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Preceptor:

dr. Oscar Djauhari, Sp.THT-KL

PresentantsKeyne Christa Monintja 2013-061-111

Laura Cynthia Bria 2013-061-113

Allergic RhinitisCase Presentation

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Patients Identity

Name : Child B

Gender : Male

Age : 13 years old

Race : Sundanese

Occupation : Junior high school student Address : Cisaat, Sukabumi

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Complain

CHIEF COMPLAIN

Runny, stuffy, itchy nose since 2 weeks ago

ADDITIONAL COMPLAIN

Red, itchy, watery eyes

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History of Present Illness

A 13 year old boy came to the ENT clinic with runny,

stuffy, and itchy noseaccompanied by red, itchy,watery eyes. He felt this symptoms especially in themorningbut relieve in the afternoon. The boy alsohad this symptoms whenhe is playing at the outside.

He already had these symptoms for 2 weeks. Healready used over the counter cold remedies but hadnot brought any relief.

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History of Past Illness

His father recalled his child having had similar symptom

but milder symptoms the previous year after movingfrom the apartment to the current home. Child B livedwith his parents in family home. He adopt one furry dogat home 3 weeks ago, no issues with mice or

cockroaches, and nobody smoked in the home. Heenjoyed go out with his dog in the morning beforegoing to school.

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History of Family Illness

His father with allergies to seafood

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Physical Examination

General condition : appearing mildly ill

Blood pressure : 100/70 mmHg

Pulse : 80 beats/minute

Respiratory rate : 24 times/minute

Temperature : 36,3

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Physical Examination

General Facial features :

Allergic salute (+)

Allergic crease (+)

Allergic shiner (+)

Eyes :Injection and swelling of the palpebral conjunctivae,with excess tear production

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Physical Examination

Left ear

Auricle : normal External auditory canal:

hyperemic (-), edema (-), mass (-),laceration (-), secretion (-),cerumen (-)

Tymphanic membrane: Intact,hyperemic (-), bulging (-), lightreflex (+)

Right ear

Auricle : normal External auditory canal:

hyperemic (-), edema (-), mass (-),laceration (-), secretion (-),cerumen (-)

Tymphanic membrane: Intact,hyperemic (-), bulging (-), lightreflex (+)

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Physical Examination

Left nose

Mucous membrane:Blue-gray (+) , swollen (+) , Thinand watery secretions (+), mass (-), laceration (-), crust (-)

Inferior conchae : eutrophy

Septum : no deviation

Air passage : normal

Right nose

Mucous membrane:Blue-gray (+) , swollen (+) , Thinand watery secretions (+), mass (-), laceration (-), crust (-)

Inferior conchae : eutrophy

Septum : no deviation

Air passage : normal

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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 (-/-)

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WORKING DIAGNOSIS

Allergic Rhinitis

DIFFERENTIAL DIAGNOSIS

Vasomotor rhinitis

DIAGNOSIS

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WORKUP

Skin test

Total serum IgE

Total blood eosinophil count

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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

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RHINITIS ALLERGY

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According to ARIA:

An inflammatory 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

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Affects 400 million people worldwide

Mostly occcur in child 9-11 years old

Decreasing the quality of life

Epidemiology

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Atopic: the formation of spesific abnormal IgE as aresponse to allergen

Risk factor:

Polluted environment

Exposure to the allergen

High concentration of IgE in serum

Etiology

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Classification

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Patophysiology

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Symptoms

o Sneezing

o Rinorrheao Itching

o Nasal congestion and obstruction

Orbital involvement

Lacrimation

Conjungtival swelling and erythema

Eyelid swelling

Diagnosis

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Anterior rhinoscopy

Concha hypertrophy Edematous mucosa,

gray to blue

Rinorrhea

Allergic shiner

Allergic crease

Allergic salute

Physical Examination

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Skin Test

In Vitro: RAST

Further Examination

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Topical Pharmacoteraphy

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Topical Pharmacoteraphy

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Oral Pharmacoteraphy

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Oral Pharmacoteraphy

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Oral Pharmacoteraphy

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Otitis media

Acute or chronic sinusitis

Complication