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Allergic Rhinitis

Supervisor :
dr. Oscar Djauhari, Sp.THT-KL

Presentator:
Christian Christopher S (2015-061-070)
Olivia Gianeta
Peter krisdiyanto
Identity
• Name : A

• Age : 14 years old

• Occupation : Student

• Weight : 50 kg

• Address : Sukabumi
Complaints

• Chief complaint : a runny nose

• Additional complaint : an itchy nose


accompanied by red, itchy, watery eyes
History of Present Illness
• The patient came to the hospital with complaints of a
runny and itchy nose accompanied by red, itchy,
watery eyes. The thing that bothered him the most
was that he could no longer breathe through his
nose. He had had these symptoms for 4 weeks.

• The symptoms are getting worse when he woke up


in the morning, and the weather is cold
History of Present Illness

• There were no pets at home and no issues with


mold, mice, or cockroaches. Nobody smoked in the
home.
History of Present Illness

• Currently he is not taking any medication, and there


is no family history of tumors, hearing problems and
hypertensive disease.
History of Family Illness

• History of tumor (-)

• History of allergy (-)

• History of hypertension (-)

• History of diabetes mellitus (-)


General Physical
Examination
General Physical Examination

• General appearance : moderate ill

• Consciousness : compos mentis

• Blood pressure : 110/70 mmHg

• Heart rate : 80x/min

• Respiratory rate : 24x/min

• Temperature : 36.7oC
Face and Neck

• Head : Symmetric, deformity (-)

• Eyes : conjunctivaes were slightly swollen, allergic shiners


(+)

• Neck : lymph node enlargement (-)


• Thorax – Heart: normal

• Abdomen: normal

• Extremity: normal
Ear, Nose, Throat and
Neck Physical
Examination
Auricle
• Right & left auricle :

• External ear : hyperemic (-/-), deformity (-/-),


laceration (-/-), mass (-/-), pain (-/-)

• External acoustic canal : hyperemic (-/-), edema (-/-),


laceration (-/-), secretion (-/-), cerumen (-/-), mass (-/-
)

• Tymphanic membrane : intact, light reflex (+/+)


normal
Nose
• Right & left nose :

• External nose : deformation (-). edema (-), hyperemic (+),


mass (-), laceration (-), Allergic Crease (+)

• Mucous membrane : hyperemic (-), pale (+/+), edema (+/+),


white and serous secret (+/+), crust (-), mass (-)

• Conchae : hypertrophic (+/+), hyperemic (-)

• Septum : no deviation

• Air passage : obstructed / obstructed


Throat
• Oropharynx
• Posterior pharynx : hyperemic (-)
• Palatine tonsils : T1/T1, hyperemic (-), detritus (-)
• Uvula : symmetrical

• Maxillofacial : facial pain on palpation at maxillary


region (-/-)

• Neck : mass (-), lymphadenopathy (-)


Work Up
• Skin Prick Test

• RAST

• Nasoendoscopy
Therapy

• Nasal wash with saline solution

• Cetirizin 1x10 mg PO for 2 weeks

• Beclomethasone 2 x 80 mcg aerosol spray for each


nostril
Diagnosis

• Working diagnosis : Allergic Rhinitis

• Differential diagnosis : Vasomotor Rhinitis, Non


Allergic Rhinitis, Upper Respiratory Tract Infection.
Allergic Rhinitis
Definition

• Allergic rhinitis is clinically defined as a symptomatic


disorder of the nose induced by an IgE-mediated
inflammation after allergen exposure of the membranes
of the nose.
Epidemiology
• Prevalention in US:

• 58 million people allergic rhinitis ± 20%

• 19 million people non-allergic rhinitis

• Diagnosis RA in age of 9 – 11 year old

• Incidence RA on children are increase, 2 times in 10 years


recently

• 5-50% in the world


TBC
Classification of Rhinitis Lues
Specific Frambusia

Sarcoidosis Boeck
Acute
Leprosy
Non-allergic
hipertrofi

Rhinitis simplex

Non- Sicca

Chronic specific Atrofi

Caseosa

True R.Alergi
Allergic
False R. Vasomotor
Symptoms
• nasal congestion,

• rhinorrhea (runny nose),

• postnasal drip,

• sneezing, and an

• itchy nose

• decrease of smelling

• symptoms involving the eyes,


ears, and throat.
Etiology
Immunology

Cellular and Molecular Immunology 5h ed., 2003; Basic Immunology:


Functions and Disorders of the Immune System 2nd ed, 2004
Diagnosis
• Anamnesis
• Physical examination
• Lab test
• Skin Prick Test
• In vitro serum test (RAST)
• Rhinoscopy
Physical Examination
• Allergic shiner

• Dennie Morgan line

• Allergic crease

• Allergic salute

• Normal moccous or oedem

• serous secret

• No structural damage (polyp, septum nasal deviation)


Physical Examination

Allergic Salute Allergic Shiner


Physical Examination

Dennie Morgan line Allergic Crease


Physical Examination
Skin Prick Test
• Mediated IgE

• Response wheal & flare (15-20 menit)

• Positive: wheal > 3cm with flare & pruritus

* Stop use of antihistamines before taking this test


In vitro serum test (RAST)
Nasoendoscopy
THANK YOU