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Kilomser
Kilomser
INTRODUCTION
Anaphylaxis occurring in the hospital Food allergy is the most common cause
results primarily from allergic of anaphylaxis occurring outside the
reactions to medications and latex. hospital, accounting for about half of
In the hospital, latex is a particular
the anaphylactic reactions reported in
problem for children undergoing
multiple operations. pediatric surveys from the United
Patients with latex allergy may also States, Italy, and South Australia.
experience food-allergic reactions Peanut allergy is an important cause of
from homologous proteins in foods food-induced anaphylaxis, accounting
such as bananas, kiwi, avocado, for the majority of fatal and near-fatal
chestnut, and passion fruit. reactions.
SIGN AND SYMPTOM
RISK FACTOR
OF
ANAPHYLAXIS
PATHOGENESIS
Acute bronchial obstruction
with pulmonary
hyperinflation
FATAL Pulmonary edema
ANAPHYLAXIS Intraalveolar hemorrhaging
Visceral congestion
Latyngeal edema
Urticaria and angioedema
Acute hypotension
It is commonly, but not always, mediated by
Plasma histamine
Serum tryptase
24-hr Urinary histamine
metabolite
Allergen
3 to 6 hours Basophil
Histamine,
(CysLTs, PAF, CysLTs, Return
IL-5) TNF-, IL-4, IL-5, IL-6
of
Monocyte Symptoms
PGs CysLTs CysLTs, TNF-, PAF,
IL-1
Proteases
Any child with food allergy and a history of asthma, peanut, tree nut, fish
or shellfish allergy, or a previous anaphylactic reaction should be given
an epinephrine autoinjector (Adrenaclick, Auvi-Q, EpiPen), (liquid
cetirizine and a written emergency plan in case of accidental ingestion.
…Prevention
symptoms develop.
…Prevention
SJS TEN
Pathologically, cell death results causing separation of the epidermis from the dermis
Sindroma Stevens-Johnson ( SSJ ) :
kumpulan gejala klinis yang ditandai oleh trias :
1. kelainan pada kulit
2. kelainan pada mukosa orifisium
3. kelainan pada mata
Insidens : 1 – 10 per 1.000.000 setiap tahun.
Sinonim :
Sindrom de Friessinger-Rendu,
Sindroma Muko-kutaneo-okular
Improvement during
hospitalization discharge
Case report :
A 9 years old girl admitted with
Steven Johnson Syndrome due
to antibiotic ( DD : NET)
a. Infectious
b. Drug-induced
c. Malignancy-related
d. Idiopathic
MANIFESTASI KLINIS
Kulit :
Eritem, papula, vesikel, atau bula
Predilepsi : ektensor tangan, kaki + muka,
yang meluas ke seluruh tubuh sampai ke
kulit kepala .
Keadaan lanjut : erosi, ulserasi, kulit
mengelupas .
MANIFESTASI KLINIS ( 3 )
• Mukosa :
Mulut, tenggorokan dan genital
Vesikel, bula, erosi, ekskoreasi, pedarahan,
krusta warna merah .
Pada faring bisa terbentuk
pseudomembrane sulit menelan .
• Mata :
Konjungtivitis kataralis, blefrokonjungtivitis,
iritis, iridosiklitis, palpebra edema dan sulit
dibuka
Pada kasus berat : erosi dan perforasi kornea .
KOMPLIKASI
• Anamnesis“trias”kelainan kulit,mukosa,mata,
dan mencari penyebab .
• Laboratorium :
mencari hubungan dengan penyebab
untuk tatalaksana secara umum.
Laboratorium : ( lanjutan )
1. Rutin : darah tepi Hb, Ht, Lekosit, Trombosit,
Diff Count,hitung Eosinofil total, LED
2. Pem Imunologik : kadar Ig, komplemen C3 & C4 ,
komplek imun .
3. Kultur + sensitivitas ( darah & lesi )
4. Histopatologik : biopsi kulit .
5. Pem. Imunofloresen melihat endapan IgM,
IgA,C3 dan fibrin .
Trauma
Progressive systemic sclerosis
DIFFERENTIAL
(scleroderma)
Erythroderma ichthyosiform congenita
DIAGNOSES
Porphyria cutanea tarda
Epidermolysis bullosa acquisita
Linear immunoglobulin A bullous disease Atopic Keratoconjunctivitis
Chemical Burns
Paraneoplastic pemphigus
Emergent Management of
Bullous systemic lupus erythematosus Thermal Burns
Corynebacterium diphtheriae conjunctivitis Exfoliative Dermatitis
Sebaceous cell carcinoma Ocular Burns
Sjogren Syndrome
Adenoviral conjunctivitis
Toxic Shock Syndrome
Intraepithelial epithelioma Trachoma
Acute generalized exanthematic
pustulosis
THERAPY
Patients should be treated with special attention to airway and
hemodynamic stability, fluid status, wound/burn care, and pain
control.
Therapy for Stevens-Johnson syndrome proceeds as follows:
Withdrawal of any agent suspected of causing the condition is
critically important
Oral lesions are managed with mouthwashes; topical
anesthetics are useful in reducing pain and allowing the patient
to take in fluids
Areas of denuded skin must be covered with compresses of
saline or Burow solution
Tetanus prophylaxis must be addressed
TERAPI
1. Tx Cairan dan elektrolit, serta kebutuhan
kalori dan protein.
2. Antibiotika spektrum luas atasi infeksi
3. Kortikosteroid parentral
4. Perawatan kulit dan mata serta terapi
antibiotika topikal
5. Faktor Penyebab : segera ditasi .
OCULAR THERAPY
Bullous
Pemphigoid
Often affects
the elderly
Dermatitis Herpetiformis
Associated with gluten intolerance
Pemphigus
Affects middle-aged or elderly
Cicatricial Pemphigoid
Mucosal involvement, sometimes cutaneous
Differential Diagnosis, cont.
Varicella/Zoster Virus
Hand-Foot-Mouth
Disease
(Enteroviruses) Contact Dermatitis
Differential Diagnosis, cont.
Erythema Multiforme
Staphylococcal Scalded Skin Syndrome
Bullous Impetigo
Toxic Shock Syndrome
Paraneoplastic Pemphigus
Cutaneous emboli
Diabetic Bullae
Porphyria Cutanea Tarda
Porphyria Variegata
Pseudoporphyria
Bullous dermatosis of Hemodialysis
Coma Bulloae
Epidermolysis Bullosa Acquisita
SKIN BIOPSY
2 points, ≥12.1%
3 points, ≥35.3%
4 points, ≥58.3%