Prediabetes

Patient is 54-year-old male who comes in because of recent hives outbreak. He states that this started about one week ago and it began to get worse for the last four to five days. He currently states that his feet keep swelling and hands are swelling and itching constantly. He has noticed now that he thinks that his feet have started to itch and swell for the last month prior to this visit. He has not used _____ of a trigger of hives and swelling. He has had nothing out of the ordinary. He does have severe seasonal allergies and has been having trouble with those and he does not _____. He denies anything insect bite or any _____ that made it different than what he normally eats. His wife is aging and makes it for him regularly, however and has used it before and his swelling and hives began in 24 to 72 hours after eating that food. He has not changed any detergents or cosmetic products or fabric softeners. He has not had any changes in his house or has moved into a new home or had an addition of a pet.

doctor who prescribed him prednisone for five days. He has had two tablets, which I believe would be 40 mg. It did seem to help a little bit, but it did not take his hives away completely. He also has been using Benadryl in the evening and that does not seem to be helping. He also uses Flonase nasal spray in the evening as well to help with sleeping and his nasal congestion. He currently complains of nasal symptoms including sneezing, clear nasal discharge, frequent nose bleeding, itching inside ears, and heartburn. This does occur starting in the spring and persists through the summer and fall. He does have occasional sinus infection. He denies nasal polyps, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad colds, or frequent tonsillitis. He states this is severe and he has been using Flonase and Benadryl for this regularly and it does provide very little relief.

He has had one ear infection in the last year. He denies dizziness, lightheadedness, or hearing impairment.

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

He has had recently some trouble breathing. He states he felt that he was having a hard time catching his breath. This was about two weeks ago after eating Chinese food at Panda Express. He states it was very salty. It did have peanuts in it as well and he was quite concerned about this, but it did resolve after a while. He does feel it may have been due to this very salty food. It is associated with a cough. He denies frequent coughing spells, recurrent night cough, coughing up mucus, blood in mucus, coughing on exertion, coughing with laughing, and coughing with talking on the phone. He does admit to having shortness breath with exercise and coughing with lying down. He has not had any other breathing troubles except for this one incident. He has not had a chest x-ray in the last five years.

ASSESSMENT:
1. Acute idiopathic urticaria.
2. Allergic rhinitis.
3. Allergic conjunctivitis.
4. Prediabetes.
5. Hypertension.

PLAN:
1. At this time, I talked with that I do think this is just an acute idiopathic urticaria that has been triggered for an unknown cause. I do not believe at this time that it is peanuts since he can eat peanut just fine and it did not occur within 5 to 30 minutes after ingesting a certain food. I do feel that if we can control these hives outbreaks he will feel much better and foods will be supplemented and resolved with time.
2. I do want him to try using Zyrtec at high doses two tablets three times daily to see if we can control these hives with the antihistamines. If he continues to have troubles even on these high diagnoses, he may try pursuing more blood work and identification of certain triggers and may be tested for peanut as well.
3. I also gave him a prescription of hydroxyzine 25 mg to take at night one to two tablets as needed to help sleep.

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