Patient comes in for a monthly recheck. At last visit, we discussed his acute idiopathic urticaria and started him on Zyrtec 10 mg twice daily. He still continues to have hives particularly when he increases his activity with vibration doing drilling. He also has hives associated with pressure on the skin. Just when my nurse measures his blood pressure, he has hives eruptions from that. He also was seen to identify his severe hypertrophy of his nasal turbinates. They do look remarkably better today after using QNASL 80 mcg one spray each nostril twice daily; however, they still are quiet inflamed. We will continue using the nasal spray and see if they can continue to improve his troubles. He was given prednisone at that time as well and that did seem to help with his nasal congestion. Other than having the acute flares of hives, everything else is going quiet well for patient.

1. Allergic rhinitis versus mixed rhinitis.
2. Dermatographism.
3. Acute idiopathic urticaria.

1. At this time, I talked with patient about increasing his dose of Zyrtec to 20 mg twice daily to see if this will help resolve his hives reaction. I also told him if he needs to increase it to three times daily using the two tablets of Zyrtec three times daily to continue identifying if his hives will respond to this antihistamine. If he does not respond well and is still having outbreak on top of his high dose of anti-histamines, then we may want to pursue lab work to rule out any other pathology that may be involved with these hives reactions and consider treatment for chronic urticaria.
2. I also want him to continue the QNASL 80 mcg one spray each nostril twice daily to continue improving his nasal symptoms. In the future, I would love to have him skin tested for allergies and see how allergic he is to his environment, but we will have to control his hives first and get him off anti-histamines to get the most the acute testing or skin testing.
3. We will follow up in one month to see if he is maintaining to control his urticaria outbreaks.


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