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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
3
Klasifikasi Rinitis Alergi(ARIA-WHO 2008)
4
Patogenesis Rinitis Alergi James N. Baraniuk
5
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)
9
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
10
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
14
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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17
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
20
Terima Kasih
21
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