Pruritus and rash

Patient comes in today for recheck on her possible contact dermatitis/allergic urticaria secondary to sap of the vegetable gardening. We saw her last on 08/11/2015. Since that time, she has noticed another irritating trigger, which was from a manicure. She did have Betaseron. They used aloe vera lotion to both her arms and massage and she broke out in hives and terrible itchiness ever since. She treated it with hydrocortisone cream and continued to take her Zyrtec with relief that occurred after a little while. The Zyrtec did not prevent those reactions from occurring, but it did help her relieve some itching afterwards. She though notices some itching after she works in a garden especially with the tomatoes, but if she washes her arms well after exposure, she does not have problems with itching or hives. I have asked to get manage her tomorrow from the same place and ask for a risk from the Betaseron the cream she used. So, she again further identified why she needs to be sensitive to it. We discussed that we can also use this in the attached testing to see if she in fact has a contact dermatitis to this allergen and that would help her avoid the allergen in different products.

She also has severe allergies that she gets itching in her garden and also tested positive for grasses and weeds. She does not feel that her allergies are out of control right now and Zyrtec is helping her itching as well as her seasonal allergies. She was given a sample of Pataday last time in the clinic that she only used once because she thought this is strong and she did not like it very much. We thought if she would like to have mild problems with itching or an acute exposure to an allergen, we can increase her Zyrtec to twice daily or even more if noted. She states she will get back try next time to help alleviate her breakthrough pruritus and exposure to allergen.

ASSESSMENT:
1. Contact dermatitis secondary to aloe vera ointment with plant base derived.
2. Possible allergic urticaria to sap of vegetable gardening.
3. Allergic rhinosinusitis.
4. Allergic conjunctivitis.
5. Pruritus and rash.

PLAN: We explained her how to continue Zyrtec once or twice a day for the itching and once itching is 95% resolved, she can try to go back on her dose and while being in vegetable garden. She will bring in ingredient list of the products, so we can identify the possible allergens in the product and pursue patch testing to further identify contact dermatitis. She would like a refill on Betaseron to avoid all possible aeroallergens since it is irritating.

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