Ankylosing spondylitis

Patient comes in for her yearly checkup for her seasonal allergies. She has seen us three times for yearly checkup since September 2013. We also saw her in August 2014. At those times, we have given her Kenalog 80 mg injection for her severe allergy symptoms. She also has tried in the past Allegra, Mucinex allergy, and various nasal sprays including Flonase and Nasonex and has had very minimal relief with these medications. We tested her first time we saw her with skin testing and she was very highly positive although we cannot seem to find her skin testing report at this time and we have also discussed the possibility of allergy immunotherapy in the past and she is quite interested in this option to minimize the steroid injections although we may need to retest her to mix with most accurate serum for her if we do not find her previous skin testing results.

Otherwise, she states that her allergies are pretty much year around and they kind of get worse at this time of year and the Kenalog injections have helped her and then stated it gives her long lasting relief. She has not started any new medication since last year when we saw her last but she did get a new diagnosis a few months back of ankylosing spondylitis that she takes intermittently Motrin or ibuprofen for.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Ankylosing spondylitis.

PLAN:
1. We will again give her the 80 mg Kenalog injection for her seasonal allergies as this is a very positive treatment option for her. We discussed the side effects of this medication and the long-term accumulation that she should be aware of.
2. She would like to pursue allergy immunotherapy in the future and may come back for more skin testing to reduce her need of a steroid injection in the future and minimize her exposure to this.
3. She will call and let us know when good time for retesting will be for her and we will schedule her at that time and passively pursue allergy immunotherapy then.

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