Allergy to naproxen

Patient is 49-year-old female who has always had a history of mild allergies but since August started to have a chronic postnasal drip. She has tried multiple medications including Sudafed, Zyrtec daily, neti-pot, and Flonase with some relief but still complains of chronic postnasal drip. She states that is clear in color but sometimes can be colored depending on the day. Her seasonal allergies seem to have been seasonal in the past but nothing that has led her to take medications or come to an allergist. She has had various sinus infections in the past but not many. She denies any nasal polyps, TMJ, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold or frequent tonsillitis. She does get frequent headaches in the frontal area of her head. She gets moderate relief mostly by the Flonase and saline solution.

She denies any frequent ear infection, dizziness, lightheadedness, hearing impairment. She does have some chronic ear popping and congestion in the ears that is bothering her significantly.

She denies any eye itching, redness, tearing, dryness, burning, light hurting her eyes, yellow discharge from eyes, eyelid swelling, or eyelid irritation.

She denies any history of lung problems or wheezing.

She denies any allergic skin problems although she states that they told her she had psoriasis when she was younger, but she does not have it now. This may have been more of an atopic dermatitis. She has not had any previous allergy evaluation.

ASSESSMENT:
1. Chronic rhinosinusitis.
2. Allergic rhinitis.
3. Allergy to naproxen.
4. History of penicillin allergy with rash.

PLAN:
1. At this time, I talked with patient that she may be developing allergies that are causing her chronic postnasal drip but nothing popped up very highly allergic so I am unsure if this is the cause of her constant postnasal drip. Because of the nature of it being this acute starting in August and not resolving, I do feel she might have an underlying chronic rhinosinusitis infection. She does complain of sinus tenderness and pain as well with the chronic ear popping. I would like to try clarithromycin 500 mg twice daily for 14 days to see if this can clear this up.
2. I also gave her Dymista nasal spray which actually is the generic form of Flonase and azelastine to use one spray each nostril twice daily for both medications to see if this helps reduce her postnasal drip.
3. We will follow up in one month to see how this is going and if she has had success with this treatment.

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