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Tonny Tanus
David Geffen School of Medicine UCLA

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EOSINOPHILIC ESOPHAGITIS Brief communication and review of the literature Tanus, Tonny
JURNAL BIOMEDIK : JBM Vol 5, No 3 (2013): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.5.3.2013.4340

Abstract

Abstrak: Esofagitis eosinofilik (EoE) merupakan inflamasi alergik pada esofagus yang secara klinis ditandai oleh gejala refluks, gangguan pencernaan, disfagia, nyeri perut kronis dengan kekambuhan sporadik, mual dan muntah. Sebagai penyebabnya ialah kondisi alergik terhadap alergen yang berasal dari makanan, lingkungan, atau keduanya. Dinding esofagus dipadati sangat banyak eosinofil. Kami melaporkan dua kasus EoE yaitu seorang laki-laki berusia 30 tahun dan seorang anak laki-laki berusia 11 tahun. Pemeriksaan yang dilakukan ialah esofagogastroduodenoskopi, biopsi, dan uji alergi. Diagnosis EoE ditegakkan oleh adanya eosinofil pada biopsi, dengan baku emas 15 eosinofil per lapangan pandang besar (LPB). Penelitian akhir-akhir ini mengajukan 5-7 eosinofil per LPB. Patologi EoE diduga diinduksi oleh makanan, kacang-kacangan, telur, dan kacang kedelai. Pengobatan yang diberikan ialah steroid topikal seperti fluticasone atau budesonide, dan proton pump inhibitors. Studi lanjut dibutuhkan untuk mengeksplorasi pengaruh pengobatan alergi lainnya, seperti cromolyn, allergen specific immunotherapy/desensitization, dan biological targeting eosinophils, antara lain anti IL-5. Menghindari alergen dan intervensi diet harus dilakukan serentak. Simpulan: Berdasarkan pemeriksaan yang dilakukan, diagnosis pasien-pasien ini ialah esofagitis eosinopfilik. Tantangan yang dihadapi ialah menentukan atau membuktikan alergen kausatif. Pengobatan ditujukan pada menghindari alergen, serta pemberian steroid inhalasi topikal dan proton pump inhibitors. Kata kunci: esofagitis eosinofilik, perkembangan alergi, pengobatan alergi, eosinofil, alergi makanan.   Abstract: Eosinophilic esophagitis (EoE), clinically manifested with reflux symptoms, indigestion, dysphagia, chronic abdominal pain with sporadic flare ups, nausea and vomiting, is an inflammation of the esophagus, where the wall of the esophagus is congested with an abundance of eosinophils. The etiology of this EoE is the allergic condition to allergens derived from food, environment, or both. We reported two cases of EoE, a 30-year-old man and an 11-year-old boy. Their work up was comprised of esophagogastroduodenoscopy, biopsies, and allergy testing. The key to diagnosing EoE is the evidence of eosinophils in a performed biopsy, the gold standard being 15 eosinophils per high power field (eos/hpf). Recent studies suggest decreasing the standard to 5-7 eos/hpf. The pathology of EoE is thought to be induced by food and environmental allergens; the most causative food allergens in EoE would be cow’s milk, nuts, eggs, and soy. The treatments typically employ topical steroids, such as Flovent (fluticasone) or Pulmicort (budesonide), and proton-pump inhibitors. More research is needed to explore the efficacy of other allergy treatments, such as cromolyn, allergen specific immunotherapy/desensitization, and biological targeting eosinophils, such as anti IL-5. Allergens avoidance and dietary intervention should be concomitantly used. Conclusion: Based on all the tests performed, the diagnosis of the patients was eosinophilic esophagitis. The challenge is to be able to determine or prove the causative allergens. Treatment usually includes avoidance of allergens, topical inhaled steroids, and proton-pump inhibitors. Keywords: eosinophilic esophagitis, allergy work up, allergy treatment, eosinophils, food allergy.
The Role of Allergic Diseases in Common Pediatric Mental Health Disorders – A brief literature review Tanus, Tonny; Wangko, Sunny; Tanus, Sally M.
Jurnal Biomedik : JBM Vol 12, No 1 (2020): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.12.1.2020.26930

Abstract

Abstrak: Peningkatan risiko masalah kejiwaan akibat kondisi alergi berdampak besar terhadap implikasi klinis. Peran dan parahnya kondisi alergi perlu dipertimbangkan pada anak dengan ansietas atau depresi. Dikatakan bahwa pengobatan alergi dapat mencegah bahkan memperbaiki masalah kejiwaan yang terjadi namun penatalaksanaan alergi secara terpadu dapat membantu mengatasi depresi dan ansietas. Antihistamin generasi pertama telah dikenal berpengaruh terhadap kesehatan mental. Adanya hubungan erat antara alergi dan kesehatan mental menyebabkan steroid topikal dan bila diperlukan anhistamin generasi kedua layak menjadi pilihan. Rentannya pasien dengan alergi terhadap risiko masalah kejiwaan mendorong para klinisi agar lebih memahami bahwa pengobatan psikiatri juga dibutuhkan pada penatalaksanaan alergi dan rekomendasi terapi yang sesuai.Kata kunci: alergi, kesehatan jiwa Abstract: Increased risk of mental health problems brought by allergic conditions has substantial clinical implications. The role and the severity of allergic conditions need to be assessed when children present with anxiety or depression. Although many have proposed that treatment of allergies may prevent and help mental health diseases and definitely deserve further consideration and studies in real practice, concurrent allergy management has been found to help relieving depression and anxiety. First generation antihistamines are well known for their mental health effect. In light of the strong link between allergies and mental health, topical steroids and if needed, the second generation antihistamines would be the preferred choice. Awareness of this link that patients with allergic disorders have higher risk of psychiatric diseases would hopefully make clinicians be more aware that psychiatric treatments will need to include assessment of allergy and recommendation of appropriate therapy.Keywords: allergy, mental health
Updates on Food Allergy, Increasingly Prevalent Challenge Tanus, Tonny; Wangko, Sunny
Jurnal Biomedik : JBM Vol 10, No 3 (2018): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.10.3.2018.21980

Abstract

Abstrak: Prevalensi alergi makanan makin meningkat di seluruh dunia dan mengenai semua usia. Keparahan dan kompleksitas penyakit juga meningkat terlebih pada populasi anak. Terdapat beberapa jenis reaksi alergi yang dibahas: immunoglobulin E (IgE) mediated allergies and anaphylaxis, food triggered atopic dermatitis, eosinophilic esophagitis, dan non IgE mediated gastrointestinal food allergic disorders seperti food protein induced enterocolitis syndrome (FPIEs). Tes alergi, baik melalui kulit maupun IgE yang telah dikerjakan sekian lama masih dibebani dengan hasil positif palsu dan negatif palsu yang bermakna dengan manfaat terbatas pada beberapa alergi makanan. Selain menghindari, tidak terdapat terapi yang ampuh untuk alergi makanan. Berbagai imunoterapi telah dipelajari melalui jalur, subkutan, epikutan, oral dan sublingual yang hanya menghasilkan desensitisasi sementara dan dibebani dengan berbagai isu mengenai keamanannya. Agen biologik yang menghambat sitokin/interleukin (IL) dan molekul pada reaksi alergi makanan tampaknya merupakan pilihan yang menjanjikan. Anti IgE telah dipergunakan pada asma dan urtikaria kronis. Anti IL-4 dan IL-13 yang menghambat produksi IgE diindikasikan untuk dermatitis atopik. Anti eosinofil anti IL-5 berhasil menurunkan eksaserbasi asma. Berbagai agen biologik telah dipelajari untuk berbagai kondisi alergik dan imunologik, tetapi efektivitas dan kepraktisan terapi yang mahal ini untuk alergi makanan masih menjadi tanda tanya.Kata kunci: alergi makanan, reaksi alergi, terapi alergi makananAbstract: Food allergies have been increasing in prevalence for years affecting all ages. Disease severity and complexity have also increased, especially in the pediatric population. There are several types of reactions including: immunoglobulin-E (IgE) mediated allergies and anaphylaxis, food-triggered atopic dermatitis, eosinophilic esophagitis, and non IgE mediated gastrointestinal food allergic disorders such as FPIEs. Though allergy testing has been around for years, both skin and IgE testing are burdened by significant false positives and negatives, and are only useful in some food allergies. Avoidance is the sole therapy for food allergy. A variety of immunotherapies have been studied; subcutaneous, epicutaneous, oral, and sublingual. At best they only produce a temporary state of desensitization and have many safety issues. Examples of biologicals which block critical cytokines/interleukins (IL) in allergic conditions are Anti IgE, anti IL-4 and IL-13, and Anti eosinophils, Anti IL-5. Other biologicals are being studied for allergic conditions, but whether these expensive future treatments will be proven effective and practical in food allergy is unknown.Keywords: food allergy, allergic reaction, food allergy therapy