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Lecture IV

-Rhinitis Alergi-

dr. Lukman Rivai Sp.THT-KL

Tujuan
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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

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Patofisiologi .

Cellular interactions pada Rhinitis alergi .

tenggorok. .Metoda diagnostik Rinitis 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. lama sakit. intermiten atau persisten. beratnya penyakit.  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 . langit-langit atau telinga Selain itu perlu ditanyakan :  Frekuensi serangan.

Oral .Ocular .History  Onset of symptoms  Infant less than 3 years old  Older child  Symptoms  Headache  Nasal ○ Pruritis ○ Sneezing ○ Congestion ○ Postnasal drip ○ Rhinorrhea .

grass.History  Frequency  Perennial (cat. cockroach. molds)  Seasonal (trees. weeds)  Severity  School absence  Loss of smell  Behavioral changes  Comorbid conditions . dust mite. dog.

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Physical Exam • Eyes • Ears • Nose • Oropharynx • Lungs .

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Differential Diagnosis • Upper respiratory infection • Chronic sinusitis • Anatomical nasal obstruction – Concha bullosa – Deviated nasal septum .Nasal polyps .Adenoidal hypertrophy • GERD .

anatomical.Should you refer for skin testing? • • • • NO Hx suggestive for AR Trial of appropriate therapy successful Symptoms mild and easily managed Mechanical. or infectious causes YES  Poor response to therapeutic trial  Drastic environmental changes are considered  Strong desire for immunotherapy .

Guideline Penatalaksanaan Rinitis Alergi dari ARIA WHO .

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Antihistamines • 1st generation: Hydroxyzine (Atarax®) Diphenhydramine (Benadryl®) Chlorphenarimine (CTM®) • 2nd generation: Cetirizine (Zyrtec®) Loratadine (Claritin®) Fexofenadine (Allergra®) Desloratadine (Clarinex®) .

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Nasal sprays • Nasal steroids • Cromolyn (Nasocrom®) • Oxymetolazone (Afrin®) • Nasal saline (Ocean®) .

Nasal steroids • Mometasone (Nasonex®) • Fluticasone (Flonase®) 25 20 15 10 5 0 Mometa Flutic Budes Beclo Flunisol % Bioavail • Budesonide (Rhinocort®) • Vancenase (Beclomethasone®) • Flunisolide (Nasalide®) .

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 Kasih .