Cashew allergy

Patient is 9-year-old girl who was brought by her father today to evaluate possible food allergies. She has for the last approximately two years started having problems with food intolerances. She states that at first it seems to be with nuts. She has always had eaten nuts but then she had kind of a visceral reaction her father puts it where she threw up the nuts. She used to have random hive reactions as well and has not had those in quite some time but was unsure if it was related to having nuts or other foods. She also states that she has problems with milk which makes her tongue and mouth itch. She also has had some puffiness in her lips and abdominal pain, gas, and bloating from milk ingestion. She also states that the same thing happens if she eats too many oranges. She has eaten these all of these foods in the past without having problems or any anaphylactic-like reaction. She does have an EpiPen but has not needed it. She was evaluated at Dr. clinic and had blood testing done and she was shown to have some allergies to cashews, tree nuts, walnuts, and oranges. She used to tolerate peanut butter just fine when she was younger. She has also tolerated almond butter and other nuts but does not particularly like nuts, so avoids them for the most part.

She denies any problems with seasonal allergies and does not have any troubles with nasal drainage that is concerning. She also denies any problems of frequent bad cold, frequent tonsillitis, frequent ear infections. She did have frequent ear infections which she was a child and had ear tubes placed otherwise she is not having any more problems. She denies any eye symptoms with itching redness, dryness, tearing, or burning.

She denies any history of asthma or lung problems. She denies any history of allergic skin problems other than the intermittent hives that started occurring approximately two years ago. Previous evaluation was done.Family Medicine shown to be allergic to cashew, tree nuts, walnuts, and oranges. She since then also has intermittent problems with just funny feeling in her mouth, itching in her mouth, lips and tongue and some swelling, that was the worst reaction she has had with these effects that were after ingesting Brie cheese and cheese pizza approximately 10 days ago.

ASSESSMENT:
1. Cashew allergy.
2. Allergic rhinitis.
3. Lactose intolerance.
4. Oral allergy syndrome.

PLAN:
1. At this time, I would like to pursue blood testing to further identify her allergies. We will include all of the tree nuts including cashew, pistachio, almond, walnut, pecan, hazelnut, and also do peanut. We will also do milk as she has problems with milk intake.
2. She does have an EpiPen in case she has an encounter that causes an anaphylactic reaction. I also encouraged them to us Zyrtec 10 mg as needed for any hives or swelling-like reaction.
3. I discussed the possibility of some of her mouth irritation, itching may be due to an oral allergy syndrome since she was so highly allergic to grasses and birch tree and could be crossreactivity to certain fruits and vegetables causing her troubles.
4. I discussed that may be trying Lactaid milk product intake will be beneficial for her GI complaints associated with milk as her mother is intolerant as well and gets great relief this intervention. I will call her when we get the lab results in and we will follow up annually to evaluate her food allergies.

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