Concern for mosquito allergies

She comes with the chief complaint of chest hurting and wheezing also. Presley is a very nice 9-year-old girl who is brought in by her mother and accompanied by her sibling who gets evaluation too. She has been noticing lately when she runs and exercise that she feels really short of breath and has hard time breathing. Her mother states that she has never been diagnosed with asthma in the past or had any wheezing problems with infectious-induced asthma or any other time. The mother states that she does have developed some exercise-induced asthma. No complications. Her mother denies any problems with seasonal allergies. She does not have any nasal complaints today other than itching and redness with tendency of having to wear glasses. She denies any sinus infections or any frequent bad colds, frequent tonsillitis, or frequent ear infections in the past.

Ever since last summer, she has noticed mild-to-moderate wheezing episodes during exercise. She denies any frequent coughing spells at time, night cough, coughing up mucus, coughing on exertion, coughing on movement, and talking on phone. She has never used any albuterol inhaler in the past, but has needed any corticosteroid to help with breathing in the past.

She denies any skin problems associated with allergies including atopic dermatitis or eczema currently or in the past. She has been previously evaluated for allergies at Boise Valley Allergy and Asthma Clinic. At that time, the mother is concerned it is a mosquito bite that swells her entire leg and they pursued allergy skin testing to seasonal allergens. She was negative for all of those. Mother does not remember if they tested for venom or not although she does not believe that they did any interdermal testing at that time. She was negative for all seasonal allergies.

ASSESSMENT:
1. Exercise-induced asthma.
2. Concern for seasonal allergies.
3. Concern for mosquito allergies.

PLAN:
1. We will prescribe albuterol inhaler one to two puffs 15 minutes before exercise to see if this helps to increase her exercise potential and to see if she can notice a difference in the chest tightness and shortness of breath or wheezing episodes with exercise.
2. We discussed at length the reason behind bite of mosquitoes and sensitivity to anaphylactic type reaction and that she denies if they are very sensitive to these. She will let us know if she would like to consider more venom testing to other insects as she is concerned that her daughter may have a problem in the future.
3. We will follow up with her in three weeks’ time to see if the albuterol inhaler before exercising is helping her. We also discussed using spirometry in the future.

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