Patient comes today to pursue skin testing for penicillin allergy. He has a history of a rash from penicillin that he had when he was 17 years old. He believes that was due to amoxicillin and at that time he also believes he may have had a mononucleosis viral infection. He would like to determine the severity of this type of allergy as he continues to have acute sinusitis infections every fall or winter and would like better antibiotic coverage if needed. We did discuss the possibility of this rash from amoxicillin being due to the Epstein Barr virus as well as other possibilities of rash due to penicillin that is not true allergy. Otherwise, patient is dong very well today. He is continuing with Flonase once spray each nostril one to two times daily for any sinus congestion or nasal complaints. He does state that he gets somewhat of a headache and is unsure if it was due to Flonase or just increase in sinus congestion. I told him most likely it is due to increasing sinus congestion and that he should try using Flonase two sprays each nostril twice daily and see if this resolves or if it makes it worse and he would let us know how that goes.
1. Chronic rhinitis.
2. Concern for allergy to penicillin.
1. Since he was negative for skin testing to penicillin, today we will go ahead and schedule an appointment for him to pursue the oral challenge. If he is able to tolerate that, then we can clear him the penicillin allergy and he can utilize this for sinusitis infections or other infections in the future.
2. He can continue using Flonase to help with his allergic versus chronic rhinitis symptoms. He will see patient next week or the week after for the oral penicillin allergy challenge.