 Allergic rhinitis (AR) is a symptomatic

disorder of the nose induced after allergen

exposure by an IgE-mediated inflammation
of the membranes lining the nose

• Major inflammatory elements in AR :

Histamine, leukotrienes and eosinophils

Bousquet J, Khaltaev N, Cruz AA, et al. Allergy 2008; 63(Suppl.86): 8-160

 Bersin > 5x/serangan
 Rinore
 Hidung tersumbat
 Hidung dan mata gatal
 Bayangan gelap bawah mata
(allergic shiner)
 Allergic salute
 Allergic crease
 Rinoskopi anterior: Konka livide dan edema,
sekret encer
 Sneezing
Anterior rhinorrhea
Nasal itch

Posterior rhinorrhea
Congestion

 Patients may not present with all symptoms

 Majority of patients experience worst symptoms in the
morning
 Symptoms suggestive Symptoms usually
of allergic rhinitis NOT associated
w/ allergic rhinitis

2 or more of the folowing • Unilateral symptoms

symptoms for > 1 hour on most days • Nasal obstruction w/o other symptoms
• Watery rhinorrhea • Mucopurulent rhinorrhea
• Sneezing (paroxysmal) • Post nasal drip : thick mucus
• Nasal obstruction • Pain
• Nasal pruritus • Recurrent epistaxis
± Conjunctivitis • Anosmia

Refer to a specialist
Classify and assess severity

Bousquet J, Khaltaev N, Cruz AA, et al. Allergy 2008; 63(Suppl.86): 8-160

 Rinitis alergi musiman (seaseonal)
- Negara 4 musim
- Rino konjungtivitis

 Rinitis alergi sepanjang tahun (parenial)

- Intermitten / terus menerus
- Alergen inhalan dan ingestan
 Intermiten (kadang-kadang)
< 4 hari/minggu atau
< 4 minggu
 Persisten (menetap)
> 4 hari/minggu dan
> 4 minggu
 Mild (ringan)

 Moderat - severe (sedang berat):

- gangguan tidur
- gangguan aktivitas harian
- gangguan belajar atau bekerja
 Intermittent Persistent
symptoms symptoms

• < 4 days per week • > 4 days per week

• or < 4 consecutive weeks • and > 4 consecutive weeks

Mild Moderate-Severe
all of the following one or more items

• normal sleep • sleep disturbance

• no impairment of daily activities, sport, • impairment of daily activities, sport,
leisure leisure
• no impairment of work and school • impairment of work or school
• symptoms present but not troublesome • troublesome symptoms

Bousquet J, Reid J, Van Weel C, et al. Allergy 2008; 63: 990-6

Ear Nose Throat
 Skin test : Prick test, Scratch test, SET
 Diet eliminasi dan provokasi (challenge test)
 Pemeriksaan IgE total
 Pemeriksaan IgE spesifik (RAST )
 Pemeriksaan eosinofil darah
 Tes provokasi
 Sitologi hidung
 Allergen
avoidance
(when possible)

Patient’s Treatment Pharmaco

education combination therapy

Immuno
therapy

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

 Agent Sneezing Rhinorrhe Nasal Itchy nose Level of
a evidence
obstruction
Oral H1- ++ ++ + +++ A
antihistamine
Intranasal ++ ++ + ++ A
H1-antihistamine
Intranasal CS +++ +++ +++ ++ A
Oral decongestant 0 0 + 0 A
Intranasal 0 0 ++++ 0 C
decongestant
Intranasal cromones + + + + A

Bousquet J, et al. Allergy 2002;57:841

Bousquet J, et al. Allergy 2008;63 (Suppl.86); 8-160
 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.
 Selektif : alergi berat
 Waktu lama
 Methodes :
› Subcutaneous,
› Sublingual,
› Intranasal,
› Tablets
  Asthma
› 25%-35% of patients with AR also have asthma
› >85% of patients with asthma have AR
 Conjunctivitis
› Prevalence ~50%
 Rhinosinusitis and Nasal Polyposis
› Prevalence of chronic rhinosinusitis >75%
 Otitis Media
 Eczema

Bousquet et al. J Allergy Clin Immund. 2001;108:S147.

 Ganguan fisiologis mukosa hidung  parasimpatis
( N.Vidianus )

 Etiologi belum diketahui ~ fungsi vasomotor:

- Obat-obatan
- Faktor fisik
- Faktor endokrin
- Faktor psikis
 N.Vidianus
Faktor fisik: Obat-obatan :
asap rokok, CPZ, antihipertensi,
udara dingin, vasokonstriktor topikal
kelembaban Parasimpatis
udara tinggi, Endokrin
bau-bauan,
makanan Psikis
pedas dan
panas Dilatasi .darah
Permeabilitas kapiler
Sekresi kelenjer
Keluhan :
 Blocker ( obstruksi ), Sneezer ( rinore )
 Hidung tersumbat kiri/kanan
 Bersin jarang

Rinoskopi anterior :
Konka merah tua, edema, pmkn licin a tdk rata, sekret
serosa/mukoid
Tes Kulit (-)
 Faktor mempengaruhi vasomotor

 Singkirkan rinitis alergi

 Gambaran klinis
 Avoidance

 Simtomatis

 Operasi

 Neurektomi n. vidianus