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ALLERGIESE RHINITIS EN CO-MORBIDITEIT

ALLERGIESE RHINITIS EN CO-MORBIDITEIT. DR BEN VERMAAK DURBANVILLE. SYSTEMIESE SIEKTE. ASTHMA. URTIKARIA. ALLERGIESE RHINITIS. SYSTEMIESE SIEKTE. KONJUNKTIVITIS. KOS ALLEGIE. DERMATITIS. LEWENSKWALITEIT. Loss of sleep (Simons, 1996) Daytime fatigue (Hudgel, 1994)

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ALLERGIESE RHINITIS EN CO-MORBIDITEIT

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  1. ALLERGIESE RHINITIS EN CO-MORBIDITEIT DR BEN VERMAAK DURBANVILLE

  2. SYSTEMIESE SIEKTE ASTHMA URTIKARIA ALLERGIESE RHINITIS SYSTEMIESE SIEKTE KONJUNKTIVITIS KOS ALLEGIE DERMATITIS

  3. LEWENSKWALITEIT • Loss of sleep (Simons, 1996) • Daytime fatigue (Hudgel, 1994) • Impaired concentration and learning (Marshall, 1993) Decreased productivity (Juniper, 1991) • Reduced quality of life (Juniper, 1991) • Increased occupational risk (Storms, 1997) • Simons FE. Allergy Asthma Proc. 1996;17:185-189. • Hudgel DW. J Respir Dis. 1994;15:203-208. • Marshall PS, Colon EA. Ann Allergy. 1993;71:251-258. • Vuurman EF, van Veggel LM, Uiterwijk MM, et al. Ann Allergy. 1993;71:121-126. • Juniper EF, Guyatt GH. Clin Exp Allergy. 1991;21:77-83. • Storms WW. Allergy Asthma Proc. 1997;18:59-61.

  4. PROGRESSIE VAN ALLERGIE RHINITIS DERMATITIS ASTHMA

  5. INTRODUCTION Ig E mediated Type 1 hypersensitivity 30% of population only2% on medication Intermittent(Seasonal) Persistent(Perennial)

  6. HYPOTHESIS Allergen T-lymphocytes Mast cell Spesific Ig-E IL-4 IL-3, IL-5 B- lymphocytes VCAM-1 Eosinophils Acute Rhinitis Chronic Rhinitis

  7. PathophysiologyVAN AllergIE:TIpe I HIpersensitivitEITS ReaKSIE TH2 = Type 2 helper T cell; IL = Interleukin; GM-CSF = Granulocyte-macrophage colony–stimulating factor; IgE = Immunoglobulin E.

  8. Investigations • History and clinical evaluation • Skin prick testing • Rast - Phadiatop (inhalent allergy) - Fx 5 (food allergy) • Pharmacia differential atopy test • 96% sensitivity • 94% specificity • 95% reliability

  9. Ideal Systemic Anti-Allergicand Anti-Inflammatory Agent • Potent antihistamine • Broad anti-allergic • Mast cell stabilization • Inhibition of release of mast cell products (e.g. prostaglandins, leukotrienes, histamine, tryptase, cytokines) • Inhibition of release of basophil products (e.g. leukotrienes, histamine, cytokines) • Inhibition of eosinophil migration and adhesion

  10. Anti-Histamines • For sneezing, scratchy throat, itchy eyes • Will have little effect on nasal congestion but may have drying effect • Sedating All cause sedation, some drying, and possible urinary retention • Non-sedating more expensive.

  11. Topical Nasal Steroids • ‘Best allergy medicine going’ • Make the nasal mucosa an inhospitable site for mast cells • Blocks synthesis of both leukotrienes and prostaglandins • Prevents influx of neutrophils

  12. Pre Rx Post Rx

  13. Systemic Steroids • Principals for safe use: • Short term Rx (2 weeks) • Not more than every fourth month • Not instead but in addition to other basic rhinitis medication • Not for children, pregnant woman or IDDM

  14. Systemic Steroids (continued) • Intermediate acting • Prednisone • Methylprednisolone (Depo-Medrol) • Long acting • Dexamethasone • Betamethasone(Celestone soluspan)

  15. anatomie

  16. ANATOMIE • 2 nasale holtes en 3 turbinate • vergroot nasale oppervlak en veroorsaak turbilente lugvloei • middel meatus - maksillêre antra - anterior ethmoidale - frontaal

  17. INLEIDING • insidensie 135/1000 • impak op kwaliteit van lewe • “medical outcome based study” • dieselfde telling as pasiënte met angina & DOPS • hoofrede vir antibiotika as voorskrif

  18. RHINOSINUSITIS • definiesie “Sinusitis is not an entity in itself, but must be considered as an inflammatory disease invovlving the ostiomeatal complex, the nasal cavity, the nasopharynx and the upper and lower respiratory tracts”. Josephson, 1994

  19. HISTOLOGIE • deel van die respiratoriese sisteem • respiratoriese epiteel - vaskulêre, gesilieerde kolomagtige epiteel • “Schneiderian membrane” • bevat bekerselle en sero-musineuse kliere

  20. AETIOLOGIE • viraal mees algemeenste voorloper • sinus obstruksie - allergie - anatomie • minder algemene oorsake - poliepe - mukosale edeem - swangerskap - bloeddruk medikasie - antiosteoporose middels • siliêre disfunksie - sistiese fibrose

  21. NASALE OBSTRUKSIE • mukosaal akute bakterie/virus infeksie allergiese rhinitis vasomotoriese rhinitis poliepe • struktureel septum deviasie agar nasi sel concha bulosa

  22. INFEKTIEWE RHINITIS

  23. ALLERGIESE RHINITIS

  24. POLIEPE

  25. NASALE SEPTUM

  26. MIDDEL MEATUS

  27. SEPTALE SPUR

  28. AGGER NASI SEL

  29. Concha Bullosa

  30. SIMPTOME EN TEKENS • major - gesig pyn/drukking/volheid - nasaal obstruksie rhinorrhoea - postnasale drip - hiposmia/anosmia - koors (slegs in akute stadium)

  31. SIMPTOME EN TEKENS • minor - hoofpyn - halitose - moegheid - tandpyn - hoes - oor pyn/drukking/volheid

  32. DIAGNOSE • klinies - gekiedenis - ondersoek anterior rhinoskopie pharyngeale ondersoek • beperkte waarde vir X-strale

  33. KLASSIFIKASIE • akuuttot 4 weke2 of meer major simptome/tekens 1 major en 2 minor simptome/tekens • subakuut <12weke • akuut 4 of meer akute episodes per jaar herhalend • chronies >12 weke

  34. BEHANDELING • gehospitaliseerde pt. • immuun onderdruk • herhalende respiratoriese infeksie • AB in laaste 6 weke • chroniese infeksie • vermoed weerstandige organisme Beta-Laktaam Weerstandige Antibiotika

  35. KOMPLIKASIES ORBITAAL I preseptale swelling II orbitale sellulitis III subperiostale abses IV orbitale abses V kaverneuse sinus trombose

  36. komplikasies INTRAKRANIAL I meningitis II abses formasie epiduraal subduraal serebraal III Trombophlebitis superior sagitale sinus trombose kaverneuse sinus tombose

  37. ADJUVANTE Rx • hidrasie • sistemiese steroide- kontroversieel • lokale steroide • nie antihistamiene nie • nasale douche - sout/koeksoda • simptomaties

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