Journal Reading

Allergic Rhinitis
Pembimbing :
Letkol Ckm dr Khairan Irmansyah, Sp. THT-KL., M.Kes

Sabrina Tasya Wardani (30101800159)

Table of contents

01 05 Classification Of
Journal Identity
Rhinitis

02 Abstract 06 Diagnosis

03 Introduction 07 Treatment

04 Pathophysiology 08 Conclusions
09 Critical Appraisal
01

JOURNAL IDENTITY
 Title

Authors

Correspondence

Date Published

Publisher
 02

ABSTRACT
 Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis.

SYMPTOMS
Nasal congestion, nasal itch, rhinorrhea and sneezing.

DIAGNOSIS
A thorough history, physical examination and allergen skin testing are important for
establishing the diagnosis of allergic rhinitis

THERAPY
2nd generation oral antihistamines and intranasal corticosteroids.
Allergen immunotherapy should be recommended if pharmacologic therapy for allergic rhinitis is not
efective or is not tolerated.

This article provides an overview of the pathophysiology, diagnosis, and appropriate management of this disorder
03
INTRODUCTION
Introduction
Rhinitis is infammation of the nasal mucosa.

It is a common disorder that afects up to 40% of the

population

Severe allergic rhinitis has been associated with signifcant impairments in quality of
life, sleep and work performance

Evidence has shown that allergen provocation of the upper airways not only leads to a local
infammatory response, but may also lead to infammatory processes in the lower airways and this is
supported by the fact that rhinitis and asthma frequently coexist
04
PATHOPHYSIOLOGY
 Pathophysiology
Makrophage IL-4, IL-13
Allergen Sel Th 0 Th-2
(APC)

B cells produce
IgE

sensitization

IgE binds mast

cell
Repeat
exposure
Vasodillatation, increased vascular
Cell mast
permeability, itching, rhinorrhea, mucous Release histamine, activation
secretion, and smooth muscle contraction in Prostaglandin, Leukotrin, PAF
the lung
 05
CLASSIFICATION
of RHINITIS
Local Allergic Rhinitis
Local allergic rhinitis (LAR)
is a clinical entity
characterized by a localized
allergic response in the nasal
mucosa in the absence of
evidence of systemic atopy
Occupational Rhinitis
Occupational rhinitis is an infammatory disease
of the nose characterized by intermittent or
persistent symptoms that include airflow
limitation, hypersecretion, sneezing and pruritus
that are attributable to a particular work
environment and not to stimuli encountered
outside the workplace
06
DIAGNOSIS
 Diagnostic tests
1. Skin-prick testing
a) placing a drop of a specifc allergen on
the skin of the forearms or back
b) pricking the skin through the drop to
introduce the extract into the epidermis
c) Within 15–20  min, a wheal-and-fare
response (an irregular blanched wheal
surrounded by an area of redness) will
occur if the test is positive
2. allergen-specifc serum IgE tests
 07

TREATMENT
Treatment
The treatment goal for allergic rhinitis is relief of symptoms

Allergen avoidance avoidance of relevant allergens (e.g., house dust mites, moulds, pets, pollens) and
irritants (e.g., tobacco smoke).

Antihistamines efectively reduce sneezing, itching and rhinorrhea.

The 2nd generation oral anti-histamines (e.g., desloratadine [Aerius], fexofenadine

[Allegra], loratadine [Claritin], cetirizine [Reactine]) are the firstline
pharmacological treatment

Intranasal corticosteroids efectively reduce infammation of the nasal mucosa and improve mucosal pathology

Combination intranasal If intranasal corticosteroids are not efective, a combination

corticosteroid and antihistamine corticosteroid/antihistamine spray can be tried
nasal spray

Leukotriene receptor antagonists LTRAs should be considered when oral antihistamines, intranasal corticosteroids
(LTRAs) and/or combination corticosteroid/antihistamine sprays are not well tolerated or are
inefective in controlling the symptoms of allergic rhinitis
 Allergen Immunotherapy
• Allergen immunotherapy involves the subcutaneous administration of gradually increasing
quantities of the patient’s relevant allergens until a dose is reached that is efective in inducing
immunologic tolerance to the allergen

Kontra
Indikasi Routes of Administration
Indikasi

• patients with severe, unstable or subcutaneous

who have not
responded to or uncontrolled asthma
tolerated • patients on beta-blocker therapy as
conventional well as in those with active oral
infammation or sores sublingual
pharmacotherapy
 Other Therapeutic Options
Oral and intranasal decongestants (e.g., pseudoephedrine, phenylephrine) are useful for relieving nasal congestion
in patients with allergic rhinitis

Side-effect oral
decongestan should not be used for
agitation, insomnia, more than 3–5  days
headache, palpitations

Prolonged use of intranasal

Contraindicated decongestants carries the
uncontrolled hypertension risk of rhinitis
and severe coronary artery medicamentosa (rebound
disease nasal congestion
Other Therapeutic Options

intranasal sodium
Oral corticosteroids The anti-IgE antibody
cromoglycate

efective in patients with

severe allergic rhinitis that
reduce sneezing, (e.g.omalizumab)
is refractory to treatment
rhinorrhea and nasal efective in seasonal
with oral antihistamines
itching allergic rhinitis and asthma
and intranasal
corticosteroids
08
CONCLUSIONS
 Conclusions
Allergic rhinitis is a common disorder that can signifcantly impact patient
quality of life. The diagnosis is made through a comprehensive history and
physical examination. Diagnostic testing using skin-prick tests or allergen-
specific IgE tests. The treatment goal for allergic rhinitis are efective in
managing symptoms and are generally safe and well tolerated
 09
CRITICAL
APPRAISAL
 Article Identity
No KRITERIA YA (+) TIDAK (-)
1 Jumlah kata dalam Judul < 12 kata + (2 kata)
2 Deskripsi Judul + (Menggambarkan isi utama
penelitian, cukup menarik dan
tanpa singkatan)

3 Daftar penulis sesuai aturan jurnal +

4 Korespondensi penulis +
5 Tempat dan waktu penelitian dalam -
judul
 ABSTRACT YA (+) TIDAK (-)
1 Abstrak 1 paragraf +
2 Mencakup IMRC -
3 Secara keselurah informatif +
4 Tanpa singkatan selain baku +
5 Kurang dari 250 kata + (116 kata)

INTRODUCTION Ya (+) Tidak (-)

1 Terdiri dari 2 bagian atau 2 paragraf - (3)
2 Paragraf pertama mengemukakan alasan -
dilakukannya penelitian
3 Paragraf kedua menyatakan hipotesis atau -
tujuan penelitian
4 Didukung oleh pustaka yang relevan +
5 Kurang dari 1 halaman +
 Research Materials and Methods Ya (+) Tidak (-)
1 Jenis dan rancangan penelitian -
2 Waktu dan tempat penelitian -
3 Populasi sumber -
4 Teknik sampling -
5 Kriteria inklusi -
6 Kriteria eksklusi -
7 Perincian cara penelitian -
8 Blind -
9 Uji statistik -
10 Program komputer -
11 Persetujuan subjektif -
 RESULT Ya (+) Tidak (-)
1 Jumlah subjek -
2 Tabel karakteristik subjek -
3 Tabel hasil penelitian -
4 -
Komentar dan pendapat penulis tentang hasil

5 Tabel analisis data dengan uji -

Discussions, Results and Bibliography Ya (+) Tidak (-)

1 Pembahasan dan kesimpulan terpisah +
2 Pembahasan dan kesimpulan di paparkan dengan jelas +
3 Pembahasan mengacu pada penelitian sebelumnya +
4 Pembahasan sesuai landasan teori +
5 Keterbatasan penelitian -
6 Kesimpulan +
7 Saran penelitian -
8 Penulisan daftar pustaka sesuai aturan +
 Validity
No Pertanyaan Ya Tidak
Apakah alokasi pasien pada penelitian ini di-
1. √
lakukan secara acak
Apakah pengamatan pasien dilakukan se-
2. √
cara cukup panjang dan lengkap
Apakah semua pasien pada kelompok yang
3. √
diacak dianalisis
Komentar dan pendapat penulis tentang
4. √
hasil
Apakah pasien dan dokter tetap blind dalam
5. √
melakukan terapi, selain dari terapi yang diuji
 Importancy
No Pertanyaan Ya Tidak
1. Apakah nilai p<0,05? √
Apakah dicantumkan interval √
2. kepercayaan?
3. Apakah dicantumkan resiko relative? √
Apakah dicantumkan absolut risk √
4. reduction?
Apakah dicantumkan relative risk √
5. reduction?
Apakah dicantumkan number need to √
6. treat?
 Applicability
No Pertanyaan Ya Tidak

Apakah pada pasien kita terdapat perbedaan

1. bila dibandingkan dengan yang terdapat √
pada penelitian sebelumnya

Apakah terapi tersebut mungkin dapat diter-

2. √
apkan pada pasien kita
Apakah pasien memiliki potensi yang men-
3. guntungkan atau merugikan jika terapi terse- √
but diterapkan
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