Curriculum Vitae

Name : Ricky Yue

Place / Date of birth : Padang/ 6 Maret 1979

Religion : Catholic

Marital status : Married

Nationality : Indonesia

Contact number : +6281510908715

Educational Background

Medical Doctor (MD), Faculty of Medicine, Atma Jaya Catholic University of Indonesia,
Jakarta, Indonesia ( 1996 2003 ).

Otorhinolaryngology-Head and Neck Surgeon, Department of Otorhinolaryngology-Head

and Neck Surgery, University of Santo Tomas Hospital, Manila, Philippines ( 2005 2008 ).

Otorhinolaryngology-Head and Neck Surgery Specialist (Sp. THT-KL), Adaptation Program,

Faculty of Medicine, Udayana University, Bali, Indonesia ( 2010 2011 ).
 Curriculum Vitae
Experiences
Assistant Staff, Department of Anatomy, Faculty of Medicine,
Atma Jaya Catholic University of Indonesia, Jakarta,
Indonesia ( 2003 2004 ).
Chief Resident, Department of Otorhinolaryngology-Head
and Neck Surgery, University of Santo Tomas Hospital,
Manila, Philippines (July 1, 2008 December 31, 2008).
Chairman, Department of Otorhinolaryngology-Head and
Neck Surgery, School of Medicine, Atma Jaya Catholic
University of Indonesia, Jakarta, Indonesia ( 2013 Now ).
Head of Medical Committee , Atma Jaya Hospital ( 2015-
present )
Allergic Rhinitis : Ricky Yue , M.D.
Focus on a Dept of ENT-HNS
College of Medicine, Atma Jaya
Therapeutic Options Catholic University of Indonesia
 Physician reference
VS
Patients expectations
 Allergic rhinitis as a burden
illness
400 million people worldwide
US > 60 million ( 10-30% adult & 40% children)
Recent survey w/ physician-confirmed Dx AR :
US adult : 14% , Children : 13%
Latin America adult : 7%
Asia-Pacific adult : 9%
In childhood : boy VS Adult : women
Cost AR in US : 6 billion annually
The highest cause productivity loss in US employee

Immunol Allergy Clin N Am 36 (2016)

 80% AR before age 20
German study > 467 children ( 54% boys) :
12-month prevalence of AR quadrupled from 6% (at age 3 years)
to 24% (at age 13 years) in no family history and more than
tripled from 13% (at age 3 years) to 44% (age 13 years) in at
least one parent has allergy.

at least 50% AR has severe persistent symptoms.

Negative impact on Quality of Life
Lancet 2011

ARIA 2008
 Allergic Rhinitis
A symptomatic disorder of the nose
induced after allergen exposure by an
IgE-mediated inflammation.
SAR VS PAR
Intermittent VS Persistent
Mild VS Moderate/Severe
2 / more following symptoms > 1 hr on
most days & 2 / more consecutive days :
watery anterior rhinorhea
Sneezing (paroxysmal)
+/- conjunctivitis
nasal obstruction
nasal pruritus
Confirmation Test : Skin Prick Test / Allergen-specific Ig E
Diagnosing Allergic Rhinitis
( Based on symptoms)

Courtesy of ARIA
2008
The Rhinitis Universe Allergic Rhinitis Algorithm

Immunol Allergy Clin N Am 36 (2016)

 Treatment Options
From the evidence point of
view
 Patients Education
Allergen Avoidance
Medical treatment
Surgical Treatment
Complimentary Medicine
 Allergen Avoidance
Not all irritants can be avoided, newer technology in allergen prevention is not an
answered. Possible but not mandatory
Allergen level is not directly proportional w/ patients symptoms.
In ARIA 2010 revision recommendation :
The clinician DO NOT administer and patients DO NOT use currently available single
chemical or physical preventive methods aimed at reducing exposure to house dust
mites (strong recommendation / low-quality evidence) or their combination (conditional
recommendation / very low-quality evidence).
Avoiding indoor Molds at home (conditional recommendation / very low-quality
evidence).
Avoiding animal dander (strong recommendation / very low-quality evidence)
Immediate and total cessation of exposure to occupational allergen (strong
recommendation / very low- quality evidence). If not possible-> need specific strategies
aimed at minimizing occupational allergen exposure (conditional recommendation / very
low-quality evidence).
STATEMENT 4. ENVIRONMENTAL FACTORS: Clinicians may advise
avoidance of known allergens or may advise environmental controls (eg,
removal of pets; the use of air filtration systems, bed covers, and acaricides
[chemical agents that kill dust mites]) in AR patients who have identified
allergens that correlate with clinical symptoms. Option based on RCTs with
minor limitations and observational studies, with equilibrium of benefit and
harm.

CPG Allergic Rhinitis, AAOHNS, 2015

 Medical Treatment

Based on severity of AR
single / appropriate combination treatment
Step up & step down therapy
 Evidences Summary on Medical Treatment
ARIA 2010 AAOHNS 2015
Recommendation Recommendation
New generation AH1 Strong Strong
Conditional ( against
Intra-nasal AH1 Option
PAR)
Conditional (SAR & PAR
LTRAs children ), Against -> Against
adult PAR
Strong ( adult ),
Intra-nasal CS Strong
Conditional ( Children )
Oral CS Conditional (-) Short course

Ipratropium Bromide Conditional (-) rhinorrhea

INCS + AH1 Against Against

severe , uncontrolled w/
INCS + INAH1 Option
single agent

AH1 + Decongestant Conditional Option observe side effect

AH1 + LTRAs Option

INCS + LTRAs Against

Immunotherapy Conditional Recommendation no response w/ all medical th/

 Diagnosis and Treatment Flow
Charts AR AAOHNS-2015

Adapted from CPG Allergic Rhinitis, AAOHNS, 2015

Adapted from CPG Allergic Rhinitis, AAOHNS, 2015
 Recommendation for
Appropriate Combination
Treatment

Adapted from CPG Allergic Rhinitis, AAOHNS, 2015

Algorithm AR ( MACVIA -
CDSS )

Adapted from Bousquet et al, MACVIA-CDSS Proposed Algorithm for

Allergic Rhinitis , 2016
Algorithm AR ( MACVIA -
CDSS )
 Surgical Treatment
Reasonable option in case failed medical treatment with :
Nasal airway obstruction
Enlarged inferior turbinates who failed medical treatments

STATEMENT 12. INFERIOR TURBINATE REDUCTION: Clinicians

may offer, or refer to a surgeon who can offer, inferior turbinate
reduction in patients with AR with nasal airway obstruction and
enlarged inferior turbinates who have failed medical management.
Option based on observational studies, with a preponderance of
benefit over harm.
 Complimentary Medicine
Acupuncture can be offered to patient
who are interested in non-
pharmacologic therapy.
Mechanism of action still unknown.
Has role in inhibits cytokine synthesis
( IL-6, IL-10)
Some studies showed acupuncture
offer some symptom control and
improve QOL in patient w/ SAR &
PAR.
No recommendation regarding herbal
therapy.
 Conclusion
Allergic rhinitis still one of the burden disease world wide
Despite the availability of guideline, research, technology on allergic rhinitis,
it is frequently ignored, under diagnosed, misdiagnosed and mistreated.
Consideration of patients preference and expectation should be counted
when treating patient with allergic rhinitis.
Comprehensive approach needed in treating allergic rhinitis, including
patient education, irritant avoidance, select appropriate medical or surgical
treatment, and also complimentary medicine.
CPG can assist clinician to establish evidence based decision making
strategy , but not absolute / mandatory.
Clinical judgment and treating AR patient individually is needed by taking
into account harm vs benefit > QOL improvement
 The Purpose of a doctor or any
human in general should not be to
simply delay the death of the patient,
but to increase the persons quality
of life
= Patch Adams =

THANK YOU FOR YOUR ATTENTION