Patogenesis Rinitis
Alergi
Referat
Ichsan Juliansyah Juanda
Pembimbing
Prof. Dr. Teti HS Madiadipoera, dr. SpTHT-KL(K) FAAAAI
DEPTARTEMEN TELINGA HIDUNG TENGGOROK
BEDAH KEPALA DAN LEHER
FAKULTAS KEDOKTERAN UNIVERSITAS PADJADJARAN
RSUP DR. HASAN SADIKIN
BANDUNG
2015
Pendahuluan
Rinitis alergi (RA) adalah suatu
gangguan fungsi hidung yang terjadi
setelah pajanan alergen melalui
inflamasi mukosa hidung dengan
diperantai IgE.
(Bersin-bersin, hidung tersumbat,
beringus dan gatal) sembuh spontan
dengan atau tanpa pengobatan
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Introduction in. Allergic Rhinitis and its
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Impact on Asthma (ARIA) 2008 Allergy. 2008
Epidemiology
Survei Nasional 2006 54.6 % di USA
menunjukan hasil positif pada 1 alergen
Angka kejadian rinitis alergi pada poli
klinik rhino alergi di RSHS dari Januari
Desember 201280%
(1037 pasien)
Data epidemiologi mendukung
hubungan antara saluran nafas atas dan
saluran nafas bawah: Asma (+) pada
20-50% pasien RA
RA (+) pada 80% pasien Asma
Prof.Supriyatin, in JIFESS 2012.
A KleinJan et al Clinical & experimental allergy 2009, 40; 494-504
Klasifikasi Rinitis Alergi
(ARIA-WHO 2008)
Patogenesis Rinitis Alergi James N. Baraniuk
Pathophysiology Of Rhinitis
Pathophysiology of Allergic and Nonallergic Rhinitis, Betul Sin and Alkis Togias
Pathophysiology Of Rhinitis
Pathophysiology of Allergic and Nonallergic
Rhinitis, Betul Sin and Alkis Togias
IgE Immediate Hypersensitivity
(Gel and Coombs Type 1)
Mast Cell-derived mediators (vasoactive amines, lipid
mediators, cytokines)
Cytokine-mediated inflammation (eosinophilis, neutrophils)
Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity. In: Basic Imunology
Function and Disorders of The Immune System, Fourth edition, p 208, Philadelphia,
Immediate Hypersensitivity
Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity. In: Basic Imunology
Function and Disorders of The Immune System, Fourth edition, p 210, Philadelphia,
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Immediate Hypersensitivity
Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity. In: Basic Imunology
Function and Disorders of The Immune System, Fourth edition, p 210, Philadelphia,
Saunder Elsivier, 2014
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Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity. In: Basic Imunology
Function and Disorders of The Immune System, Fourth edition, p 211, Philadelphia,
Saunder Elsivier, 2014
12
Produksi dan Aksi Mediator
Mast Sel
Vasoactive amines
Protease
Prostaglandin
Leukotriens
Cytokines e.g TNF
Abbas, AK, Lichtman AH, Pillai S.
Immediate Hypersensitivity. In: Basic
Imunology Function and Disorders of The
Immune System, Fourth edition, p 212,
13
Philadelphia, Saunder Elsivier, 2014
Respon Cepat dan Lambat
Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity.
In: Cellular And Molecular Immunology, International Edition, Sixth edition, Saunder
Elsivier, 2014
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Proses Inflamasi Neurogenik Yang
Menyebabkan Hidung Gatal Dan
Bersin
Oliver Pfaar. Pathophysiology of Itching and Sneezing in Allergic Rhinitis. Swiss Med 2009;139 35-40
15
The Hygiene Hypothesis
16
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Mekanisme Hidung
Tersumbat
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Penatalaksanaan Rinitis
Alergi
Hindari
Alergen
Bila
memungkinkan
Farmakoterapi
Keamanan
Efektifitas
Mudah didapatkan
Manajeme
n
Immunotherapy
Efektivitas
Oleh Spesialis
Menekan awal
penyebab penyakit
Edukasi
Pasien
Diwajibkan
Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147.
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20
Terima Kasih
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Intradermal Dilution Test
The upper outer, hairless surface of the arm is wiped with
alcohol and dried
Mark horizontally from 6 to 1 with 2 cm spaces
After controls are placed, and response indicating the
patients appropriate state
Specific antigen testing begins for #6 dilution of all of the
different antigens
Inject 0,02 mL of antigen to produce 4 mm skin wheal
Observe for 10-20 minutes
If initial test at #6 is negative, another #5 dilution is
placed and so on until the dilutions are shown to be
negative or positive response (horizontal testing)
Krouse, J. Managing the Allergic Patient, Saunders, 2009
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