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"Background: nowadays, specific IgE measurement has been conducted in Indonesia, however there is still lack of data regarding diagnostic test to detect inhalant allergen in patients with respiratory allergies.This study aimed to determine the accuracy of specific IgE test in diagnosing specific sensitization of inhalant allergen in patients with respiratory allergies.Methods: this was a cross sectional study in patients with respiratory allergies and part of epidemiology study regarding to specific IgE sensitization in Allergy-Immunollogy Division, Cipto Mangunkusumo Hospital, Jakarta within November-December 2016. Measurement of specific IgE sensitization using Immunoblot method (Euroline, Euroimmun AG, Germany). The tested allergen is house dust mites Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Blomia tropicalis (Blo t) and cockroach Blatella germanica (Bla g). The result is compared with gold standard, skin prick test. The diagnostic result includes sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-).Results: a total of 101 patients were enrolled; 77 (76.2%) were women. Patients mean age was 38.8 years old. Based on SPT, sensitization was highest for Blo t (76.2%), followed by Der p (70.3%), Der f (69.3%), and Bla g (41.6%). Specific IgE-sensitization was highest for Der f (52.9%), followed by Der p (38.2%), Blo t (33.3%) and Bla g (10.8%). Der p allergen had 50.7% sentivity, 90% specificity, 92.3% PPV, 43.5% NPV, 5.1 LR+ and 0.1LR-. Der f showed 71.4% sensitivity, 87.1% specificity, 82.6% PPV, 57.4% NPV, 5.5 LR+ and 0.3 LR-. Blo t allergen had 41.6% sensitivity, 91.7% specificity, 94.1% PPV, 32.8% NPV, 5.0 LR+, and 0.6 LR-. Bla g allergen had 23.8% sensitivity, 98.3% specificity, 90.9% PPV, 64.4% NPV, 14.5 LR+ and 0.8 LR-.Conclusion: serum specific IgE testing to common inhalant allergen in patients with respiratory allergy showed only low-to-moderate sensitivity, but high specificity and PPV. This new assay can be used to diagnose allergen sensitization in the population with high prevalence of TDR and cockroach."

"Rhinos® SR adalah kapsul kombinasi tetap loratadin 5 mg dengan pseudoefedrin 60 mg lepas cepat dan pseudoefedrin 60 mg lepas lambat. Studi ini bertujuan untuk menilai efikasi Rhinos® SR pada nasal airway resistance (NAR) secara obyektif dengan rhinomanometer dan gejala-gejala nasal serta nonnasal pada pasien dengan rinitis alergik sepanjang tahun (RAST) di negara tropis. Ini adalah studi paralel berpembanding plasebo, acak, tersamar ganda, dilakukan pada 59 pasien RAST berobat jalan di klinik THT RS Umum Dr. Soetomo, Surabaya. Pasien laki-laki dan perempuan, menderita RAST sedang sampai berat minimal 2 tahun, berumur 12 tahun ke atas, dengan total skor gejala nasal (TSGN) > 6 dan skor kongesti nasal (SKN) > 2, mendapat Rhinos® SR atau plasebo 2 kali sehari selama 7 hari. Parameter efikasi yang utama adalah berkurangnya nilai-nilai NAR (yang diukur dengan rhinomanometer pada hari pertama) dari Rhinos® SR dibandingkan dengan plasebo. Nilai-nilai NAR dihitung sebagai luas area di bawah kurva (area under the curve = AUC) dari NAR terhadap waktu. Parameter efikasi sekunder adalah berkurangnya gejala-gejala klinik (nasal dan nonnasal) yang dinilai oleh pasien maupun oleh dokter peneliti setelah 1 minggu penggunaan Rhinos® SR atau plasebo. Dari 59 pasien yang memenuhi syarat, semuanya menyelesaikan studi 1 minggu ini. Untuk nilai-nilai NAR, setelah baseline disamakan menjadi 100%, AUC0-10 jam tidak berbeda bermakna antara Rhinos® SR dan plasebo. Akan tetapi waktu pseudoefedrin mencapai kadar puncak, yakni 2 jam untuk yang lepas cepat dan 6 jam untuk yang lepas lambat, maka AUC0-2 jam dan AUC0-6 jam Rhinos® SR lebih rendah secara bermakna dibandingkan dengan plasebo. TSGN berdasarkan penilaian penderita (jumlah skor 3 pagi terakhir) untuk Rhinos® SR menurun 33.0% dari skor awal (p < 0.001), untuk plasebo juga menurun 21.9% dari skor awal (p = 0.002), tetapi penurunan oleh Rhinos tidak berbeda bermakna dengan penurunan oleh plasebo. Penurunan TSGN berdasarkan penilaian dokter peneliti, serta penurunan skor kongesti nasal (SKN) dan total skor gejala (nasal dan nonnasal), dan bahkan skor masing-masing gejala, berdasarkan penilaian pasien maupun dokter peneliti, menunjukkan pola yang sama, yakni Rhinos® SR dan plasebo menurunkan gejala secara bermakna dari nilai awal, dan penurunan oleh Rhinos® SR lebih besar dibandingkan penurunan oleh plasebo tetapi tidak berbeda bermakna. Dalam studi ini tidak ditemukan efek samping. Dari penelitian ini disimpulkan bahwa pada pasien RAST sedang sampai berat di negara tropis, Rhinos® SR efektif dalam mengurangi kongesti nasal dengan pengukuran obyektf NAR. Rhinos® SR 2 x sehari selama 7 hari juga efektif dalam mengurangi gejala-gejala klinik RAST meskipun tidak mencapai kemaknaan statistik dibandingkan dengan plasebo, serta dapat ditoleransi dengan baik.

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AbstractRhinos® SR is a fixed combination of 5 mg loratadine and 60 mg pseudoephedrine immediate release and 60 mg pseudoephedrine sustained release. The present study was aimed to assess the efficacy of Rhinos® SR on nasal airway resistance (NAR) objectively using rhinomanometer and on nasal symptoms in patients with perennial allergic rhinitis (PAR) in a tropical country. This was a randomized, double-blind, parallel group study in 59 PAR patients who visited the ENT clinic at Dr. Soetomo General Hospital, Surabaya. Outpatients of both gender, having moderate to severe PAR for a minimal of 2 years, aged 12 years or older, with a total nasal symptom score (TNSS) > 6 and a nasal congestion score > 2, received Rhinos® SR or placebo twice daily for 7 days. The primary efficacy parameter was the decrease in the NAR values (measured by rhinomanometer on Day 1) of Rhinos® SR from those of placebo. The NAR values were calculated as the area under the curve (AUC) of NAR versus time. The secondary efficacy parameters were the percentage reduction of the clinical symptoms (nasal and nonnasal) evaluated by both the patient and the physician after 1 week use of Rhinos® SR or placebo. From 59 eligible patients, all completed this 1-week trial. For NAR values, after the baseline were considered as 100%, the AUC0-10 h were not significantly different between Rhinos® SR and placebo. However, as the pseudoephedrine reached its peak concentration, i.e. 2 hrs for the immediate release and 6 hrs for the sustained release, then AUC0-2 h and AUC0-6 h of Rhinos® SR were significantly lower compared to those of placebo. Total nasal symptom score (TNSS) evaluated by the patient (sum of the last 3 mornings) for Rhinos® SR decreased 33.0% from baseline (p < 0.001), for placebo decreased 21.9% from baseline (p = 0.002), but the decrease by Rhinos® SR was not significantly different from the decrease by placebo. TNSS evaluated by the physician, nasal congestion score (NCS) and total symptom score (TSS, total nasal and nonnasal), and even the individual symptom scores, evaluated by the patient and the physician, showed similar pattern, i.e. both Rhinos® SR and placebo decreased the symptoms significantly from baseline, and the decreases by Rhinos® SR were larger than the decreases by placebo, but the decreases by Rhinos® SR and placebo were not statistically different. No adverse event was found in this study. From the present study it was concluded that in patients with moderate to severe PAR in a tropical country, Rhinos® SR was effective in relieving nasal congestion by objective measurements of NAR. Rhinos® SR twice a day for 7 days was also effective in reducing the clinical symptoms of PAR although the reductions did not reach statistical significance compared to those by placebo, and was well tolerated. "

"Background: Vitamin D role in immune system have been investigated due to the presence of VDR on immune cells. Based on this information deficient level of vitamin D could affect the progression of allergic rhinitis. Unfortunately the data regarding vitamin D status in the normal population and allergic rhinitis patient were very limited in Indonesia. This research was done to provide illustration regarding the status of vitamin D in healthy and allergic rhinitis patients in Jakarta and also to investigate the factor that might affect the level of vitamin D in allergie rhinitis. Methods: This research was an observational cross sectional research. There were 22 subjects used during this research all diagnosed with moderate-severe allergic rhinitis. The study used the Electrochemiluminescence Immunoassay (ECLIA) technique. The data then were analyzed with IBM® SPSS statistic version 22 Results: The difference between the mean vitamin D of patients suffering from allergic rhinitis with healthy controls (12.7±10.3 ng/mL to 15.1±8.1 ng/mL). There was no significant diference in mean vitamin D between the gender groups (Independent Sample T-test p= 0.62). There were no statistical difference between the vitamin D level in patient with different eosinophil count and IL-5 level (IL-5 group: one-way ANOVA: p= 0.897; eosinophil group: One Way ANOVA: p = 0.752). Conclusion: The mean level of vitamin D in allergic rhinitis patients compared to healthy controls showed no significant difference. Comparison studies about level of vitamin D between groups with different gender, IL-5 and eosinophil count showed no significant difference"

"ABSTRAKLatar Belakang: Asma alergi merupakan salah satu jenis fenotipe asma yang terbanyak, ditandai dengan adanya sensitisasi terhadap alergen lingkungan. Pada asma alergi terjadi respons inflamasi tipe 2 yang akan menghasilkan periostin yang dapat dideteksi dalam darah. Salah satu faktor yang mempengaruhi keterkontrolan asma adalah paparan alergen yang dapat bervariasi bergantung pada pola musim. Wilayah Indonesia sebagai benua maritim memiliki dua musim (hujan dan kemarau) berbeda dengan wilayah lain yang memiliki empat musim. Tujuan: Penelitian ini bertujuan untuk melihat perbedaan kadar periostin serum pada asma alergi terkontrol dan tidak terkontrol. Metode: Penelitian ini merupakan penelitian potong lintang dengan subjek penelitian adalah pasien asma alergi yang berobat ke poliklinik divisi Alergi Imunologi Klinik Rumah Sakit Dr Cipto Mangunkusumo bulan Januari-April 2017. Keterkontrolan asma dinilai dengan skor Tes Kontrol Asma sementara periostin serum digunakan sebagai penanda proses inflamasi Th2. Hasil: Dari 80 pasien asma alergi didapatkan rerata usia 39,7 tahun dengan proporsi perempuan lebih banyak (76%). Sebagian besar pasien memiliki riwayat rinitis alergi (73,8%) dan riwayat asma dalam keluarga (71%). Tungau debu rumah merupakan jenis alergen yang banyak memberikan sensitisasi. Kadar periostin serum pada subjek yang tidak terkontrol tidak berbeda dengan subjek yang terkontrol (209,78 ng/mL vs 627,66 ng/mL, p = 0,424) Simpulan: Tidak terdapat perbedaan kadar periostin pada kelompok asma alergi terkontrol dan tidak terkontrol.

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ABSTRACTBackground: Allergic asthma is the most common asthma phenotype, defined by the presence of sensitization to environmental allergens. In allergic asthma, following allergen exposure there will be an activation of T2-type inflammation producing periostin that can be detected from blood. Many factors can influence asthma control, including allergen exposure, which may vary greatly with climatic and seasonal changes. The Indonesia region as the Maritime Continent is characterized by a wet and a dry season which is different from other regions with four seasons. Objective: To see the difference of serum periostin level in uncontrolled and controlled allergic asthma. Methods: This is a cross sectional study using samples from allergic asthma patients who went to Allergy and Clinical Immunology Clinic, Dr. Cipto Mangunkusumo Hospital in January to April 2017. Asthma control was assessed clinically by using Asthma Control Test, while serum periostin was used as biological markers reflecting Th2 inflammation. Results: From 80 allergic asthma patients, the average of age was 39.7 years old with a greater proportion of women (76%). Most of the subjects had history of allergic rhinitis (73.8%) and positive family history of asthma (71%). House dust mites were the most common cause of sensitization. Serum periostin level in uncontrolled allergic asthma was not different from those in controlled allergic asthma (209,78 ng/mL vs 627,66 ng/mL, p = 0,424). Conclusions: There was no difference in the level of serum periostin in controlled and uncontrolled allergic asthma."

"Purpose: Rhinitis and conjunctivitis are common diseases worldwide that are frequently associated. Nevertheless, the risk factors for rhinoconjurc tiitis are not well-described and the impact of conjunctivitis on rtinitis and asthma in children remains unknown. This study explored the different risk factors and evaluated the burden of rhinoconjunctivitis among adolescents. Methods: This was a cross-sectional study conducted on a random sample of schoolchildren, aged 10-17 years, using skin prick tests and a self-administered questionnaire on respiratory health investigating pact of thinitis and rhinoconjunctivitis on daily activities. Results: A complete evaluation was obtained for 2.150 children. The prevalence of rhinitis alone was 18.2% and tinitis associated with conjunctivitis was 20.5%. Rhinoconjunctivitis was more frequently associated with females, a parental history of atopt domestic exposure to mold/dampness, passive smoke exposure, and reported truck traffic in residential streets. Moreover, rhino-conjunctivitis was associated with a higher level of allergic sensitization. The prevalence of current asthma was 1.7% in subjects without rhinitis or rhinoconjunctivitis, 5.1% in rhinitis and 10.7% in rhinoconjunctivitis. In a logistic model, rhinoconjunctivitis yielded a 2-fold risk for current asthma with respect to thinitis Subjects with rhinoconjunctivitis had poorer quality of life (QoL); there was an impact on daily activities in 4.6% of rhinitis and 107% of rhinoconjunctivitis. Conclusions: Ocular symptoms increase the role of rhinitis as a risk factor for asthma and its impact on daily activities in children. "

"Latar belakang: Rinitis alergi (RA) merupakan suatu kelainan hidung yang sering memengaruhi kualitas hidup penderitanya. Perubahan kualitas hidup pasien RA secara subjektif dapat diukur dengan kuesioner mini RQLQ dan secara objektif dengan hitung jumlah eosinofil pada mukosa hidung dan kadar IL 5 serum. Tujuan: Mengetahui karakteristik subjek RA dan mengetahui perubahan kualitas hidup, jumlah eosinofil mukosa hidung dan kadar interleukin 5 pada pasien rinitis alergi persisten sedang berat sebelum dan setelah terapi medikamentosa. Metode: Pre eksperimental yang bersifat analitik sebelum dan setelah terapi dengan jumlah subjek RA persisten sedang berat sebanyak 33 orang. Subjek diminta untuk mengisi kuesioner Mini RQLQ, dilakukan kerokan mukosa hidung dan pengambilan darah sebelum dan 2 minggu setelah terapi. Hasil: Didapatkan 14 subjek berjenis kelamin laki-laki dan 19 subjek perempuan dari 33 subjek penelitian dengan rerata usia 32,55 ± 11,67. Sebanyak 31 dari 33 subjek mengalami perubahan bermakna dari kualitas hidup, seluruh subjek mengalami perubahan jumlah eosinofil yang bermakna dan 30 dari 33 subjek mengalami perubahan kadar IL 5 yang responsif setelah terapi selama 2 minggu. Kesimpulan: Kualitas hidup pasien RA persisten sedang berat dapat diukur dengan menggunakan kuesioner mini RQLQ dan jumlah eosinofil mukosa hidung dan kadar IL 5 dapat digunakan untuk evaluasi terapi RA namun tidak untuk pemeriksaan penunjang rutin.

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Background: Allergic rhinitis (AR) is a nasal disorders that frequently affects the quality of life. Changes in quality of life AR patient can be measured subjectively using mini RQLQ and objectively by eosinophil count of nasal mucosa and IL 5 level. Objectives: To find the subject characteristic of AR and quality of life, eosinophil count of nasal mucosa and IL 5 level changes of moderate-severe AR patient before and after medicamentosa therapy. Methods: Pre experimental analytic study before and after therapy with 33 subjects of moderate-severe AR. All subjects were asked to fill out Mini RQLQ, collect nasal scrapping and blood specimens before and 2 weeks after therapy. Result: Fourteen subjects were male and 19 were women out of 33 subjects, with mean age 32,55 ± 11,67 years. Thirty one out of 33 subjects had significant quality of life changes, all subjects had significant changes of eosinophil nasal scrapping and 30 out of 33 subjects had significant changes of IL 5 level after 2 weeks of medicamentosa therapy. Conclusion: Allergic rhintis patient quality of life can be measured by mini RQLQ and eosinophil nasal scrapping and IL 5 level can be used for therapy evaluation but not for routine examination."

"Mekanisme berkurangnya gejala rinosinusitis alergi setelah terapi assisted drainage. Rinosinusitis terutama disebabkan oleh virus dan alergi, serta akan sembuh dengan sendirinya tanpa antibiotik. Akan tetapi, antibiotik masih sering dipakai sebagai obat pilihan untuk rinosinusitis. Bila terapi konservatif gagal maka perlu dilakukan tindakan bedah. Selain alergi, keradangan neurogenik juga terlibat dalam rinosinusitis. Beberapa laporan kasus menduga bahwa gingivitis kronis memicu rinosinusitis dan suatu terapi yang disebut sebagai assisted drainage (ADT) dapat mengurangi gejala dalam hitungan menit. Terapi periodontal temuan baru tersebut merupakan pembersihan karang gigi yang disertai dengan pemijatan subgingiva, namun demikian mekanismenya masih perlu diverifikasi. Tujuan: Untuk melakukan verifikasi mekanisme kerja ADT dalam mengurangi gejala rinosinusitis dengan cepat. Metode: Studi eksperimental randomized control time series design dilakukan pada dua kelompok tikus Wistar. Sensitisasi alergi dilakukan dengan injeksi dan inhalasi ovalbumin (OVA). Gingvitis diinduksi dengan lipopolisakarida Porphyromonas gingivalis (PgLPS1435/1450) sintetis. Pada satu kelompok dilakukan ADT sebelum inhalasi dan kelompok lain tanpa ADT. Pemeriksaan jaringan hidung dilakukan dengan pemeriksaan imunohistokimia pada biomarker reaksi alergi (LTC4 dan ECP) serta keradangan neurogenik (CGRP dan VIP). Analisa data menggunakan ANOVA. Hasil: Beberapa menit setelah inhalasi OVA, ekspresi biomarker reaksi alergi dan keradangan neurogenik lebih rendah secara signifikan (p=0,001) pada tikus yang mendapat perlakuan ADT sebelum inhalasi dibandingkan tanpa inhalasi. Simpulan: ADT mampu secara signifikan mengurangi biomarker reaksi alergi dan keradangan neurogenik dalam hitungan menit, sehingga dapat diusulkan sebagai terapi ajuvan rinosinusitis alergi.

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Rhinosinusitis is mostly affected by viral infections and allergy and resolves without antibiotics usage. However, antibiotics are still frequently used as drug of choice for rhinosinusitis. If conservative treatments failed, surgical procedures had to be done. Neurogenic inflammation is involved in rhinosinusitis. Possibly because rhinosinusitisinduced chronic gingivitis successfully relieved by the “assisted drainage therapy” (ADT). This new periodontal therapy consists of scaling and root planing followed by subgingival massage. However, the mechanism had not been clearly verified. Objective: To verify the mechanism of allergic rhinosinusitis symptoms relief by ADT.Methods: Randomized control time series design experimental study was conducted in two groups of Wistar rats. Allergic sensitization was performed by injections and inhalation of ovalbumin (OVA). Gingivitis was induced by synthetic Porphyromonas gingivalis lipopolysaccharide (PgLPS1435/1450). One group was subjected to ADT before inhalation and another groups without ADT. Immunohistochemistry for biomarkers of allergic reaction (LTC4 and ECP) and neurogenic inflammation (CGRP and VIP) performed. Results: After OVA inhalation, allergic reaction and neurogenic inflammation biomarkers had significantly lower in rats subjected to ADT before inhalation than without ADT (p=0.001). Conclusion: ADT significantly decreased nasal allergic reaction and neurogenic inflammation biomarkers, therefore could be proposed as an adjunct therapy of allergic rhinosinusitis."