Pengantar lunch simposium

alergi dan imunologi

pada anak
Prevalensi & Pencegahan
Dalam rangka desiminasi
Forum Nasional Sadar Alergi (ForNASA)
Sofyan Ismael
Ikatan Dokter Anak Indonesia

DIAGRAM KERANGKA KONSEPTUAL PROSES TUMBUH KEMBANG ANAK

LINGKUNGAN
Ibu

Ibu

o Pendidikan
o Gizi (Early Life

Anggota keluarga
o Ayah
o Saudara

Nutrition)
o Pendidikan
o KB
Rumah
o Exclusive
Suasana rumah
Gizi (Early Life Nutrition)
Breathfeeding
o MPASI
KB

Imunisasi
Pengobatan (oralit)
MIKRO

MINI

Lingkungan
tetangga
Sarana bermain

Fasyankes
(Dokter)
Sistem Pendidikan
Nasional
Lembaga Riset
MESO

Exclusive Breastfeeding
KEBUTUHAN DASAR ANAK
Utilisasi Growth Chart
ASUH
ASIH
ASAH
Makanan
Pendamping ASI
Primary
Imunisasi
prevention
FETUS
NEONATUS
Pengobatan
sederhana
REMAJA
TUMBUH - KEMBANG
in
allergy
(oralit)
Air bersih
GENETIK / HEREDOKONSTITUSIONAL
MIKRO

INDIVIDU

Kebijakan

Pemerintah
o KEMKES

o Kemendikbud
o Kemenag, dll
Sosial budaya
masyarakat
Lembaga non
pemerintah
MAKRO

ForNASA

BAYI

ANAK

WHO / WAO meeting on the

Prevention of Allergy and Allergic
Asthma, Geneva, 8-9 January 2002
Over 20% of the world population is
atopic
Asthma occurs in 10-15% of the
paediatric population
Asthma affects approximately 150
million people worldwide

Atopic Dermatitis :
Significance

May be the first step in the Allergy

March:
the relationship between allergic
manifestations throughout life

Approximately 75- 80% of atopic

dermatitis patients develop allergic
rhinitis
More than 50% of atopic dermatitis
Leung
-- JJ Allergy
Immunol
patients
develop
Leung DY
DY
Allergy Clin
Clinasthma
Immunol -- 01-DEC-2003;
01-DEC-2003; 112(6
112(6 Suppl):
Suppl): S117
S11
Spergel
Spergel JJ Allergy
Allergy Clin
Clin Immunology
Immunology 2003;
2003; 112
112 (6
(6 Suppl):
Suppl): S
S 118-27
118-27

The Allergic March

Atopic, GI and dermal
allergy
Upper respiratory tract

(rhinitis, rhino-conjunctivitis, allergic otitis

(75-85 %)
media)

Lower respiratory
tract
(wheezing)

Allergic
asthma
9(5)9(5)- 314-20
314-20

(50 %)

Cantani,
Cantani, 1999
1999 Invest
Invest Allergol
Allergol Clin
Clin Immunol
Immunol

Allergy is a chronic disease

Adapted from Holgate S Church MK eds. Allergy. London: Gower Medical Publishing 19

Atopic Dermatitis :
Significance

Healthcare Costs in the U.S.

1.6 billion (conservative)
3.8 billion (all inclusive)

Ellis
Ellis CN,
CN, Drake
Drake et
et al.
al. JJ Am
Am Acad
Acad Derm
Derm 2002,
2002, 46:
46: 361-70
361-70

Preventing Pediatric
Allergy

Allergy, particularly atopic dermatitis,

is a significant health issue
High incidence in developed countries
Increasing incidence and prevalence
High costs
Impact on quality of life
Allergy March may greatly magnify the
problem

Primary Prevention is a
Priority

Good Clinical Governance

(Tata kelola klinis yang baik)
Patient
S

afety

Education
Education
&&Training
Training

Risk
Risk
management
management

Atopic
dermatiti
s
Prevalence

Burden of
disease

Clinical
Clinical
audits
audits
Clinical
Clinical
Governance
Governance

AccountAccountability
ability
Research
Research&&
development
development

Problem
EBM
Babies with
# Valid
feeding
challenges
(30%# Important
50%)
# Applicable
EBM # Feeding
Intolerance
# Cows Milk
Protein Allergy

Clinical
Clinical
EffectiveEffectiveness
ness

Cost-effectiveness
Cost-benefit analysis
analysis

Financial
consequence
s

burden of
disease

burden of
disease

Mengapa prevalensi meningkat ?

Perubahan pola hidup
Pola makanan
Polusi lingkungan
Tata kelola klinis belum memadai

Genetic Factors
A Positive family history for allergy

Risk of allergy
Both
parent no
allergies

One sibling
with
allergy

10 %

20-30 %

20-40 %

60% - 80 %

risk of
allergy

risk of
allergy

risk of
allergy

risk of
allergy

Sensitivity 61 %;
Specificity 83%

Both
One parent
parent with
with
allergies
allergy

Koning,1996; Bousquet,2002

Prevention in infant
Exclusive
breastfeeding
pHF or eHF &
probiotic
Primary prevention

(risk factor !)
burden of
disease

Pencegahan dilakukan sebelum timbul gejala

alergi, terutama pada bayi yang mempunyai
faktor risiko

Prevention in infant

Suppress disease
expression after
sensitization
burden of
disease

Secondary
prevention
eHF/AAF

Anak yang telah terpajan alergen, tetapi dengan

manifestasi yang ringan, misalnya eksema dengan tujuan
untuk mencegah

Prevention in infant
Tertiary
prevention
Elimination diet, eHF/AAF,
Steroid, Antihistamine,
Emergency treatment

Treatment to avoid
recurrence of
symptom
(clinical
manifestation)

burden of
disease

Anak sudah terkena rinitis atau asma, dengan tujuan

supaya penyakitnya tidak terjangkit kembali, tidak
bertambah berat, dan diupayakan tidak berlanjut sampai
dewasa

Co-morbidities of allergic rhinitis

Tata kelola klinis yang

baik

Kendali mutu
dan Kendali
biaya
Valid
Important
Applicable

Audit
Patient safety P2KB
medik
Education
Education
&
& Training
Training
Risk
Clinical
Risk
Clinical
management
audits
management
audits
Clinical
Clinical
EBM:
Governance
Governance
# HTA
Clinical
Clinical
AccountPersetujua
Account# Clinical guidelines
EffectiveEffectiveability
n
ability
# Clin pathways
ness
ness
Research
# Algorithms
Research &
&
development
# Protocols
development
Rekam
# Procedures
medik
Manajemen alergi #Standing orders

Recommendations regarding milkformula

Breastfeeding is highly recommended for high-risk
infants, as exclusive breastfeeding is more protective
than hydrolized formula. However, a hydrolyzed
formula can be recommended for high-risk infants
who cannot be completely breastfed.
Grade A, Level 1

Osborn DA, Sim J. Formula containing hydrolyzed protein for prevention of allergy
and food intolerance infant. Cochrane Database Syst Rev. 2006(4):CD003664

Cows-milk based formula should be avoided in the

first 5 days of life as the administration of cows
milk-based formula during the first 5 days in
the newborn nursery increases the risk of
specific sensitization.
Grade C, Level 2

Kjaer HF et al. The prevalence of allergic diseases in an selected group of 6-year-old

children. The DARC birth cohort study. Pediatr Allergy Immunol. 2008 Dec:18(8):737-4

Why Clinical Practice Guidelines

(CPG) on Food Allergy
OVER
DIAGNOSIS

TRIVIALIZED
True food allergy
can be life
threatening

Perceived >>
True

Unsubstansiated
Tests and
Treatments

Tujuan Clinical Practice

Guidelines
Meningkatkan kualitas pelayanan pada
keadaan klinis dan lingkungan tertentu
Mengurangi intervensi yang tidak perlu
atau berbahaya
Memberikan opsi pengobatan terbaik
dengan keuntungan maksimal
Memberikan opsi pengobatan dengan
risiko terkecil
Tata laksana dengan biaya yang memadai

Algoritme pencegahan alergi pada

anak
ADA RISIKO

(UKK Alergi 2015)

u
o
Y
k
n
a
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