Patogenesis Rinitis Alergi

ReferatIchsan Juliansyah Juanda

PembimbingProf. Dr. Teti HS Madiadipoera, dr. SpTHT-KL(K) FAAAAI

DEPTARTEMEN TELINGA HIDUNG TENGGOROK BEDAH KEPALA DAN LEHER

FAKULTAS KEDOKTERAN UNIVERSITAS PADJADJARANRSUP DR. HASAN SADIKIN

BANDUNG2015 1

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

2Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Introduction in. Allergic Rhinitis and its 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

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Klasifikasi Rinitis Alergi(ARIA-WHO 2008)

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Patogenesis Rinitis Alergi James N. Baraniuk

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Pathophysiology Of Rhinitis

7Pathophysiology of Allergic and Nonallergic Rhinitis, Betul Sin and Alkis Togias

Pathophysiology Of Rhinitis

8Pathophysiology of Allergic and Nonallergic Rhinitis, Betul Sin and Alkis Togias

IgE Immediate Hypersensitivity(Gel and Coombs Type 1)

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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, Saunder Elsivier, 2014

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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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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

Produksi dan Aksi Mediator Mast Sel

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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 212, Philadelphia, Saunder Elsivier, 2014

• Vasoactive amines• Protease• Prostaglandin• Leukotriens• Cytokines e.g TNF

Respon Cepat dan Lambat

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Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity. In: Cellular And Molecular Immunology, International Edition, Sixth edition, Saunder Elsivier, 2014

Proses Inflamasi Neurogenik Yang Menyebabkan Hidung Gatal Dan Bersin

15Oliver Pfaar. Pathophysiology of Itching and Sneezing in Allergic Rhinitis. Swiss Med 2009;139 35-40

The Hygiene Hypothesis

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Mekanisme Hidung Tersumbat

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Penatalaksanaan Rinitis Alergi

Hindari AlergenBila memungkinkan

FarmakoterapiKeamananEfektifitas

Mudah didapatkan

ImmunotherapyEfektivitas

Oleh SpesialisMenekan awal penyebab

penyakit

Edukasi PasienDiwajibkan

Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147. 19

Manajemen

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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 patient’s

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)

31Krouse, J. Managing the Allergic Patient, Saunders, 2009