&'i. /


20/24

Unt' !*er#i %!!n!n, ')i '*it se$erti terse"'t di!t!s 'r!n# d!$!t

di!nd!*!n. Di!#nosis "i!s!n(! dite#!!n den#!n diet e*i%in!si d!n

$ro5o!si >C&!**en#e Test?./

A*er#en in#est!n se!r! t'nt!s *en(!$ d!ri t'"'& d!*!% !t' *i%!

&!ri. =!ren! it' $!d! C&!**en#e Test, %!!n!n (!n# di'ri#!i di"eri!n

$!d! $!sien sete*!& "er$!nt!n# se*!%! 3 &!ri, se*!n)'tn(! di!%!ti

re!sin(!. P!d! diet e*i%in!si, )enis %!!n!n seti!$ !*i di&i*!n#!n

d!ri %en' %!!n!n s!%$!i s'!t' eti! #e)!*! %en#&i*!n# den#!n

%eni!d!!n s'!t' )enis %!!n!n. /

2. !entlksnn

Hind!ri ont! e*i%in!si, =ed'!n(! %er'$!!n ter!$i $!*in#

ide!*. Hind!ri ont! den#!n !*er#en $en(e"!", sed!n#!n e*i%in!si 'nt'

!*er#en in#est!n >!*er#i %!!n!n?.

Si%$to%!ti + Ter!$i %edi!%entos! (!it' !nti&ist!%in, deon#est!n d!n

ortiosteroid

!. Anti&ist!%in

Anti&ist!%in (!n# serin# di#'n!!n !d!*!& !nti&ist!%in or!*.

Anti&ist!%in or!* di"!#i %en)!di d'! (!it' #ener!si $ert!%!

>nonse*etif? dien!* )'#! se"!#!i !nti&ist!%in sed!tif sert! #ener!si

ed'! >se*etif? dien!* )'#! se"!#!i !nti&ist!%in nonsed!tif.

Efe sed!ti5e !nti&ist!%in s!n#!t oo di#'n!!n 'nt' $!sien

(!n# %en#!*!%i #!n##'!n tid'r !ren! r&initis !*er#i (!n# diderit!n(!.


21/24

Se*!in it' efe s!%$in# (!n# "i!s! diti%"'*!n o*e& o"!t #o*on#!n

!nti&ist!%in !d!*!& efe !ntio*iner#i se$erti %'*'t erin#, s's!& "'!n#

!ir ei* d!n onsti$!si. Pen##'n!!n o"!t ini $er*' di$er&!ti!n 'nt'

$!sien (!n# %en#!*!%i en!i!n te!n!n intr!o'*er, &i$ertiroidis%e,

d!n $en(!it !rdio5!s'*!r.

Anti&ist!%in s!n#!t efetif "i*! di#'n!!n / s!%$!i 2 )!% se"e*'%

ter$!$!r !**er#en. Pen##'n!!n !nti&ist!%in &!r's se*!*' di$er&!ti!n

ter't!%! %en#en!i efe s!%$in#n(!. Anti&ist!%in #ener!si ed'!

%e%!n# %e%"eri!n efe sed!ti5e (!n# s!n#!t ei* n!%'n se!r!

eono%i *e"i& %!&!*.

". Deon#est!n

Deon#est!n to$i!* d!n siste%i %er'$!!n si%$!to%i%eti !#en

(!n# "er!si $!d! rese$tor !drener#i $!d! %'os! n!s!*, %e%$rod'si

5!soonstrisi. To$i!* deon#est!n "i!s!n(! di#'n!!n %e*!*'i sedi!!n

tetes !t!' s$r!(. Pen##'n!!n deon#est!n )enis ini &!n(! sediit !t!'

s!%! se!*i tid! di!"sor"si se!r! siste%i >Di$iro, 2003?. Pen##'n!!n

o"!t ini d!*!% )!n#! !t' (!n# *!%! d!$!t %eni%"'*!n r&initis

%edi!%entos! >r&initis !ren! $en##'n!!n o"!t-o"!t!n?. Se*!in it' efe

s!%$in# (!n# d!$!t diti%"'*!n to$i!* deon#est!n !nt!r! *!in r!s!

ter"!!r, "ersin, d!n erin# $!d! %'os! &id'n#. Unt' it' $en##'n!!n

o"!t ini %e%er*'!n onse*in# "!#i $!sien.

Siste%i deon#est!n onsetn(! tid! see$!t deon#est!n to$i!*.

N!%'n d'r!sin(! "i!s!n(! "is! *e"i& $!n)!n#. A#en (!n# "i!s!


22/24

di#'n!!n !d!*!& $se'doefedrin. Pse'doefedrin d!$!t %en(e"!"!n

sti%'*!si siste% s!r!f $'s!t !*!'$'n di#'n!!n $!d! dosis ter!$in(!

>Di$iro, 2003?. O"!t ini &!r's &!ti-&!ti di#'n!!n 'nt' $!sien-$!sien

tertent' se$erti $enderit! &i$ertensi. S!!t ini te*!& !d! $rod' o%"in!si

!nt!r! !nti&ist!%in d!n deon#est!n. =o%"in!si ini r!sion!* !ren!

%e!nis%en(! "er"ed!.

. N!s!* Steroid

Mer'$!!n o"!t $i*i&!n 'nt' r&initis ti$e $erenni!*, d!n d!$!t

di#'n!!n 'nt' r&initis se!son!*. N!s!* steroid diet!&'i %e%i*ii efe

s!%$in# (!n# sediit.

O"!t (!n# "i!s! di#'n!!n *!inn(! !nt!r! *!in sodi'% ro%o*in,

d!n i$!tro$i'% "ro%id!.

O$er!tif + =onoto%i %er'$!!n tind!!n %e%oton# on! n!si inferior

(!n# %en#!*!%i &i$ertrofi "er!t. L!'!n sete*!& it! #!#!* %en#ei*!n

on! n!si inferior %en##'n!!n !'teris!si (!n# %e%!!i A#NO8 234

!t!' tri*or !set!t.

I%'noter!$i + Jenisn(! desensit!si, &i$osensit!si netr!*is!si.

Desensit!si d!n &i$osensit!si %e%"ent' "*oin# !nti"od(. =ed'!n(!

'nt' !*er#i in&!*!n (!n# #e)!*!n(! "er!t, "er*!n#s'n# *!%! d!n &!si*

$en#o"!t!n *!in "e*'% %e%'!s!n. Netr!*is!si tid! %e%"ent'

"*oin# !nti"od( d!n 'nt' !*er#i in#est!n.

2.9 Ko/6liksi


23/24

/? Po*i$ &id'n#. Rinitis !*er#i d!$!t %en(e"!"!n !t!' %eni%"'*!n

e!%"'&!n $o*i$ &id'n#.

2? Otitis %edi!. Rinitis !*er#i d!$!t %en(e"!"!n otitis %edi! (!n# serin#

residif d!n ter't!%! it! te%'!n $!d! $!sien !n!-!n!.

8? Sin'sitis roni

Otitis %edi! d!n sin'sitis roni "'!n*!& !i"!t *!n#s'n# d!ri rinitis

!*er#i %e*!in!n !d!n(! s'%"!t!n $!d! &id'n# se&in##! %en#&!%"!t

dr!in!se.

+A+ I*

!EN&%&!

6./ =esi%$'*!n

R&initis !d!*!& s'!t' inf*!%!si > $er!d!n#!n ? $!d! %e%"r!n

%'os! di &id'n#. >Di$iro, 2003?.R&initis !d!*!& $er!d!n#!n se*!$'t

*endir &id'n#. > Dor*!nd, 2002 ?

Berd!s!r!n !r! %!s'n(! !**er#en di"!#i !t!s +

A*er#en In&!*!n,A*er#en In#est!n,A*er#en In)et!n,A*er#en

=ont!t!n,

Den#!n %!s'n(! !**er#en e d!*!% t'"'&, re!si !*er#i di"!#i %en)!di

ti#! t!&!$ "es!r +

Res$on Pri%er,Res$on Se'nder,Res$on Tersier


24/24

Pen!t!*!s!n!!nn(! +

Hind!ri ont! e*i%in!si, =ed'!n(! %er'$!!n ter!$i $!*in# ide!*.

Hind!ri ont! den#!n !*er#en $en(e"!", sed!n#!n e*i%in!si 'nt'

!*er#en in#est!n >!*er#i %!!n!n?. Si%$to%!ti + Ter!$i %edi!%entos!

(!it' !nti&ist!%in, deon#est!n d!n ortiosteroid

6.2 S!r!n

$en('s'n s!n#!t %e%"'t'&!n s!r!n, de%i %enin#!t!n !*it!s

d!n %'t' %!!*!& (!n# !%i "'!t di*!in !t'. Se&in##! $en('s'n d!$!t

%e%"eri!n infor%!si (!n# *e"i& "er#'n! 'nt' $en('s'n &'s'sn(! d!n

$e%"!! '%'%n(!.

DA7%AR !&$%AKA

M!ns)oer, !rif d. /

imunologi pada rhinitis alergi

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