Pengantar lunch simposium

alergi dan imunologi

pada anak
Prevalensi & Pencegahan

Dalam rangka desiminasi

Forum Nasional Sadar Alergi (ForNASA)
Sofyan Ismael
Ikatan Dokter Anak Indonesia
 DIAGRAM KERANGKA KONSEPTUAL PROSES TUMBUH KEMBANG ANAK

LINGKUNGAN

Ibu
 Ibu
o Pendidikan
o Gizi (Early Life
 Anggota keluarga
o Ayah
o Saudara
 Lingkungan
tetangga
 Sarana bermain
 Kebijakan
Pemerintah
o KEMKES
o Pendidikan
Nutrition)
o KB
o Kemendikbud
o Kemenag, dll
 Rumah  Fasyankes  Sosial budaya
Gizi (Early Life Nutrition)
o Exclusive  Suasana rumah (Dokter) masyarakat
Breathfeeding  Sistem Pendidikan  Lembaga non
KB
o MPASI
Imunisasi
Nasional
 Lembaga Riset
pemerintah

 Pengobatan (oralit)  ForNASA

MIKRO MINI MESO MAKRO
Exclusive Breastfeeding
Utilisasi Growth Chart
KEBUTUHAN DASAR ANAK

Makanan Pendamping ASI ASIH

ASUH ASAH

Primary prevention
Imunisasi
Pengobatan
FETUS sederhana
NEONATUS BAYI ANAK REMAJA
in allergy TUMBUH - KEMBANG
(oralit)
Air bersih
GENETIK / HEREDOKONSTITUSIONAL
MIKRO INDIVIDU
 WHO / WAO meeting on the
Prevention of Allergy and Allergic Asthma,
Geneva, 8-9 January 2002

• Over 20% of the world population is atopic

• Asthma occurs in 10-15% of the paediatric
population
• Asthma affects approximately 150 million
people worldwide
 Atopic Dermatitis :
Significance
• May be the first step in the Allergy March:
the relationship between allergic
manifestations throughout life

– Approximately 75- 80% of atopic dermatitis

patients develop allergic rhinitis
– More than 50% of atopic dermatitis patients
develop asthma

Leung DY - J Allergy Clin Immunol - 01-DEC-2003; 112(6 Suppl): S117

Spergel J Allergy Clin Immunology 2003; 112 (6 Suppl): S 118-27
 The Allergic March

Atopic, GI and dermal allergy

Upper respiratory tract
(rhinitis, rhino-conjunctivitis, allergic otitis media)
(75-85 %)
Lower respiratory tract
(wheezing)

Allergic asthma (50 %)

Cantani, 1999 Invest Allergol Clin Immunol 9(5)- 314-20
Allergy is a chronic disease

Adapted from Holgate S Church MK eds. Allergy. London: Gower Medical Publishing 1993
 Atopic Dermatitis :
Significance

• Healthcare Costs in the U.S.

–1.6 billion (conservative)
–3.8 billion (all inclusive)

Ellis CN, Drake et al. J Am Acad Derm 2002, 46: 361-70

 Preventing Pediatric Allergy
• Allergy, particularly atopic dermatitis, is a
significant health issue
– High incidence in developed countries
– Increasing incidence and prevalence
– High costs
– Impact on quality of life
– Allergy March may greatly magnify the problem

Primary Prevention is a Priority

 Good Clinical Governance
(Tata kelola klinis yang baik)

Education
& Training
Risk Clinical
management audits
Clinical
Governance
EBM
Problem
Account-
Clinical Babies with feeding
Atopic ability
Effective- # Valid
challenges (30%-50%)
ness
dermatitis Research &
# Important
# Feeding Intolerance
development # Cow’s Milk Protein
# Applicable
EBM Allergy
Prevalence ?

Financial
Burden of Cost-effectiveness
disease Cost-benefit analysis consequences
analysis
burden of disease
 burden of disease

Mengapa prevalensi meningkat ?

• Perubahan pola hidup
• Pola makanan
• Polusi lingkungan
• Tata kelola klinis belum memadai
 Genetic Factors
A Positive family history for allergy

Risk of allergy

Both parent no One sibling One parent Both parent

allergies with allergy with allergy with allergies

10 % 20-30 % 20-40 % 60% - 80 %

risk of allergy risk of allergy risk of allergy risk of allergy

Sensitivity 61 %; Specificity 83%

Koning,1996; Bousquet,2002
 Prevention in infant

Exclusive breast feeding

pHF or eHF & probiotic
Primary prevention (risk factor !)

burden of disease

Pencegahan dilakukan sebelum timbul gejala alergi,

terutama pada bayi yang mempunyai faktor risiko
 Prevention in infant

Suppress disease expression

after sensitization
burden of disease

Secondary prevention
eHF/AAF

Anak yang telah terpajan alergen, tetapi dengan manifestasi yang

ringan, misalnya eksema dengan tujuan untuk mencegah terjadinya
rinitis dan asma
 Prevention in infant

Tertiary prevention
Elimination diet, eHf/AAF, Steroid,
Antihistamine, Emergency treatment

Treatment to avoid
burden of disease
recurrence of symptom
(clinical manifestation)

Anak sudah terkena rinitis atau asma, dengan tujuan supaya

penyakitnya tidak terjangkit kembali, tidak bertambah berat, dan
diupayakan tidak berlanjut sampai dewasa
Co-morbidities of allergic rhinitis
 Tata kelola klinis yang baik
P2KB
Kendali mutu dan
Patient safety Audit medik Kendali biaya
Education
& Training Valid
Important
Risk Clinical Applicable
management audits
Clinical
Persetujuan Governance EBM:
Clinical # HTA
Account-
Effective- # Clinical guidelines
ability
ness # Clin pathways
Research & # Algorithms
development # Protocols
Rekam medik
# Procedures
Manajemen alergi #Standing orders
Recommendations regarding milk-formula

• Breastfeeding is highly recommended for high-risk

infants, as exclusive breastfeeding is more protective
than hydrolized formula. However, a hydrolyzed formula
can be recommended for high-risk infants who cannot
be completely breastfed. Grade A, Level 1
Osborn DA, Sim J. Formula containing hydrolyzed protein for prevention of allergy
and food intolerance infant. Cochrane Database Syst Rev. 2006(4):CD003664

• Cow’s-milk based formula should be avoided in the first

5 days of life as the administration of cow’s milk-based
formula during the first 5 days in the newborn nursery
increases the risk of specific sensitization. Grade C, Level 2
Kjaer HF et al. The prevalence of allergic diseases in an selected group of 6-year-old
children. The DARC birth cohort study. Pediatr Allergy Immunol. 2008 Dec:18(8):737-45
 Why CPG on Food Allergy

OVER DIAGNOSIS TRIVIALIZED

Perceived >> True True food allergy can
be life threatening

Unsubstansiated
Tests and Treatments
Tujuan Panduan Praktik Klinis (CPG)
• Meningkatkan kualitas pelayanan pada
keadaan klinis dan lingkungan tertentu
• Mengurangi intervensi yang tidak perlu
atau berbahaya
• Memberikan opsi pengobatan terbaik
dengan keuntungan maksimal
• Memberikan opsi pengobatan dengan
risiko terkecil
• Tata laksana dengan biaya yang memadai
 Algoritme pencegahan alergi pada anak
(UKK Alergi 2015)
ADA RISIKO
Tidak ada pantang makanan tertentu
untuk pencegahan penyakit alergi
Masa kehamilan
Hindari pajanan asap rokok aktif dan pasif

ASI eksklusif 6 bulan

Bila ASI eksklusif tidak memungkinkan,

ASI/pengganti beri formula hidrolisat parsial atau
ASI ekstensif sampai 4-6 bulan

Makanan padat mulai diberikan pada

Makanan anak usia 4-6 bulan secara bertahap
Sesudah lahir padat
Restriksi diet terhadap makanan tertentu
tidak diperlukan
Lingkungan

Hindari pajanan asap rokok