Allergic Rhinitis

Department of Pediatrics
University of North Sumatera Medical Faculty
H. Adam Malik Hospital

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THE ALLERGIC MARCH

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BMJ 2002
Allergic rhinitis is clinically defined as a
symptomatic disorder of the nose induce by an
IgE-mediated inflamation after allergen exposure
of the membrane of the nose

The new classification of allergic rhinitis:

Uses symptoms and quality of life parameters
Is based on duration: intermitten or persistent
Is base on severity: mild or moderate-severe

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Classification of allergic rhinitis
Intermittent Persistent
Symptoms Symptoms

<4 days per week >4 days/ week

Or<4 weeks and > 4 weeks

Moderate- Severe
Mild
One or more items
Normal sleep
Abnormal sleep
Normal daily actvities,
Impairment of daily activites,
sport, leisure
sport, leisure
Normal work and school
Problems caused at work or scholl
No troublesome sympoms 4
Troublesome symptoms
Allergic Rhinitis
Seasonal allergic rhinitis/Hay fever :
symptom complex that follows sensitization
to windborne pollens of trees, grasses, and
weeds.

Perennial allergic rhinitis : the patient

has year-round symptoms, caused
generally by allergens which exposed with
the patient. Most often by indoor inhalant
allergens.
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The mediator in allergic rhinitis
Nasal blockage
LTC4,LTD4,PGD2,PGI2
Kinins
Nasal itch
Histamin
Histamine

Rhinorrhoea Sneezing
Histamine MEDIATORS Histamine
LTC4,LTD4

Basophil Mast cell Eosinophil

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Pathogenesis

Manifestasi alergi pada hidung lebih sering

dibanding organ lain
The important mediator : histamin
After histamin release, follow by leukotrien
(LTB4, LTC4), PGD2 dan PAF (platelet
activating faktor)
vasodilatation and
vascular permeability
Other mediator : sitokin
50% hypersensitivity reaction type I, late
phase (manifestation 4-6 hr after exposure)
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The pathogenesis in allergic rhinitis
Allergen APC

Th2 cell
IgE B cell Cytokines Cytokines
Mast cell
Basophil Eosinophil
Chemoattractants

Mediator/
Cytokines

Vasodilatation
Edema Nerves
Mucus

CHRONIC INFLAMATION
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Etiology
Weather changes
Food
Dust
House mite, tick
Pollution
Scent of alcohol
Chemical scent :ink,
paint
Detergent ,powder
Pollen
Animal fur

Iritan non spesifik
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Diagnosis / clinical manifestations
Atopy history, Allergic salute, Allergic crease,
Dennie`s line, Allergic shiner, Allergic face

No one`s phatognomonic
Clinical manifestatio : > 4-5 yo
by age

Paroxysmal sneezing Itching of the nose,

Rhinorrhea palate, pharynx, & ears
Nasal obstrucion Itching, redness
Headache / lethargic tearing of the eyes
(conjunctive erythema)
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Diagnosis / clinical manifestations.

The nasal mucous membranes are bluish,

pale
Clear mucoid nasal discharge, may become
purulent (with secondary infection)
Mannerisms (due to the itching nose /
attempts to improve the airway)
Mouth breathing
Fever (unusual)

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Diagnosis / clinical manifestations

SPT
< 3 yo (?)

In vitrro (ELISA, RAST)
sensitivity (-),
expensive
Total IgE
Eosinofil (nasal secret)

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Treatment
General : avoidance of exposure to
suspected allergens/ irritants, environment
control
Immunotheraphy (if cannot avoid the
inhalant allergens)
Medicamentosa :
Antihistamines (AH-1 oral, AH-1 lokal)
Pseudoephedrine (nasal obstruction)
2-5 years : 15 mg / 6 hour
6-12 years : 30 mg / 6 hour
>12 years : 60 mg / 6 hour 14
Treatment .cont
- Topical nasal corticosteroid
(beclomethasone, budesonide,
fluticasone, mometasone) for children
with nasal symptoms are resistant to
antihistamine-decongestant
Initial dosage : 1-2 spray in each nostril
(2-3 times) per day. After 3-4 days as
symptoms improves, the dose /
frequency of use are reduced until a
minimal effective dosage is reached.
Complications : local burning, irritation &
epistaxis 15
Treatment .cont
- Kortikosteroid oral /IM
- Local chromones :
kromoglikat,nedokromil
stabilize mast
cell
- Intra nasal anticholinergik
(ipratropium)
- Antileukotrien : montelukast, zafirlukast

blok reseptor

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Prognosis
Depend on age
more severe
The problem in adult
old age

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