Psoriasis

Patient is 36-year-old female who has had a chronic hives episode in 2012. She actually saw us back at that time working with Dr. for her chronic hives. She also complains of possible food allergies or food irritations causing nausea, vomiting, and stomach pain. Milk seems to bother her tongue causing stinging and as well as with her lips. She also noticed that she gets hives outbreak with soy products as well as milk but is unsure if she gets these hives immediately after ingestion each time or if it is spontaneous and intermittent with ingestion of these foods. She states that her abdominal complaints seem to be worse when she eats out or at fast food restaurants. She has currently been making everything from scratch at home and avoiding dairy products and that seems to make her stomach issues better.

She also complains of seasonal allergies including nasal symptoms of frequent nose blowing, nasal stuffiness, mouth breathing and has sinus infection. She denies any nasal polyps, TMJ, frequent headaches, frequent bad cold or frequent tonsillitis. She uses Benadryl when she has her hives outbreaks as well as allergy outbreaks and has moderate relief with this. She does admit to eye itching and dryness and eyelid swelling with her allergy outbreaks.

She does have a history of asthma and was diagnosed when she was in high school. She gets mild to moderate wheezing episodes during or after exercise. It is associated with cough and slight tightness of chest. She uses Flovent daily as well as albuterol as needed and she feels that her asthma is very well controlled on this medication regimen. She does admit to having frequent coughing spells, coughing up mucus of clear color, shortness of breath with exercise, coughing, wheezing and laughing.

She has never had to use prednisone to help resolve an asthma flare. She has been evaluated for allergies in the past including here at the Allergy Group as well as Idaho Allergy both places. She pursued skin testing and was quite negative for all skin testing.

ASSESSMENT:
1. Concern for food allergy.
2. Chronic urticaria.
3. Dermatographism.
4. Psoriasis.
5. Abdominal pain unspecified with or without diarrhea.

PLAN:
1. We will pursue food allergy panel, celiac panel as well as serum IgE total for lab work to see if there are any allergies identified on this lab work.
2. I also provided her FODMAP diet plan to try to identify if she is having associated irritable bowel syndrome symptoms with the certain foods and to avoid if they seem to bother her.
3. She will continue to avoid dairy products as they seem to bother her symptoms significantly.
4. For her chronic urticaria, we will start Zyrtec 20 mg daily to see if this helps resolve some of her outbreaks as well as her dermatographism and possibly food sensitivity that could be IgE mediated.
5. She is currently working with her primary care physician to get approval for Humira for her plaques psoriasis and will let us know if that gets approved. We also will consider Xolair injections in the future if she feels high dose antihistamines for her urticaria.
6. We will follow up in one month’s time.

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