Allergy to garlic

Patient is 49-year-old male who has been seen by Dr. in the past the last time being in 2013. He has had a couple of steroid injections from Dr. to help with acute allergy troubles. Currently, he is having significant problems again. He said they began on Sunday. He was at the tamarack, it was very windy, and then on Monday and Tuesday he just had severe allergy symptoms including nasal congestion, eye irritation, and feeling fatigued and overall horrible he states. He currently complains of nasal symptoms including sneezing, itching, of the nose, nose rubbing, clear nasal discharge, frequent nose blowing, nasal stuffiness, and hoarseness. This does not occur every day. It just seems to be this time of the year May through July. He denies having any sinus infection, nasal polyp, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold, and frequent tonsillitis. This can be quite severe. He does take Zyrtec as needed. He has used fluticasone nasal spray as well and that does help some.

He denies frequent ear infections, dizziness, lightheadedness, and hearing impairment.

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

He denies any history of wheezing or lung troubles, frequent coughing spells, or shortness of breath with exercise. He has not had a chest x-ray in the last five years. He denies any allergic skin problems such as eczema or hives. He has not been skin tested for his allergies before.

ASSESSMENT:
1. Acute allergic rhinitis.
2. Acute allergic conjunctivitis.
3. Eosinophilic esophagitis.
4. Allergy to garlic.

PLAN:
1. At this time, I do see that patient is having significant allergy troubles. He would benefit from a dose of prednisone. We will do 30 mg for the next four days. I also want him to use Dymista nasal spray one spray each nostril twice daily and an antihistamine to help control his acute allergy symptoms.
2. We did discuss at length that I think it will be important for patient to do skin testing to further evaluate his allergy triggers and possibly pursue allergy immunotherapy to help desensitize his immune system to his allergens. This could help treat his allergic disorders.
3. I also encouraged him to be honest with himself about his EOE and if it is well controlled so he can prevent food getting stuck.

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