Patient is here for annual recheck. She is a very pleasant, healthy young woman who comes in with increase in nasal congestion and dizziness. She has severe seasonal allergies. She has been evaluated by Dr. in the past and was remarkably positive for grasses, trees, and weeds. She always has a hard time this time of the year. She was given a Depo-Medrol shot in May of 2014 and that really-really improved her symptoms since the last over two years. Unfortunately, she is having a lot of troubles again. She uses Allegra daily as well as fluticasone nasal spray daily and Sudafed for her symptoms and nothing seems to help as well as the allergy injection. We did discuss adverse effects and long-term effects of using steroid shots and how it is not a very good maintenance plan for allergies. She does state that she is aware of this and is aware that she will need to manage her allergies better in the future, however, at this time, she cannot afford the time or money to utilize allergy immunotherapy and that really would like some assistance with her allergies.

1. Acute allergic rhinitis.
2. Acute allergic conjunctivitis.
3. Dizziness.
4. Possible acute sinusitis infection.

1. At this time, I did discuss with all the adverse effects of glucocorticoid injections and stated that we will be able to give her another one this year, but then I would no longer be able to consent to this. She understands the side effects and consents; however, she will want to try to stay off of them in the future. She has a huge plan with outdoor activities this summer and really would like to pursue this today.
2. I did encourage her continue using her Allegra. I gave her samples of Dymista nasal spray one spray each nostril twice daily to use and see if this helps better than the Flonase to keep her out of trouble.
3. We will follow up next year. We did discuss long-term allergy immunotherapy. She is kind of afraid of shots and everything and does not want to pursue that at this time from a financial reason, but she will consider in the future as we will not be able to do it for her again.


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