RHINITIS

NON INFECTION
Kartono Sudarman
Dep./KSM THT-KL
FKKMK UGM/RSUP DR Sardjito
2021
 TOPICS
• ALLERGIC RHINITIS
• NON ALLERGIC RHINITIS WITH
EOSINOPHILIA.
MICROVASCULATURE
IN NASAL MUCOSA
Consist of :
• Capacitance vessels
• Resistance vessels
 NERVES IN NASAL CAVITY
• Component :
– Sympathies --> blood vessels
– Parasympathies --> glands
– Nociceptive branch of the fifth cranial nerve
• Functions :
– Regulate the blood flow/supply
– Regulate the thickness of the mucous
– Regulate the secretions volume
– Arcus of reflex
– Local neurogenic inflammation
 CELLS IMMUNITY
IN NASAL CAVITY
• Dendritic cells
• Macrophages
• T cells (CD 4+ )
• B cells
• Mast cells
• Eosinophil
 DEFFENS MECHANISM
IN NASAL CAVITY
NON IMMUNOLOGIC IMMUNOLOGIC
• Physically :
– Vibrissae
• Non specific
– Mucous blanket
– Cilliary movement – Complement
– Epithelial structure – Macrophages
• Mechanic – Neutrophils
– Sneeze reflex • Specific
• Chemical – T cells, B cells, specific
– Mucous acidity immunoglobuline : S IgA,
– Lisozyme Ig. G, Ig E.
– Lactoferin
 ALLERGIC RHINITIS
• The inflammation of the mucous of the nose
which mediated by IgE/type 1
hypersensitivity, following allergen exposure;
and causes symptoms: nasal congestion or
obstruction, sneezing, watering and itching of
the nose.
 Unified airway disease

RINITIS ALLERGI

SINUSITIS ASMA ATOPIC

OTITIS MEDIA
 ALLERGIC RHINITIS
• EPIDEMIOLOGY :
– 10-20 % population
– Age : 15-20 yrs.
• Classification according type of disease
1. Persisten: > 4 days in a week AND > 4 weeks in a year.
2. Intermitten : < 4 days in a week OR < 4 weeks in a year.
3. Occupational allergic rhinitis
• Classification according severity of disease.
1. Mild : without disturbance to dayly activity (work, school, social )
2. Moderate and severe : with disturbance to dayly activity (work,
school, social ).
3. With complications : chronic rhinosinusitis, serous otitis media ,
chronic pharyngitis.
• Diagnosis :
– History of the disease
– Physical examinations
– Laboratoric examinations
 ALLERGIC RHINITIS
EPIDEMIOLOGY

• Allergic rhinitis is the most

common form of allergic
disease

• Prevalence 10-20%

• Both sexes equally affected

• Onset, usually in
adolescence
Pathophysiology
 ALLERGIC RHINITIS
DIAGNOSE
• History taking:
– Nasal blocked, itching, sneezing, serous nasal
discharge.
– Provacations agent or environment conditions
– History of atopy for patient and or his/her
family.
– Type of disease, give disturbance to daily live ?
– Treatment or medication up now.
– Possibity complications.
ALLERGIC RHINITIS
DIAGNOSE
Physical examinations

• Allergic salute
• Allergic crease
• Mannerism
• Mouth open/facies adenoid
• Height arched-palate
 ALLERGIC RHINITIS
DIAGNOSE
• Laboratory examinations
– Skin prick test :
• provocation of allergen to the skin
• Identified of specific IgE in the skin tissue ←
distributed to all of the body.
• Contra indication : uncontrol astma brochiale,
consum β blocker agent.
• Preparation : avoid consum antihistamine , systemic
corticosteroid; 5 days before skin prick test.
– IgE specifik test
• Identified specific IgE in the blood circulation.
• If skin prick test imposible.
 ARIA guideline recommendation

moderate
severe
mild persistent
moderate persistent
severe
mild intermittent
intermittent intra-nasal steroid
local chromone
oral or local non-sedative H1-blocker
intra-nasal decongestant (<10 days) or oral decongestant
allergen and irritant avoidance

immunotherapy
 ALLERGIC RHINITIS
treatment
MILD INTERMITTENT
1. Avoidance , according skin prick test, IgE specific exam., history
, epidemiology.
2. Medicamentous :
Second generation antihistamine.

MODERATE-SEVERE INTERMITTENT AND MILD

PEERSISTENT
1. Avoidance , according skin prick test, IgE specific exam., history
, epidemiology.
2. Medicamentous :
1. Second generation antihistamine OR
2. Local corticosteroid .
FAILED →
Immunotherapy

STEPWAYS : REVIEW EVERY 2-4 WEEKS

 ALLERGIC RHINITIS
treatment
MODERATE-SEVERE PERSISTENT
1. Avoidance , according skin prick test, IgE specific
exam., history , epidemiology.
2. Medicamentous :
1. Local corticosteroid AND
2. Second generation antihistamine
FAILED →
Immunotherapy

STEPWAYS : REVIEW EVERY 2-4 WEEKS

Avoidance & environmental control
Pharmacotherapy

pharmacotherapy
 NON ALLERGIC RHINITIS WITH
EOSINOPHILISA SYNDROME
(NARES)
• 10 % of rhinitis, female > male, 30-40 yrs old
• Has correlation with non specific bronchial
hyperreactivity.
• Symptoms : watery rhinorhea, obstruction
• Eosinophilia > 10 %, nasal swab : eosinophil (+)
• Allergic test (-)
• Treatment ?
 DRUG-INDUCED RHINITIS
ASPIRIN AND NSIDs

– Naso-oculer reactions and astma attack with

in about 3 hours after ingestion .
– Symptoms : rhinorhea, conjuctival injection,
periorbital oedem, scarlet flussing of the head
and neck.
– Eosinophilia, eosinophil in nasal swab nad
bronchila swab.
– Has correlation with nasal polyposis.
DRUG-INDUCED RHINITIS
OTHER DRUGS ARE KNOWN CAUSE NASAL
SYMPTOM :
– Reserpin,
– guanethidine,
– phentolamine,
– methyldopa,
– ACE inhibitor,
– α adrenoceptor antagonis,
– β blocker,
– chlorpromazine,
– oral contraceptives.