Hypertension

Patient is 33-year-old female who comes today to get allergy testing done due to increasing congestion that has been going on for a few years now. She did move here from xx about three years ago and ever since she has moved to Boise she feels that her allergies have been getting worse and worse. She currently complains of nasal irritation including nose rubbing, nasal stuffiness, and mouth breathing. It seems to be year-round. She has had history of sinus infections in the past and frequent headaches and frequent bad colds. She denies nasal polyps, TMJ, aspirin-induced nasal symptoms, nasal surgery, or frequent tonsillitis. She did have tonsillectomy when she was young. She states her nasal symptoms are severe. She has used Nasonex and other nasal sprays in the past that appeared to be most effective for her allergy symptoms. She also uses Claritin and has used Singular and Zyrtec in the past.

She denies frequent ear infections, dizziness, lightheadedness, or hearing impairment.

She does have eye itching, redness, tearing, burning, light hurting her eyes, dryness, yellow discharge from eyes, eyelid swelling, and eye irritation. This occurs a lot of the time.

She has had some mild to moderate wheezing episodes ever since she was 17 years old. It occurs during or after exercise. It can be associated with the cough. She does have albuterol to use as needed. She states at this time she uses about once or twice per week and usually is less than that. She has used a maintenance dose inhaler in the past but feels that currently her asthma is well controlled. She has used prednisone in the past many times for her asthma control generally due to infection-induced asthma exacerbation. She denies frequent coughing spells, recurrent night cough, coughing up mucus, blood in mucus. She denies coughing with lying down and coughing with talking on the phone. She does admit having shortness of breath with exercise, coughing on exertion, coughing when wheezing, and coughing with laughing. She has not had a chest x-ray performed in the last five years.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis infection-induced.
3. Mild intermittent asthma infection and exercise-induced.
4. Hypertension.

PLAN:
1. At this time, Michelle will like to try to do the allergy immunotherapy for long-term management and reduction of medication needs for her allergies to Boise. We will begin this shortly.
2. I also gave her a sample of Dymista nasal spray to use one spray each nostril twice daily to see if this has any added benefit compared to the Nasonex, Flonase and other nasal sprays she has used. She will let me know how she likes these
3. I wrote a prescription for Allegra, fexofenadine so that her Medicaid will cover this prescription and she can take this regularly as well.
4. We will see her for first shot appointment and she will let me know if she likes the Dymista so that we can continue using that.

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