Possible allergy to watermelon

Patient is 1-year-old girl. In fact, she is 17-month-old girl brought in by her mother to evaluate for allergic reaction. She states that approximately three weeks ago she developed fascial rash that became quite severe. It was eventually diagnosed with erythema multiforme and was given a prednisone dose for five days to help cleared this out. It did cause swelling as well around the eyes and face. She was currently taking amoxicillin for a possible sinus infection, and this was day 9 of the amoxicillin when this rash occurred. They did stop the amoxicillin and it has slowly resolved, but otherwise not completely gone as of yet. She still has flares of this rash occasionally, particularly after eating and after waking up. She is slightly dermatographic as well, meaning that if she scratched her or push on her skin too hard she will flare up in that area. They have tried using Benadryl 5 mL but that was not really helping too much. She did notice too particularly that after she ate watermelon the rash initially came up and then again when she had watermelon she had a flare up of her rash and she is not sure if she has eaten watermelon before this.

She does currently complain of significant nasal troubles in the last couple of months causing sneezing, nose reddening, clear nasal discharge, and colored nasal drainage. She states that it is mostly green in color. That is why she went to a doctor to begin with and was given an amoxicillin for possible sinus infection.

She also is having significant eye droop everyday. It has gotten better since she was on the amoxicillin, but she still has it. She states that it seems to be persistent since March. She denies a history of nasal polyps, TMJ, frequent headaches, any nasal surgery, or frequent tonsillitis. She does occasionally have frequent bad colds. Her nasal symptoms can be quite severe. She has been given amoxicillin and Benadryl for this and it improves things very little.

She has had one ear infection. She denies dizziness, lightheadedness, or hearing impairment.

She does have some eye itching, redness, tearing, yellow discharge from eyes, eyelid swelling, and eyelid irritation. She denies dryness, burning, or light hurting her eyes, this occurs some of the time.

She denies any history of wheezing or lung problems. She did get diagnosed with RSV at 10 days old and has had gotten frequent viral infection since then, but none requiring hospitalization, nebulization, or antibiotic use. She has used amoxicillin prior to this last time for an ear infection.

She has never had any allergic skin problems such as this before including eczema or hives. She has never been evaluated for allergies before.

ASSESSMENT:
1. Erythema multiforme minor possible infectious induced first amoxicillin induced.
2. Possible allergy to watermelon.
3. Possible allergic rhinitis.
4. Possible acute idiopathic urticaria.

PLAN:
1. At this time, I am not sure why she has developed an erythema multiforme reaction and I am sure if she keeps getting flares of this or if it is just urticaria at this point due to dermatographic skin and flare of an allergy trigger. She is slowly resolving. I do want her to be on one teaspoon Zyrtec daily to see if this will help reduce flares.
2. I did encouraged her to avoid watermelon at this time if she has had two reactions within 30 minutes after eating watermelon and they are not sure if she has had this before. I do think this may be false positive and might not have anything to do with her troubles, but we will further evaluate at next visit.
3. I do want her to avoid amoxicillin at this time too as this may have been the trigger of erythema multiforme. We will follow up in two weeks to see how she is doing. If she is having more trouble controlling this rash or she continues to have flares, we may pursue more workup to identify.

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