Ear ringing

Patient comes in for a recheck for his allergy immunotherapy. He needs a vial refill. He has been on the immunotherapy since April 2015. He states that it is going quite well. He has noticed this last fall that he had reduction in his severe allergy symptoms. He did have a reaction when we were titrating up the most potent vial of 1:20, so we discontinued that use. He was given epinephrine at that time and resolved quite well. He now stays on the 1:200 vial at 0.5 mL and has been on the maintenance therapy for that. He has been coming in weekly for that. He does need a vial refill. He has no concerns about the immunotherapy. He now that is on the smaller dose he does not have any large local reactions at the injection site or any trouble concerning a reaction. He does use Flonase two sprays each nostril twice daily as needed for his allergy symptoms. He has not needed it through the winter. He may need it coming up for his spring season. He is significantly positive to grasses, trees, and weeds as well as cat and dust mite. He feels that his nasal symptoms have improved. He also has less eye irritation and less snoring since he has been on the allergy shots. He would like to continue with the immunotherapy as this is providing him a very effective treatment. He does use Zyrtec prior to shots to help reduce risk of reaction.

ASSESSMENT:
1. Allergic rhinosinusitis.
2. Allergic conjunctivitis.
3. Snoring.
4. Oral allergy syndrome.
5. Ear ringing.

PLAN:
1. At this time, we will continue with the allergy immunotherapy to help his severe allergy symptoms. He can continue using Flonase two sprays each nostril one or two times daily as needed to help control his allergy symptoms. He may want to begin at the beginning of the spring to help reduce severity of symptoms.
2. He will continue with the 1:200 vial at least to the 0.5 maintenance dose. If he feels he would like to try to increase the dose gain, we may pursue that in the future if he is not having good response to immunotherapy as he would like, but for now we will continue with this dose. This is going to be a great long-term management plan for his allergies and associated symptoms.
3. We continue to watch his apneic spells and ensure that he is getting resolution of the snoring, ear ringing as well as oral allergy symptoms with the immunotherapy. If he has any other concerns about this, he will contact us and let us know. We will see him back for his next refill.

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