RINITIS

RINITIS
ALERGI
SEASEONAL

PARENIAL

RINITIS
VASOMOTOR
RINITIS
AKUT

RINITIS
SPESIFIK
R.DIFTERI
R. SIFILIS

RINITIS
HIPERTROPI

R. ATROFI
R. TUBERKULOSA

RINITIS
INFEKSI
RINITIS
KRONIS
RINITIS
SIKA

Allergic rhinitis (AR) is a symptomatic

disorder of the nose induced after
allergen exposure by an IgE-mediated
inflammation of the membranes lining
the nose

Major inflammatory elements in AR :

Histamine, leukotrienes and eosinophils

Bousquet J, Khaltaev N, Cruz AA, et al. Allergy 2008; 63(Suppl.86): 8-160

Bersin > 5x/serangan

Rinore
Hidung tersumbat
Hidung dan mata gatal
Bayangan gelap bawah mata
(allergic shiner)
Allergic salute
Allergic crease
Rinoskopi anterior: Konka livide dan
edema, sekret encer

Sneezing
Anterior rhinorrhea
Nasal itch
Posterior rhinorrhea
Congestion

Patients may not present with all symptoms

Majority of patients experience worst symptoms in
the morning

Symptoms
suggestive
of allergic rhinitis

2 or more of the folowing

symptoms for > 1 hour on most
days
Watery rhinorrhea
Sneezing (paroxysmal)
Nasal obstruction
Nasal pruritus
Conjunctivitis

Symptoms usually
NOT associated
w/ allergic rhinitis

Unilateral symptoms
Nasal obstruction w/o other
symptoms
Mucopurulent rhinorrhea
Post nasal drip : thick mucus
Pain
Recurrent epistaxis
Anosmia

Classify and assess

severity
Bousquet J, Khaltaev N, Cruz AA, et al. Allergy 2008; 63(Suppl.86): 8-160

Refer to a
specialist

Rinitis alergi musiman ( seaseonal )

- Negara 4 musim
- Rino konjungtivitis / polinosis

Rinitis alergi sepanjang tahun ( parenial )

- Intermitten / terus menerus
- Alergen inhalan dan ingestan

Intermiten ( kadang-kadang )
< 4 hari/minggu atau
< 4 minggu

Persisten ( menetap )
> 4 hari/minggu dan
> 4 minggu

Mild ( ringan )

Moderat - severe ( sedang berat ) :

- gangguan tidur
- gangguan aktivitas harian
- gangguan belajar atau bekerja

Intermittent
symptoms
< 4 days per week
or < 4 consecutive weeks
Mild
all of the following
normal sleep
no impairment of daily activities,
sport,
leisure
no impairment of work and school
symptoms present but not
troublesome

Bousquet J, Reid J, Van Weel C, et al. Allergy 2008; 63: 990-6

Persistent
symptoms
> 4 days per week
and > 4 consecutive weeks

Moderate-Severe
one or more items
sleep disturbance
impairment of daily activities,
sport,
leisure
impairment of work or school
troublesome symptoms

Ear

Nose

Throat

Skin test : Prick test, Scratch test, SET

Diet eliminasi dan provokasi (challenge
test)
Pemeriksaan IgE total
Pemeriksaan IgE spesifik (RAST )
Pemeriksaan eosinofil darah
Tes provokasi
Sitologi hidung

Bousquet J, et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147.

Bousquet J, et al. Allergy 2002;57:841

Bousquet J, et al. Allergy 2008;63 (Suppl.86); 8-160

Moderate
severe
intermittent
Mild
intermittent

Mild
persistent

Moderate
severe
persistent

Intra-nasal steroid
Local cromone
Leukotriene receptor antagonists

Second-generation nonsedating H1 antihistamine

Intranasal decongestant (<10 days) or oral decongestant
Allergen and irritant avoidance
Immunotherapy
ARIA = Allergic Rhinitis and its Impact on Asthma.
Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147.

Selektif : alergi berat

Waktu lama
Methodes :
Subcutaneous,
Sublingual,
Intranasal,
Tablets

Asthma
25%-35% of patients with AR also have asthma
>85% of patients with asthma have AR

Conjunctivitis
Prevalence ~50%

Rhinosinusitis and Nasal Polyposis

Prevalence of chronic rhinosinusitis >75%

Otitis Media
Eczema

Bousquet et al. J Allergy Clin Immund. 2001;108:S147.

Ganguan fisiologis mukosa hidung

parasimpatis
( N.Vidianus )

Etiologi belum diketahui ~ fungsi vasomotor:

- Obat-obatan
- Faktor fisik
- Faktor endokrin
- Faktor psikis

N.Vidianus
Faktor fisik:
asap rokok,
udara dingin,
kelembaban
udara tinggi,
bau-bauan,
makanan
pedas dan
panas

Parasimpatis

Obat-obatan :
CPZ, antihipertensi,
vasokonstriktor topikal
Endokrin
Psikis

Dilatasi .darah
Permeabilitas kapiler
Sekresi kelenjer

Keluhan :

Blocker ( obstruksi ), Sneezer ( rinore )

Hidung tersumbat kiri/kanan
Bersin jarang

Rinoskopi anterior :
Konka merah tua, edema, pmkn licin a tdk rata,
sekret
serosa/mukoid
Tes Kulit (-)

Faktor mempengaruhi vasomotor

Singkirkan rinitis alergi

Gambaran klinis

Avoidance

Simtomatis

Operasi

Neurektomi n. vidianus