Rash

Patient is 3-year-old girl who is accompanied by her mother, who comes in today with concerns of a possible peanut allergy and other nut. She has noted that when she was one year’s old that when she ingested anything with peanut in that she gets a small papular red rash over her trunk and all over her body. She denies any throat closure or severe hives or anything other than anaphylactic response at this time. She thus has avoided peanuts and all other nuts. She did have macadamia nut cookie and had the same effect. She also has tried shrimp and crab and they eat a lot of seafood in the family and does get the rash when it is not cooked all the way. She does not seem to have a problem with fried shrimp, however.

She also complains of nose allergy symptoms including nose rubbing, clear nasal discharge, nasal stuffiness, hoarseness, or swelling. These symptoms occur mostly in the summer and considered as moderate. She has a history of sinus infections one that happened in March or April and turned into pneumonia and needed outpatient treatment. She has used Equate Children’s Allergy Relief in the past with very little relief.

She does admit she has similar ear infections. She has had two in the last year but antibiotics were not needed.

She complains of some eye irritation and redness, but denies tearing, drainage, burning, eyelid swelling or eyelid irritation.

She denies any lung symptoms, history of wheezing, or severe lung diseases as a kid.

In early 2015, she had a chest x-ray done and was diagnosed with pneumonia that occurred in last April. She denies any allergic skin problems including atopic dermatitis or any family history of atopic dermatitis.

She has never been evaluated for allergies in the past.

ASSESSMENT:
1. Rhinitis, unspecified.
2. Concern for food allergy.
3. Rash.

PLAN:
1. We will further investigate food allergy with RAST testing with nut panel, macadamia nuts, shrimp, crab, and peanut, and follow up with those results.
2. We will start Flonase one spray each nostril once daily as to see if this helps with allergic rhinitis symptoms.
3. We will follow up in two to three weeks to go over RAST skin testing as note we do more skin prick testing of certain nuts that we were not able to do today and see how Flonase is working.

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