Concern for mold allergy

Patient is 34-year-old female who for the last five months has been having chronic complaints of urticaria and swelling attacks that occur almost every day. She does not know what trigger these events and does not recall being sick or changing anything in her environment. She has not added any medication, switched detergents, or being trying new foods. All of a sudden it started five months ago and then she has been struggling with it ever since. She has been to the ER twice for swelling and hives. She also has been to two family physicians and a primary health to help her control her hives outbreaks. She has had multiple prednisone Dosepak starting with 60 mg and having a taper until she is done and it seems to be the only thing that seems to help her hives. She has been told to take Benadryl every six hours or Zyrtec 10 mg twice daily but she does not feel that Zyrtec helps at all. She also does not feel like Benadryl does much either and it makes her very drowsy. She states that these hives seem to occur every day in the last five months.

She does complain of nose symptoms as well including itching of the nose, clear nasal discharge, nasal stuffiness, mouth breathing, sore throat, hoarseness, itching inside ears, frequent nose bleeds, and heartburn that began at the same time as the hives. She has not really had a history of seasonal allergies before that. She states that she hired a mold inspector to come to her house. They did a testing of her backyard where there is mold from rotting apple tree and it was positive for penicillium. She also has an allergy to penicillin antibiotic and is concerned that this may be what triggered her hives.

She denies any problems with sinus infections, frequent bad cold, frequent tonsillitis, or frequent ear infection. She denies any nasal polyps, TMJ, or any history of aspirin-induced nasal symptoms or nasal surgeries. She does complain of frequent headaches. She has only used Benadryl or Zyrtec to help with her nasal symptoms. It helps very little. She does admit having eye redness, eyelid swelling and irritation at sometimes of these hives outbreaks. She denies itching, tearing, dryness, burning, light hurting her eyes, or yellow discharge from eyes.

She denies any history of wheezing or lung problems. She denies any allergic skin problems. She has never been evaluated for allergies before.

ASSESSMENT:
1. Chronic idiopathic urticaria with angioedema.
2. Concern for mold allergy.
3. History of penicillin antibiotic allergy.

PLAN:
1. At this time, we will try she on high doses of antihistamines. I encourage her to do two Zyrtec twice daily to see if this is enough to suppress her hives. If she needs to go up to two Zyrtec three times daily, I encouraged her to do so.
2. I also prescribed her dose of prednisone 10 mg every eight hours for any signs of swelling to start at that time and then to stop when the swelling recurs.
3. If she does not gain good relief in two weeks’ time with this treatment we will try Xolair sample and see if we can that approved for her so she can be hives free.

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