Concern for allergy to apple. It causes mouth itching

Patient comes in for recheck. We last saw her on 03/18/2016. She is doing very well. She is having a little bit increasing allergy symptoms. Mother continues using Flonase every day and that just seems to help and she is not having this chronic runny nose anymore. She also has been doing the Flovent two puffs twice daily and with spacer and that has been helping her asthma. She does get occasional flares where she needs a rescue inhaler. She states this happened about four to five times since last time we saw her. She has tried to give her an over-the-counter to see if this helps with her allergies. She states that it may help her a little bit but she continues to have a little bit of increased allergy troubles for the last month and half. Otherwise, she has been doing very well. We did revaccinate her with Pneumovax vaccine and got her blood work back in her and she is well protected from pneumococcal. Her mother has no other concerns at this time. She has history of allergy to Singulair. She has never seen anything like this and she has not been on Singulair.

ASSESSMENT:
1. Acute allergic rhinitis.
2. Allergic conjunctivitis.
3. Mild-to-moderate persistent asthma.
4. Concern for allergy to apple. It causes mouth itching.
5. History of recurrent ear and sinus infection.

PLAN:
1. At this time, I will prescribe Zyrtec one teaspoon daily to help with her allergy symptoms. They are great flavored oral suspension and she can pick this up at the pharmacy.
2. She will continue with the Flonase one spray each nostril daily as well as Flovent two puffs twice daily and her albuterol inhaler as needed. If she begins any of these inhaler more than twice per week, they will let me know so that we can evaluate her asthma control or if she does have any flares that get her in trouble to come see us so we can listen to her lungs.
3. We will follow up in six months if she continues to do well. If she does need to see us sooner, she will certainly do so. I did sign paperwork to allow her to remove apple out of her diet at school because it does cause mouth irritation that causes a rash and diarrhea. She was negative on testing, but that way she would not be exposed to this per mother’s preference. We will follow her up in six months.

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