Allergy to dust mites and mild sensitivity to grasses and trees

Patient comes to the clinic today for a recheck of allergic rhinitis and chronic idiopathic urticaria with dermatographism. She is doing very well today and has no complaints as far as her treatment goes. She takes one Zyrtec daily to reduce her hive outbreaks. She also uses Flonase on an as needed basis. She has not trialed Flonase and takes this at least for more than a couple of days. A pharmacist told her to be careful to use the long-term due to risks of nasal bleed and sinus infection which scared her, so she discontinued its use. I further educated her about the use of Flonase to help prevent sinus infections and also reduce nasal bleeds if she is highly allergic and has friable necrosis from her allergies. So, she is not to worry about what pharmacist told her. She would like to, at this time, try Flonase again. She may delay until she has her allergic symptoms due to the fact that she is not allergic to any of the weeds as we are currently in weed season. She is mostly mildly allergic to grasses and trees. So, I encouraged her to start Flonase a couple of weeks before March to help prevent her allergic symptoms to return for the tree season.

She denies any outbreaks of hives and she started to use Zyrtec daily for any dermatographism problems since then. She has currently been on Zyrtec for approximately three weeks and I encouraged her to continue using Zyrtec to prevent the rash from coming back. She states that her hives mostly are related to pressure and hot water and even with different types of cloths or new cloths.

She is not complaining of any allergic symptoms at this time including eye itching, redness, tearing, dryness, or burning or any cough, tightness of chest, or allergic skin problems.

ASSESSMENT:
1. Allergy to dust mites and mild sensitivity to grasses and trees.
2. Chronic idiopathic urticaria.
3. Dermatographism.
4. Concern for physical urticaria.

PLAN:
1. At this time, we will continue the use of Zyrtec for at least the next two and a half months. Then, she can try putting off the Zyrtec for a couple of days to see if her hives come back. If she does not have outburst of hives, she can continue to disuse Zyrtec. However, if they do return, she can continue to use Zyrtec for the next three months and then trial off again. We encouraged her to come and visit us in about six months to assess her hive situation.
2. We will encourage her to use Flonase on an as needed basis to begin at the end of February to prevent from her true allergy or any other time that she has problems with rhinorrhea or nasal congestion.

We also discussed another long-term treatment of allergy with immunotherapy to see if she would like to take care of that in future if having any factor, incident, or problems with medication, cough, or effectiveness.

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