12. Prof. SI_Alergi Simposium Pengantar Ritz Carlton 18 April
-
Upload
mochamad-burhanudin -
Category
Documents
-
view
216 -
download
1
description
Transcript of 12. Prof. SI_Alergi Simposium Pengantar Ritz Carlton 18 April
Pengantar lunch simposiumalergi dan imunologi
pada anakPrevalensi & Pencegahan
Sofyan IsmaelIkatan Dokter Anak Indonesia
Dalam rangka desiminasi Forum Nasional Sadar Alergi (ForNASA)
DIAGRAM KERANGKA KONSEPTUAL PROSES TUMBUH KEMBANG ANAK
LINGKUNGAN
INDIVIDU
GENETIK / HEREDOKONSTITUSIONAL
TUMBUH - KEMBANG
FETUS NEONATUS BAYI ANAKREMAJA
KEBUTUHAN DASAR ANAK
ASUH ASIH ASAH
Ibuo Pendidikano Gizi (Early Life
Nutrition)o KB
Exclusive Breathfeeding
MPASI Imunisasi Pengobatan (oralit)
Anggota keluargao Ayaho Saudara
Rumah Suasana rumah
Lingkungan tetangga
Sarana bermain
Fasyankes (Dokter)
Sistem Pendidikan Nasional
Lembaga Riset
Kebijakan Pemerintaho KEMKESo Kemendikbudo Kemenag, dll
Sosial budaya masyarakat
Lembaga non pemerintah
ForNASA MIKRO MINI MESO MAKRO
Ibuo Pendidikano Gizi (Early Life Nutrition)
o KB
Exclusive Breastfeeding Utilisasi Growth Chart Makanan Pendamping ASI Imunisasi Pengobatan sederhana
(oralit) Air bersih
MIKRO
Primary preventionin allergy
WHO / WAO meeting on thePrevention 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 patients
develop asthma
Leung DY - J Allergy Clin Immunol - 01-DEC-2003; 112(6 Suppl): S117Spergel J Allergy Clin Immunology 2003; 112 (6 Suppl): S 118-27Leung DY - J Allergy Clin Immunol - 01-DEC-2003; 112(6 Suppl): S117Spergel J Allergy Clin Immunology 2003; 112 (6 Suppl): S 118-27
The Allergic March
Cantani, 1999 Invest Allergol Clin Immunol 9(5)- 314-20 Cantani, 1999 Invest Allergol Clin Immunol 9(5)- 314-20
Atopic, GI and dermal allergy
Atopic, GI and dermal allergy
Allergic asthmaAllergic asthma
Lower respiratory tract (wheezing)
Lower respiratory tract (wheezing)
Upper respiratory tract (rhinitis, rhino-conjunctivitis, allergic otitis
media)
Upper respiratory tract (rhinitis, rhino-conjunctivitis, allergic otitis
media)
(50 %)
(75-85 %)
Allergy is a chronic disease
Adapted from Holgate S Church MK eds. Allergy. London: Gower Medical Publishing 1993
Atopic Dermatitis : Significance
• Healthcare Costs in the U.S.–1.6 billion (conservative) –3.8 billion (all inclusive)
Ellis CN, Drake et al. J Am Acad Derm 2002, 46: 361-70Ellis CN, Drake et al. J Am Acad Derm 2002, 46: 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
problemPrimary Prevention is a PriorityPrimary Prevention is a Priority
Good Clinical Governance (Tata kelola klinis yang baik)
Atopic dermatitis
Prevalence ?
Burden of disease
ClinicalGovernance
ClinicalGovernance
Clinical audits
Clinical audits
Education & Training
Education & Training
Riskmanagement
Riskmanagement
Account-ability
Account-ability
Research &development
Research &development
ClinicalEffective-
ness
ClinicalEffective-
ness
EBM
Babies with feeding challenges (30%-50%) # Feeding Intolerance # Cow’s Milk Protein Allergy
Problem
# Valid# Important# Applicable
EBM
Financial consequences Cost-benefit analysis
Cost-effectiveness analysis
Patient Safety
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
Both parent no allergies
One sibling with allergy
One parent with allergy
Both parent with
allergies
10 %
risk of allergy
20-30 %
risk of allergy
20-40 %
risk of allergy
60% - 80 %
risk of allergy
Koning,1996; Bousquet,2002Sensitivity 61 %; Specificity 83%
Risk of allergy
burden of disease
Primary prevention (risk factor !)
Exclusive breastfeedingpHF or eHF &
probiotic
Prevention in infant
Pencegahan dilakukan sebelum timbul gejala alergi, terutama pada bayi yang mempunyai
faktor risiko
burden of disease
Suppress disease expression after
sensitization
Secondary preventioneHF/AAF
Anak yang telah terpajan alergen, tetapi dengan manifestasi yang ringan, misalnya eksema dengan tujuan
untuk mencegah terjadinya asma dan rinitis
Prevention in infant
burden of disease
Treatment to avoidrecurrence of
symptom(clinical
manifestation)
Tertiary prevention
Elimination diet, eHF/AAF, Steroid, Antihistamine, Emergency treatment
Anak sudah terkena rinitis atau asma, dengan tujuan supaya penyakitnya tidak terjangkit kembali, tidak
bertambah berat, dan diupayakan tidak berlanjut sampai dewasa
Prevention in infant
Co-morbidities of allergic rhinitis
ClinicalGovernance
ClinicalGovernance
Clinical audits
Clinical audits
Education & Training
Education & Training
Riskmanagement
Riskmanagement
Account-ability
Account-ability
Research &developmentResearch &
development
ClinicalEffective-
ness
ClinicalEffective-
ness
EBM:# HTA
# Clinical guidelines# Clin pathways
# Algorithms# Protocols
# Procedures#Standing orders
Patient safety Audit medik
ValidImportantApplicable
Tata kelola klinis yang baik Kendali mutu
dan Kendali biaya
Rekam medik
P2KB
Persetujuan
Manajemen alergi
Recommendations regarding milk-formula
• 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.
• Cow’s-milk based formula should be avoided in the first 5 days of life as the administration of cow’s milk-based formula during the first 5 days in the newborn nursery increases the risk of specific sensitization.
Osborn DA, Sim J. Formula containing hydrolyzed protein for prevention of allergy and food intolerance infant. Cochrane Database Syst Rev. 2006(4):CD003664
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):737-45
Grade A, Level 1
Grade C, Level 2
Why Clinical Practice Guidelines (CPG) on Food Allergy
OVER DIAGNOSISPerceived >>
True
TRIVIALIZED True food allergy can
be life threatening
UnsubstansiatedTests 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
(UKK Alergi 2015)
Sesudah lahirASI/pengganti ASI
ASI eksklusif 6 bulanBila ASI eksklusif tidak memungkinkan, beri
formula hidrolisat parsial atau ekstensif sampai 4-6 bulan Makanan padat
Makanan padat mulai diberikan pada anak usia 4-6 bulan secara bertahap
Restriksi diet terhadap makanan tertentu tidak diperlukan
LingkunganHindari pajanan asap rokok
Masa kehamilanTidak ada pantang makanan tertentu untuk
pencegahan penyakit alergi
Hindari pajanan asap rokok aktif dan pasif
ADA RISIKO