Concern for milk allergy

Patient is 1-year-old boy who was brought in by his mom to evaluate concern for allergies. He approximately one month ago started having hives reaction that started on his cheeks and developed all over his body. She did try Benadryl and they did not seem to resolve well with Benadryl. They lasted for about two weeks’ time and then during this time he did present with ear infection and they were concerned about possibly being milk allergy. They discontinued milk after he was having hives for few weeks and the hives did tend to resolve thereafter. His primary care provider pursued blood testing for allergies and all came back negative. There is no family history of allergies.

Mom denies any problems with serious allergies like nasal congestion, sore throat, mouth breathing, snoring. He does occasionally have some clear nasal discharge that seems to come and go.

She denies any problems with frequent bad cold, frequent tonsillitis or frequent ear infections. She also denies any eye irritation, eyelid swelling, itching, redness, tearing or burning.

He has not had any troubles with his lungs, wheezing other than one croup infection last year that they used albuterol nebulizer for one week and he resolved just fine thereafter. She has not needed a nebulizer treatment since then. He was a product of full-term normal delivery and breastfed for 10 months. They deny any frequent coughing spells, recurrent night cough, coughing up mucus or shortness of breath when running around.

He denies any skin problems, any eczema or atopic dermatitis in his history or currently other than the hives reactions he just had.

ASSESSMENT:
1. Acute idiopathic urticaria most likely viral in origin.
2. Concern for milk allergy.
3. Possible allergic rhinitis.

PLAN:
1. As his urticaria has resolved and has not had any recurrences, we will just treat with Zyrtec one-half to one teaspoon daily as needed if the hives come back. He does appear to have some sensitive skin evident with testing, so I did provide her with Olivamine lotion to use and discussed the skin hydration plan so that she can help protect his skin from allergens, otherwise she can purchase this item.
2. I encouraged her to continue using milk products as this will help prevent any allergies from occurring as well as encouraged all allergenic foods in his diet. She will let me know if he has any hives reaction after 30-60 minutes after ingesting milk product. Otherwise, the ImmunoCAP testing and the skin testing being negative, I reassured her that he most likely does not have milk allergy.
3. We will continue if he is having any allergic rhinitis that may be coming into play and if she has more concerns about more progression of allergies she will contact us.

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