Multiple drug allergies

Patient is 41-year-old female who has interesting history of random anaphylaxis episode. She states that on December 26, 2015, at the move she developed abdominal cramp and severe diarrhea. This eventually turned into coughing, sneezing and having a hard time catching her breath. She also starts feeling swelling in her parotid gland. Her eyes started swelling and she got hive across her chest. This occurred approximately one hour to one and half hours after eating food at Applebee’s. She went to emergency room at that time and they gave her epinephrine. She did have another episode similar to this about three to four years ago at Restaurant after ingesting a Reuben sandwich and similar symptoms occurred and ended up having an epinephrine injection at the emergency room for this as well. She denies any history of having food allergies specifically and can tolerate milk, egg, weed, soy, peanut, other tree nut, shellfish, and fish without any problems as far she knows. She is not sure if she is having reaction with certain chemicals. She does state that she has a history of having significant sensitivity to chemical in the past. She denies any family history of angioedema or swelling event. She denies any history of using ACE inhibitors or NSAIDs medications prior to these episodes.

She does have a history of seasonal allergies that seems to be mostly in the winter, spring and summer. She states that she also complains of sneezing, itching, runny nose, nose rubbing, clear nasal discharge, postnasal drip, clear nasal drainage, frequent nose or nasal stuffiness, mouth breathing, frequent throat clearing, sore throat, chills, itching inside ears, swelling, heartburn, and blenching a lot. She has a history of chronic sinusitis infections. She denies any nasal polyps, aspirin-induced nasal symptoms or nasal surgery. She does admit having frequent bad colds and frequent headaches. She states that her symptoms are moderate.She uses nasal spray including Flonase as needed for seasonal allergies. She is using neti pot regularly. She does state she has had some frequent ear infections since coming back from a cruise on December 20, 2015. She also states she has some episodes of dizziness.

She denies any itching of her eyes, dryness, burning, redness and tearing and might hurting her eyes. She says since the anaphylaxis is given, she has had some twitching and burning of the eye.

She does have a history of wheezing episode that can limit her exercise and seems to be associated with cough and tightness in chest. She does have chronic bronchitis infections and pneumonias. She states that her viral infection goes to the lungs and causes a significant bronchitis infection. She has a ProAir inhaler to use as needed. She has needed some prednisone in the past for her wheezing episodes. She admits the frequent coughing spells, recurrent night cough, coughing up mucus yellow in color, shortness of breath with exercise, sudden mucus, coughing on exertion, coughing on wheezing, coughing with lying down, and coughing with laughing. She has had a chest x-ray done in August last year in 2015 at Center. She denies any history of allergic skin problems. She has been evaluated allergies in the past approximately five to six years ago and shown to be significant allergic to sagebrush.

ASSESSMENT:
1. History of anaphylaxis, currently on _____.
2. Concern for food allergy.
3. Allergic rhinitis.
4. Allergic conjunctivitis.
5. History of chronic rhinosinusitis.
6. Possible chronic idiopathic angioedema with urticaria.
7. Multiple drug allergies.
8. Joint pain and swelling.

PLAN:
1. At this time, I would like to pursue some lab works to rule out any autoimmune disorder including ANA, comprehensive panel, and serum tryptase, also autoimmune or hereditary allergy rule out or acquired angioedema with angioedema panel as well as
2. Zyrtec 10 mg twice daily to help reduce flares of swelling and urticaria.
3. She also has an EpiPen just in case if she has another anaphylactic episode.
4. We will follow up in one month’s time to evaluate control of her swelling episodes as well as go over lab results. At that time, we will also possibly do a spirometry test to evaluate her lung function. I also provided her a sample of QVAR 80 mcg to use at the time of her sickness to help prevent these colds from going straight to her lungs causing bronchitis. She can continue her ProAir as needed.

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