Tips Dan Trik Menegakkan Diagnosis Rinitis Alergi

7/24/2019 Tips Dan Trik Menegakkan Diagnosis Rinitis Alergi

1/21

TIPS DAN TRIKSRINITIS ALERGI

dr. Lusiana Herawati Y, Sp. T.H.T.K.L

RSUD Raden Mattaher

a!"i


2/21

PENDAHULUAN

#PS !en$e%uar&an '(( )enispen*a&it untu& d+&ter %a*ananpri!er

Sa%ah satun*a ada%ah rinitis a%er$i


3/21

GEALA ALERGI MULTIPLE TARGET -RGAN

/ 0 DI KEPALA LEHER Hidung Tenggorok Mulut Telinga Mata

Ku%it #r+n&us Sa%uran pen1ernaan


4/21

Dia$n+sis

Ana!nesis

Pe!eri&saan 2sis

Pe!eri&saan penun)an$ Pe!eri&saan in 3i3+

Pe!eri&saan in 3itr+


5/21

ANAMNESIS

Riwa*at pen*a&it se1ara u!u!

Pertan*aan %e"ih spesi2& $e)a%a dihidun$,te!pat tin$$a%4&er)a dan pe&er)aan penderita

Ge)a%a rinitis a%er$i *$ per%u ditan*a&an ad% #ersin "ersin 56/ 7 setiap &a%i terpapar a%er$en8

Rin+re

Hidun$ tersu!"at 5!enetap4"er$anti9$anti8,$ata%

dihidun$, ten$$+r+&, %an$it9%an$it4te%in$a Kd$ disertai!ata $ata%, "erair4&e!erahan,

hip+s!ia4an+s!ia, PND4"atu& &r+ni&


6/21

ten$$+r+& terdapat sensasi $%+"us d$serin$ "erdehe!, "atu&

:re&uensi seran$an, "eratn*apen*a&it, %a!a sa&it,inter!itten4persisten

Apa&ah "erpen$aruh thp &ua%itashidup seperti $$ thp pe&er)aanse&+%ah, tidur dan a&ti2tas seharihari


7/21

Mani;estasi pen*a&it a%er$i %ainse"e%u!4"ersa!aan d$n rinitisAs!a "r+n&ia%

Der!atitis at+pi

Urti&aria

A%er$i !a&anan

Riwa*at at+pi di &e%uar$aApa&ah ada an$$+ta &e%uar$a dari

a*ah4i"u *an$ perna !enderita sa%ahsatu pen*a&it ts" diatas


8/21

:a&t+r pe!i1u ti!"u%n*a $e)a%a Rinitis a%er$i

Lin$&un$an diru!ah, te!pa& &er)a, se&+%ah

Apa&ah ada hu"un$an antara h+"i penderita*an$ dapat !e!pr+3+&asi ti!"u%n*a $e)a%a

Penderita rinitis a%er$i dapat "er&e!"an$!en)adi &eadaan hipera&ti2tas hidun$ thp iritan

n+n spesi2& spt asap r+&+&, "au *$ !eran$san$,udara din$in, p+%utan, "au par;u!, "au de+d+ran

Riwa*at pen$+"atan

E;e&ti2tas +"at *an$ di$una&an se"e%u!n*a

Ma1a! pen$+"atan *an$ sdh diteri!a Kepatuhan "er+"at


9/21

Ge)a%a spesi2& pada ana& A%%er$i1 shiner

A%%er$i1 sa%ute

A%%er$i1 1rease :a1ies aden+id


10/21

Pe!eri&saan :isis :+&us pd hidun$, !ata,

ten$$+r+& dan te%in$a Rin+s&+pi anteri+r atau

nas+end+s&+pi

Mu&+sa hipere!i, pu1at, Li3ideRin+re seperti air, ser+us,

!u&us

Ede!a atau hipert+pi &+n&a

P+%ip, sinusitis, de3iasi =

P+steri+r :arin$ cobblestoneappearance


11/21

Tes A%er$i

In3i3+ Test

oS&in Pri1& TestoIntrader!a% Di%uti+n Test5 IDT 8

Sin$%e Di%uti+n

Mu%tip%e Di%uti+noNasa% Pr+3+1ati+n Test

In3itr+ Testo

A%%er$en Spe1i21 I$ EAssa*RAST

RAST M+di21ati+n

oNasa% S!ear


12/21


13/21

Watery anterior and sneezing

*es

Nasal obstruction

Symptoms occur at the

same time every year

N+

Post nasaldrip

Colored discharge

and/orfacial pain

Thepatientmay beallergic

Thepatientis likely

to beallergic

Thepatient isunlikely tobe allergic

Suspectchronic

rhinosinusitis


14/21

Symptoms suggestive of

Allergic Rhinitis

skin prick test

(+)

eosinophil on nasal cytology

(+) (-)

non allergicrhinitis

NARES

(-)

Allergic rhinitis

Classify andassess severity


15/21

Allergic rhinitis ARIA-W! classification

IntermittentSymptom:

>< 4 days/ week

>or < 4 weeks

PersistentSymptom

* > 4 days/ week

* and > 4 weeks

M+derate9se3ere> a"n+r!a% s%eep> a"n+r!a% dai%* a1ti3ities> w+r& and s1h++% pr+"%e!s> distur"in$ s*!pt+!s

Mi%d> n+r!a% s%eep> n+r!a% dai%* a1ti3it*,

sp+rt, re1reati+n>n+r!a% w+r& ? s1h++%>n+ distur"in$ s*!pt+!

G%+ria @'


16/21

PENATALAKSANAANRINITIS ALERGI

Tu)uan pen$+"atan !e598 $e), per"ai&an &ua%itashidup, !598 ES +"at, edu&asi, !en$u"ah )a%ann*apen* 4 terapi &ausa%


17/21

Intermittent symptoms

ild"ot in preferred order

-ra% H'"%+1&er

+r intranasa%

and4+r de1+n$estant

!iagnosis o" #llergic rhinitis


18/21

Intermittent symptoms #ersistent symptoms

oderate$se%ere ild

"ot in preferred order-ra%4 intranasa% H'"%+1&er

and4 +r de1+n$estant+r intranasa%


19/21

#ersistent symptoms

$oderate- severe

improved failure

Step-do%n & continue ' (mo Revie% ) D*+ complianceInfection or other causes

Increaseintranasal &S

doses

'hinorrheaadd

ipratropium

(lockade) adddecongestant/ ral

&S

,ailure) referred to specialist

&onsider speci+c

!iagnosis o" #llergic rhinitis

In preferred orderIntranasal CS, ! bloc"er

'e%iew a"ter ,$4 weeks

Updated ARIA re1+!!endati+n5A%%er$* Sup% BC C @B8


20/21

DA:TAR PUSTAKA


21/21

Tips Dan Trik Menegakkan Diagnosis Rinitis Alergi

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