TATALAKSANA RINITIS ALERGIKA

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TATALAKSANA RINITIS ALERGIKADiana Riskilianty1061050122Fakultas Kedokteran Universitas Kristen Indonesia

Tujuan Pengobatan Rinitis Alergika Mengurangi gejala akibat paparan alergen,

hiperreaktifitas nonspesifik dan inflamasi. Perbaikan kualitas hidup penderita sehingga dapat menjalankan aktifitas sehari-hari. Mengurangi efek samping pengobatan. Edukasi penderita untuk meningkatkan ketaatan berobat dan kewaspadaan terhadap penyakitnya. Termasuk dalam hal ini mengubah gaya hidup. Mengubah jalannya penyakit atau pengobatan kausal.

Effy Huriyati, Al Hafiz. Diagnosis dan Penatalaksanaan Rinitis Alergi yang Disertai Asma Bronkial. Bagian Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala dan Leher, Fakultas Kedokteran Universitas Andalas. h.7.

A set of allergen-control measures (washing all walls and floors, removing carpeting from bedrooms, applying tannic acid, washing bedding, replacing duvets and pillows, using impermeable covers, washing the cat every 2 weeks, etc.) Allergen avoidance should lead to an improvement of symptoms.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.53-55.

Oral H1-antihistamines. H1-blockers or H1-antihistamines are medications that block histamine at the H1receptor level. Oral H1-antihistamines are effective against symptoms mediated by histamine (rhinorrhoea, sneezing, nasal itching and eye symptoms) but are less effective on nasal congestion.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.57-58.

Topical H1-antihistamines. Intranasal H1-antihistamines are effective at the site of their administration in reducing itching, sneezing, runny nose and nasal congestion. Given ocularly, they are effective in allergic eye symptoms.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.58-59.

Decongestants. In the treatment of nasal obstruction, in both allergic and nonallergic rhinitis, intranasal decongestants are effective in the short term. However, they do not improve nasal itching, sneezing or rhinorrhoea.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.60.

Kortikosteroid. Kortikosteroid oral sangat efektif dalam mengurangi gejala rinitis alergi terutama dalam episode akut. Efek samping sistemik dari pemakaian jangka panjang kortikosteroid sistemik baik peroral atau parenteral dapat berupa osteoporosis, hipertensi, memperberat diabetes, supresi dari hypothalamic-pituitary-adrenal axis, obesitas, katarak, glukoma, cutaneous striae.

Effy Huriyati, Al Hafiz. Diagnosis dan Penatalaksanaan Rinitis Alergi yang Disertai Asma Bronkial. Bagian Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala dan Leher, Fakultas Kedokteran Universitas Andalas. h.8.

Kortikosteroid. Pemakaian kortikosteroid topikal (intranasal) untuk rinitis alergi seperti Beclomethason dipropionat, Budesonide, Flunisonide acetate fluticasone dan Triamcinolone acetonide dinilai lebih baik karena mempunyai efek antiinflamasi yang kuat dan mempunyai afinitas yang tinggi pada reseptornya, serta memiliki efek samping sitemik yang lebih kecil. Pemakaian dalam jangka waktu yang lama: mukosa hidung menjadi atropi dan dapat memicu tumbuhnya jamur.

Effy Huriyati, Al Hafiz. Diagnosis dan Penatalaksanaan Rinitis Alergi yang Disertai Asma Bronkial. Bagian Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala dan Leher, Fakultas Kedokteran Universitas Andalas. h.8.

Anticholinergic agents. Double-blind, placebocontrolled studies have shown that ipratropium bromide is effective in controlling watery nasal discharge, but that it does not affect sneezing or nasal obstruction in perennial allergic and nonallergic (vasomotor) rhinitis. Side effects: Minor local side effects, Almost no systemic anticholinergic activity.Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.60.

Sodium Kromolin. Suatu penstabil sel mast mencegah degranulasi sel mast dan pelepasan mediator, termasuk histamin.

Dalam bentuk Semprotan hidung. Efek sampingnya : iritasi lokal (bersin dan rasa perih pada membran mukosa hidung. Dosisnya untuk pasien di atas 6 tahun adalah 1 semprotan pada setiap lubang hidung 3-4 kali sehari pada interval yang teratur.Ikawati, Zullies. Rhinitis Alergi. 2009

Allergen-specific immunotherapy is the practice of administering gradually increasing quantities of an allergen extract to an allergic subject to ameliorate the symptoms associated with the subsequent exposure to the causative allergen.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.61.

Subcutaneous immunotherapy is effective in adults and children for pollen and mite allergy, but it is burdened by the risks of side effects. These reactions may be life-threatening. Sublingual immunotherapy is recommended for the treatment of pollen allergy in adults. Intranasal immunotherapy may be used for the treatment of patients with pollen allergy. Subcutaneous immunotherapy appears to be effective several years after its cessation.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.61-64.

As surgery cannot contribute to the treatment of allergic disease itself, it may only be used in certain precise conditions such as turbinate hypertrophy, cartilaginous or bony obstruction of the nasal airways or secondary and independent sinus disease. In patients who have been suffering from perennial allergic or nonallergic rhinitis for many years, a severe drug-resistant hypertrophy of the inferior turbinates may develop, which leads to constant nasal obstruction and watery secretion due to an increase in glandular structures. Consequently, the surgical reduction of the inferior turbinate body and mucosal surface, which should always be limited as much as necessary, reduces nasal obstruction and secretion.Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.65-66.

Endoscopically-controlled minimal-invasive techniques for the sinuses, but also for the turbinates, have replaced former procedures in most countries, and a range of new tools and instruments have beencreated to allow for more precise and less traumatic surgery. Laser surgery (1771) may also be used.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.65-66.

Indications for a surgical intervention are: Drug-resistant inferior turbinate hypertrophy; Anatomical variations of the septum with functional relevance; Anatomical variations of the bony pyramid with functional/aesthetic relevance; Secondary or independently developing chronic sinusitis; Different forms of nasal unilateral polyposis (choanal polyp, solitary polyp and allergic fungal sinusitis) or therapy-resistant bilateral NP (Nasal Polyp); Fungal sinus disease (mycetoma, invasive forms) or other pathologies unrelated to allergy (cerebrospinal fluid leak, inverted papilloma, benign and malignant tumors, Wegeners disease, etc.).Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization). P.65-66.

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