Vertigo

Patient is 63-year-old female who comes here to get her seasonal allergies worked up. She has lived in Idaho and she is having year round allergy symptoms for the past three to four year. She moves here from California where she has minimal seasonal allergies although during sagebrush time she did have some allergy.

She complains of nasal symptoms including sneezing, itching, which is extreme in her nose, nose rubbing, clear nasal discharge, nasal stuffiness, hoarseness, decreased smell, decreased taste, itching inside ears, and snoring. She states it is year around. She gets mild relief in wintertime. She also has a history of sinus infections, but they are not frequent. She denies any history of nasal polyps, TMJ, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold, or frequent tonsillitis. She does have some frequent headaches. She states her nasal symptoms has been for years. She has used Flonase in the past and that does seem to help. Currently, she is using lysine for her eyes, saline nasal sprays and over-the-counter antihistamines and sinus medications with good relief. She has not had CT scan of the sinuses done.

She denies any frequent ear infections although she does complain of dizziness, lightheadedness and has had complaints of vertigo since 2007. She states that this vertigo gets worse when she is off antihistamines and since she is related to seasonal allergies.

She also complains of eye symptoms including itching, redness, tearing, drying, burning, and light hurting her eyes. She denies yellow discharge from eyes, eyelid swelling, or eyelid irritation which occurs frequently.

She denies any history of wheezing or lung problems and has never had any asthma.

No other allergic skin problems. She denies any atopic dermatitis or eczema currently or in the past.

Previous allergy evaluation: She has never been evaluated for allergies in the past. She does have food allergies. She does have food allergies to raspberries that give hives allover her body. She does eat strawberry and blueberry with no problems. She also eats other foods including milk, egg, wheat, nuts, and peanuts, and shellfish without any problem.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Vertigo.

PLAN:
1. At this time, we discussed the use of Flonase one spray each nostril twice daily to help with her nasal congestion as well as her ocular complaints.
2. I also encouraged her to use over-the-counter antihistamines either Zyrtec or Allegra as she has only used Benadryl and that makes her very sleepy. I think that the use of Zyrtec daily can really help with her vertigo as well and reduce her allergic response to her allergens.
3. We also discussed the opportunity of allergy immunotherapy. She likes this idea due to the fact that her mother and sister has had very positive results with allergy immunotherapy and overall probability to evaluate the cost of this with her.
4. We will follow up in two weeks’ time or at first shot if she pursued allergy immunotherapy after understanding cost, whichever comes first.

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