Preceptor:

dr. Oscar Djauhari, Sp.THT-KL

Presentants
Keyne Christa Monintja 2013-061-111
Laura Cynthia Bria 2013-061-113


Allergic Rhinitis
Case Presentation
Patients Identity
Name : Child B
Gender : Male
Age : 13 years old
Race : Sundanese
Occupation : Junior high school student
Address : Cisaat, Sukabumi

Complain
CHIEF COMPLAIN
Runny, stuffy, itchy nose since 2 weeks ago

ADDITIONAL COMPLAIN
Red, itchy, watery eyes

History of Present Illness
A 13 year old boy came to the ENT clinic with runny,
stuffy, and itchy nose accompanied by red, itchy,
watery eyes. He felt this symptoms especially in the
morning but relieve in the afternoon. The boy also
had this symptoms when he is playing at the outside.
He already had these symptoms for 2 weeks. He
already used over the counter cold remedies but had
not brought any relief.
History of Past Illness
His father recalled his child having had similar symptom
but milder symptoms the previous year after moving
from the apartment to the current home. Child B lived
with his parents in family home. He adopt one furry dog
at home 3 weeks ago, no issues with mice or
cockroaches, and nobody smoked in the home. He
enjoyed go out with his dog in the morning before
going to school.

History of Family Illness
His father with allergies to seafood

Physical Examination
General condition : appearing mildly ill
Blood pressure : 100/70 mmHg
Pulse : 80 beats/minute
Respiratory rate : 24 times/minute
Temperature : 36,3

Physical Examination
General Facial features :
Allergic salute (+)
Allergic crease (+)
Allergic shiner (+)
Eyes :
Injection and swelling of the palpebral conjunctivae,
with excess tear production

Physical Examination
Left ear
Auricle : normal
External auditory canal:
hyperemic (-), edema (-), mass (-),
laceration (-), secretion (-),
cerumen (-)
Tymphanic membrane: Intact,
hyperemic (-), bulging (-), light
reflex (+)

Right ear
Auricle : normal
External auditory canal:
hyperemic (-), edema (-), mass (-),
laceration (-), secretion (-),
cerumen (-)
Tymphanic membrane: Intact,
hyperemic (-), bulging (-), light
reflex (+)

Physical Examination
Left nose
Mucous membrane:
Blue-gray (+) , swollen (+) , Thin
and watery secretions (+), mass (-
), laceration (-), crust (-)
Inferior conchae : eutrophy
Septum : no deviation
Air passage : normal

Right nose
Mucous membrane:
Blue-gray (+) , swollen (+) , Thin
and watery secretions (+), mass (-
), laceration (-), crust (-)
Inferior conchae : eutrophy
Septum : no deviation
Air passage : normal

Physical Examination
Oropharynx
Posterior pharynx : hyperemic (-) secretion (-)
Palatine tonsils : T1 / T1, hyperemic (-), detritus (-)
Uvula : symmetrical
Dental : no abnormatlities

Maxillofacial : symmetrical
Neck : mass (-), lymphadenopathy (-)
Lung : VBS (+/+) Rhonki (-/-) wheezing (-/-)


WORKING DIAGNOSIS
Allergic Rhinitis

DIFFERENTIAL DIAGNOSIS
Vasomotor rhinitis

DIAGNOSIS
WORKUP
Skin test
Total serum IgE
Total blood eosinophil count
Treatment
Know and avoid allergen
Pharmacological management
Cetirizine 1x10 mg PO for 7 days
Pseudoephedrine 4x60 mg PO if needed
Nasal saline spray 2x2 sprays per nostril


RHINITIS ALLERGY
According to ARIA:
An inammatory disorder of nasal mucosa, which is characterised by
o Sneezing
o Rinorrhea
o Itching
o Nasal congestion and obstruction
As a response to allergen exposure which mediated by imunoglobulin E
(IgE)
Definition
Aects 400 million people worldwide
Mostly occcur in child 9-11 years old
Decreasing the quality of life
Epidemiology
Atopic: the formation of spesific abnormal IgE as a
response to allergen
Risk factor:
Polluted environment
Exposure to the allergen
High concentration of IgE in serum
Etiology
Classification
Patophysiology
Symptoms
o Sneezing
o Rinorrhea
o Itching
o Nasal congestion and obstruction
Orbital involvement
Lacrimation
Conjungtival swelling and erythema
Eyelid swelling
Diagnosis
Anterior rhinoscopy
Concha hypertrophy
Edematous mucosa,
gray to blue
Rinorrhea
Allergic shiner
Allergic crease
Allergic salute
Physical Examination
Skin Test
In Vitro: RAST
Further Examination

Topical Pharmacoteraphy
Topical Pharmacoteraphy
Oral Pharmacoteraphy
Oral Pharmacoteraphy
Oral Pharmacoteraphy
Otitis media
Acute or chronic sinusitis
Complication