Dr Lukman Rivai
description
Transcript of Dr Lukman Rivai
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