Epistaxis

He is here for follow up on his allergy immunotherapy for his known diagnosis of allergic rhinosinusitis with chronic sinusitis, uncontrolled GERD, and lactose intolerance. patient has been doing very well on the allergy immunotherapy. He states that it has changed his life dramatically. He no longer has severe allergy troubles or frequent sinus infections and can finally enjoy his life much better. He does use Flonase as needed if he has any great allergy symptoms or nasal congestion, which occurs occasionally, but not very often. He also has gotten a eustachian tube dysfunction that occurs causing some ear popping and plugging and will use the Flonase for that as well. He has not been needing any antihistamines. He does get a lot of small local reaction at the injection site that goes away within a day, but can be slightly irritating; however, he wants to continue with his allergy treatment. He currently was given a 0.45 cc of his 120 vial for his maintenance dose and he does this every four weeks. He could be happier with this treatment and would like to continue as planned. He has used QNASL in the past as well and that did help, but now he feels he does not need it anymore and can tolerate Flonase just fine.

ASSESSMENT:
1. Allergic rhinosinusitis.
2. Chronic sinusitis.
3. Gastroesophageal reflux disease.
4. Epistaxis.

PLAN:
1. At this time, I did give him a sample of Dymista to try for any acute nasal symptoms and eustachian tube dysfunction to use one spray each nostril twice daily as needed to see if he likes this better than the Flonase.
2. I will also refill his allergy immunotherapy so we can continue him on with that treatment for infection and medication needs and increasing his quality of life.
3. I did encourage him to try using Allegra prior to the injection to help with the small local reactions and see if that will make it less irritating.
4. We will follow up for next vial of refill and see him regularly for his injections.

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