Rinitis Alergi (RA) =

kelainan hidung karena proses

inflamasi mukosa hidung yang
dimediasi oleh hipersensitifitas tipe I

sensitisasi

aktivasi

Classical Pathophysiology of Allergic Inflammation

( Sensitization phase, Early phase, Late phase )

(II)

EARLY PHASE
Rhinorea
Sneezing
Congestion

(I)

A
C
U
T
E
S
Y
M
T
O
M
S

Mastosit
Histamine
Triptase
PGD2
LTs
Cytokines

Allergen

LATE P H A S E
IgE antibody

IgE

IgE

IgE-bearing B-cells
MHC

CHRONIC

Th2

INFLAMMATION

Basic
proteins
Lts
Cytokines

Fragment

HISTAMINE

Lts
Cytokines

( Adapted from Creticos, 1998 )

(LATE PHASE)

Rhinorea
Sneezing
Congestion

MAST CELL DEGRANULATION

YY

allergen

Y Y Y

Newly formed mediators

PLA2 AA + PAF
C.O

PGD2

Preformed mediators
Histamine, Heparin, Tryptase,
TNF , TGF , IL 3, 4, 5, 13

5 L.O

LTC4
LTD4
LTE4

LTB

HISTAMINE EFFECTS
HISTAMINE
DEGRADATION

( histamine methyl transferase)

H1-R
Vascular wall

Nociceptive Nerves
CNS
Itch.
Systemic Reflexes
Sneeze
Allergic Salute
Parasympathic Reflexes
Glandular Exocytosis

Endothelium
(Vascular Permeability)

Vasodilatation
Serous/Mucous Secretion

Mild
intermittent

Moderate
severe
intermittent

Mild
persistent

Moderate
severe
persistent

Intranasal steroid
Local cromone

Second-generation nonsedating H1 antihistamine

Intranasal decongestant (<10 days) or oral decongestant
Allergen and irritant avoidance
ARIA = Allergic Rhinitis and its Impact on Asthma.
Bousquet et al. Allergy. 2003;58:192.
Bousquet et al. Allergy. 2002;57:841.

Immunotherapy
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