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Management And Prevention


Allergic Rhinitis
1. THERAPY NON PHARMACOLOGY
Avoid contact with allergens causes (avoidance) and elimination.

2. TREATMENT OF SYMPTOMATIC
Medikamentosa
Antihistamines have 5 classes but in the case of disease of allergic rhinitis used is an antihistamine H-1, which works on a
receptor inhibitor komperitif H-1 target cells, and is a pharmacological preparations are most commonly used first-line
treatment of allergic rhinitis. Administration may be in combination with or without combination with oral decongestants
basis.
Antihistamines are divided into two groups : first generation antihistamines (classic) and second generation (non-sedating).
First generation antihistamines are lipophilic so that it can penetrate the blood-brain barrier (has an effect on the CNS) and
the placenta and have cholinergic effects. This group included, among others, is difenhidhamin, chlorpheniramine,
prometasin, cyproheptadine while that can be administered topically is azelastin.
Second generation antihistamines are lipofobik, making it difficult to penetrate the blood-brain barrier. Selective increase the
H-1 receptor and not possessed peripheral anticholinergic effects, and effects on the CNS antiadrenergik minimal (non
sedative). Antihistamines absorbed orally with a fast, easy and effective to treat symptoms in response to rapid phase such as
rhinorrhea, sneezing, itchy, but it is not effective to treat symptoms of nasal obstruction on a slow phase. Non-sedating
antihistamines can be divided into 2 groups according to its security. The first group is astemisol and terfenadine which has
cardiotoxic effects. Caused toxicity to the heart by cardiac repolarization were delayed and can cause ventricular arrhythmias,
cardiac arrest and sudden death. The second group is loratadin, setirisin and fexofenadin.
Desloratadine have the same effectiveness with montelukast in reducing the symptoms of rhinitis accompanied with asthma.
Lovontixizine which are given for 6 months proven reduce symptom persistent allergic rhinitis and improving the quality of
life of patients with allergic rhinitis with asthma.

Mixture sympathomimetic group adregenik alpha antagonist used as a nasal decongestant oral with or without combination
with antihistamines or topical. However use it topical may only be for a few days only to avoid medical rhinitis.
Preparation corticosteroid selected when the symptoms of nasal obstruction due to late-phase response is not resolved with
other drugs. Is often used topical corticosteroids (beclomethasone, budesonide, flunisolid, fluticasone, and triamcinolone
mometasonfuroat).
Mixture sympathomimetic group adregenik alpha antagonist used as a nasal decongestant oral with or without combination
with antihistamines or topical. However use it topical may only be for a few days only to avoid medical rhinitis.
Preparation corticosteroid selected when the main symptoms of nasal obstruction due to late-phase response is not resolved
with other drugs. Is often used topical corticosteroids (beclomethasone, budesonide, flunisolid, fluticasone, and triamcinolone
mometasonfuroat). Topical corticosteroids are working to reduce the number of mastoid cells in the nasal mucosa, prevent
cytotoxic protein from eosinophils spending, reduce the activity of lymphocytes, preventing the leaking of plasma. This
causes the nasal epithelia allergens hyperresponsiveness to stimuli (works on fast and slow phase response).
Topical preparations are anticholinergics ipratropium bromide, useful to overcome rhinorrhea, because the inhibition activity
cholinergic receptors on the surface of effector cells.

a.Oral Decongestants
Oral decongestants such as ephedrine, phenylephrine and pseudoephedrine, a sympathomimetic drugs can reduce the
symptoms of nasal congestion. The use of these drugs in patients with heart disease should be cautious. Drug side effects are
hypertension, palpitations, anxiety, agitation, tremor, insomnia, headaches, dryness of mucous membranes, urinary retention,
and exacerbation of glaucoma or thyrotoxicosis. Oral decongestants can be given with attention to central effects. In
combination with oral H1-antihistamines can increase its effectiveness, but the side effects also increases.

b. Intranasal Decongestants
Intranasal decongestants (eg, epinephrine, naftazolin, oksimetazolin, and xilometazolin) is also a sympathomimetic drug that
can reduce the symptoms of nasal congestion. These drugs work more quickly and effectively than oral decongestants. Its use
should be limited to less than 10 days to prevent the occurrence of medical rhinitis. The same side effects as oral dosage but
lighter. Award topical vasoconstrictor is not recommended for allergic rhinitis in children under the age of l year because the
boundary between the therapeutic dose to toxic dose is narrow. In toxic doses will occur cardiovascular disorders and central
nervous system.

Preparations Corticosteroids
Corticosteroids are used very widely in the treatment of various allergic diseases by the nature of the strong anti-
inflammatory. Various anti-inflammatory corticosteroids work mediated by the expression of various genes setting specific
targets. It is known that corticosteroids inhibit the synthesis of a number of cytokines such as interleukin IL-1 and IL-6,
tumor necrosis factor- (TNF-), and granulocyte-macrophage colony stimulating factor (GM-CSF). Corticosteroids also
inhibit the synthesis of chemokines IL-8, regulated on activation normal T cell Expressed and secreted (RANTES), eotaxin,
macrophage inflammatory protein-1 (MIP-1), and monocyt chemoattractant protein-1.
a. Intranasal corticosteroids
Intranasal corticosteroids (eg, beclomethasone, budesonide, flunisolid, fluticasone, mometasone, and triamcinolone) can
reduce nasal hyperreactivity and inflammation. This drug is the most effective medical treatment for allergic rhinitis and
effective against nasal congestion. The effect will be visible after 6-12 hours, and the maximum effect seen after a few days.
Topical nasal corticosteroids in children are still many disputed because of the systemic effects of chronic use and local
effects of this drug. But there has been no reports of adverse events after administration of topical nasal corticosteroids long
term. Topical nasal steroid dose can be administered at a dose of half the adult and is recommended once a day in the
mornings. The drug is administered in cases of allergic rhinitis with symptoms of nasal congestion are prominent.

b. Oral corticosteroids / IM
Oral corticosteroids / IM (eg, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, triamcinolone,
and betamethasone) potent to reduce nasal inflammation and hyperreactivity. Short-term administration may be required. If
possible, intranasal corticosteroids are used to replace the use of oral corticosteroids / IM. Local side effects of this drug is
quite mild, and systemic side effects have wide limits. Systemic corticosteroids are not recommended for allergic rhinitis in
children. In young children to consider the use of intranasal and inhaled drug combination :
a. operative
b. immonoterapi

Prevention
1. Maintain always clean the body, especially the nose
2. Keeping the environment clean environment good place to live, work and others
3. Avoid factors that can trigger allergen
4. Note the types of foods that can cause allergies
5. Avoid high polluting environment that can trigger allergies
6. Multiply the daily consumption of foods that contain high antioxidant
7. Wearing a nasal mask