Allergic urticaria to pet rat

Patient comes in for a recheck. She was evaluated by Dr. last week on May 17, 2016. She was given Zyrtec to use daily 10 mg to see if this will help with some of her hives reaction. She currently is getting hives when she plays with her pet rat. She does not get these hives if she is not playing with her pet rat and it does seem to only occur where the rat touches her skin. I do feel that these hives are not in an acute idiopathic urticaria, but probably a more allergic triggered urticaria from her pet rat. She also has some various food complaints. She says that citric acid and high doses will irritate her taste buds and cause some swelling and sensitivity in her tongue and also down her throat. If she takes too much citric acid especially in the form of grapefruit juice this really bothers her and she feels that her throat may be swelling. She cannot tolerate some citric acid products though without having any trouble. She also feels the same thing with avocados but has not had any severe swelling, associated with that as well. She otherwise is doing very well. She did stop ibuprofen, although she does not use it very often at all. She felt it was contributing to her hives, but I do believe that the hives seem to be directly associated with her pet rat and may be either an allergen based that cause her to rat urine or feces or saliva. I do not know if she was tested for rat on skin testing at last visit. She was tested for seasonal allergies and was all negative. She was also tested for various food products and that was negative as well. She was just mildly positive to dust mites. She does have some nasal congestion as well that bothers her slightly, nothing that is quite severe but it does seem to be the worse this time of the year. She does state that this gets worse during windy days as well as when she is around people with high fragrances. She may be exhibiting an allergic rhinitis. Otherwise, no changes.

ASSESSMENT:
1. Non-allergic rhinitis.
2. Hypersensitivity to citric foods and avocado. No food allergy identified.
3. Allergic urticaria to pet rat.

PLAN:
1. At this time, I discussed with that the best thing for her with her hives she gets when playing with her rat is probably to wear long sleeves and keep her rat off of her direct skin, but she could still play with her rat and enjoy with her pet if she can keep the rat from running and scampering up her raw skin along her torso and arms as that is where she tends to get the hives reaction. These do resolve after she washes up after petting her rat, could be without any medications.
2. I also wanted to try using a fluticasone nasal spray one spray each nostril once daily to see if this will help some of her nasal congestion. She can use this if she knows she is going to be outside all day with high winds or other triggers as well.
3. I do not feel that she is exhibiting any allergic reaction to citric acid foods or avocado; however, it does seem to be triggering an irritation of her taste buds and irritation in her throat, so she will continue to eat these products in moderation. If she has worse troubles and she is concerned she will come back and see me while she is having one of these events. I did tell her that I will do some research on citric acid involving taste buds and see if I can come up with any interesting information for her. Her father also states that he has the same sensitivity and they are interested in finding out the etiology. It may be just a genetic sensitivity to sour foods or other substances.
4. We will follow up as needed. I will contact her if I find out anything interesting about their conditions, but I do not feel that they have any significant allergy troubles that may lead to health consequences at this time.

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