DIAGNOSIS & TATALAKSANA

RINITIS ALERGI

Sumadiono
Bagian Ilmu Kesehatan
Anak FK UGM
 Allergy Management

Educati-
on

Manage- Drug-
Diet ment therapy

Immuno-
therapy
3
 PENDAHULUAN
• Rinitis alergi  penyakit inflamasi yang banyak ditemui 
prevalensi : bervariasi, 15 – 20 %
• Int. Study of Asthma & Allergies in Children (ISAAC) di
Indonesia: 0,8%-14,9%(6-7 th), 1,4%-39,7%(13-14 th) , 10-
20% % dewasa
• Prevalensi terbesar  usia 15-30 tahun  prevalensi pada
usia sekolah dan produktif  penurunan kualitas hidup 
fisik, emosional, gangguan bekerja dan sekolah, gangguan
tidur malam hari akibat sumbatan hidung, sakit kepala, lelah,
penurunan kewaspadaan dan penampilan
• FAKTOR : .lingkungan ( alergen,polutan ), perub.gaya
hidup, kebiasaan pola mkn, kejadian infeksi
 RINITIS ALERGI

• Definisi

– Kelainan pada hidung dengan gejala bersin,

rinore, gatal, tersumbat setelah mukosa
terpapar alergen yang diperantarai IgE
(WHO-ARIA 2001)
 6 school of medicine - gadjah
mada university

DIAGNOSIS
 History taking
 Physical examination
 Allergic test
 In vivo : prick test
 In vitro : IgE specific
 Support examination
 CT scan of the Para nasal sinuses
 Or MRI
 ITCHY
TRIAS
ALLERGIC RHINY NOSE
RHINITIS SNEEZE

7
LATE PHASE

Nasal Blockade
Mouth Respiration 8
 Allergic
Conjunctivitis

ALLERGIC SHINERS
D-MORGAN LINE

9
AllergicConjunctivitis Palpebra type Allergic Conjunctivitis Limbal type
Salute sign 10
 11
Grimace
 CLASSIFICATION
BASED ON
TIME OF EXPOSURE ALLERGEN

 INTERMITTEN
 OCCURRED < 4 DAYS/IN A WEEK OR 4
WEEKS IN A YEAR
 PERSISTENT
 OCCURRED > 4 DAYS IN A WEEK AND
> 4 WEEKS IN A YEAR
 OCCUPATIONALE
 OCCURRED DURING IN WORKPLACE
 CLASSIFICATION OF
ALLERGIC RHINITIS :

BASED ON DURATION BASED ON THE SEVERITY OF

OF ATTACK DISEASE
1. Mild : no disturbance of:
1. Intermittent
• Sleeping pattern
• < 4 days in a week • Working/studying
• < 4 weeks in a year • Social activities
2. Persistent 2. Moderate/severe : with disturbance of :
• Sleeping pattern
• > 4 days in a week
• Working/studying
• > 4 weeks in a year
• Social activities
3. Occupational 3. With complications : sinusitis, otitis
media

13
 Classification of Allergic Rhinitis
Intermittent Persistent
symptoms symptoms
 <4days per week  >4 days per week
 Or < 4 weeks  Or > 4 weeks

Mild Moderate-severe
 normal sleep One or more items
 normal daily activities  Abnormal sleep
 normal work an school  Impairment of daily
 no troublesome activities, sport, leisure
symptoms  Problems caused at school or
work
 Troublesome symptoms
 15 school of medicine - gadjah
mada university

OBJECTIVE OF THE
MANAGEMENT

1. Decrease morbidity
2. Decrease new attack
3. Reduce sign and clinical symptoms
4. Avoid complication
5. Improve quality of life
6. Reduce drug consumption
Therapeutic considerations of AR16 management
school of medicine - gadjah
mada university

Allergen ARIA WHO 2001

avoidance
indicated when
possible
Immunotherapy
Pharmaco Effective
Specialist prescription
therapy May alter the natural
course of the disease
Safe
Effective
Easy administration

Patient
education
always
indicated
Optional therapy:
Other medications and/or surgery for complications
or Treatment combination of both approaches
 2 Mech allergy.flv

ARIA Guidelines: Recommendations for

Management of Allergic Rhinitis
Moderate
Mild severe
Moderate
persistent persistent
severe
intermittent

Mild
Intra-nasal steroid
intermittent
Local cromone
Leukotriene receptor antagonists

Second-generation nonsedating H1 antihistamine

Intranasal decongestant (<10 days) or oral decongestant

Allergen and irritant avoidance

Immunotherapy
ARIA = Allergic Rhinitis and its Impact on Asthma.
Bousquet et al. J Allergy Clin Immunol. 2001;108 (5 suppl):S147.
 AVOIDANCE DIETS
1. Identify the allergen
2. Identify the allergen in the food supply
– Original form
– Other products that contain the allergen
• Label reading
3. Provide a nutritionally balanced diet within the
context of the allergen avoidance diet

Pediatric allergy: principles and practice. 2nd edition