Atopic deramititis

Patient is 3-year-old girl brought in by her mother to evaluate possible food allergies. She currently last week had facial swelling at daycare that lasted for about two days. Mother states that it was fairly mild, but noticeable and her daycare wanted her to get her allergy tested. At that time that she had a facial swelling, she was not given any new foods and also was given Benadryl, but it did not seem to help. She has not noticed that she has had any problems with allergies in the past and tolerates milk, egg, wheat, nuts, peanuts, and soy just fine. She has not early tried shellfish yet the day that she had this reaction, she had potatoes and fruit that she has had in the past.

Patient is a product of a full-term delivery, C-section, and she was breast-fed for one year. She has not showed signs of nasal congestion or problems with seasonal allergies. She occasionally had some clear nasal discharge or increased nasal mucus secretions although nothing that seems to be in a seasonal variation. She denies any history of sinus infections, nasal surgeries, frequent bad cold, frequent tonsillitis, or frequent ear infections. She has used Benadryl in the past and it did not seem to help with her supposed allergy reactions.

She does admit this one time having itching, redness, eyelid swelling, eyelid irritation, although this has never happened in the past as one time event.

She denies any history of lung problems or wheezing. She did have one time infection of croup at 12 months old, but it did not require hospitalization. She denies any frequent coughing spells, coughing up mucus, shortness of breath with exercise or coughing on exertion.

She does have a history of eczema. She currently has a little mild eczema on her cheeks. Her mother states that she does get it at upper arms as well. She uses eczema moisturizer for her and it seems to do well. She has never needed to use any steroid creams to resolve her problems. She has never been evaluated for allergies in the past.

ASSESSMENT:
1. Concern for food allergy.
2. Atopic deramititis.
3. Acute angioedema, idiopathic.

PLAN:
1. At this time, she was not tested for any seasonal allergies or food allergies. So, we do not believe that her facial swelling and eyelid swelling for those two days was associated with any allergy at this time specifically since she was given Benadryl and it did not help resolve her all problems. She may have just an acute angioedema due to a mild upper respiratory infection that triggered it or some other idiopathic etiology. We will further continue to monitor Symphony and see if this seems to recur, but hopefully it was a onetime event.
2. She is negative for any seasonal allergies today. So, there is no need for any medication management for that.
3. They will return if needed for any recurrent events. Otherwise, we will see her as needed.

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