Fibromyalgia

Patient is 34-year-old female who comes today mostly to test her food allergies. She had pineapple when she was very little approximately 4-5 years old and had a severe reaction. She cannot recall the specifics of reaction or if she went to an emergency room or if she got epinephrine at that time. They do think she had hives, but notes that her mother decided not to give her pineapple ever since. She also notices sores on her tongue when she ate fresh tomatoes and this irritates her mouth very much. She is able to each pizza sauce, pasta sauce, and other cooked tomatoes as well as sauces without any problems. She is unsure if she has any other food allergies and would like to be tested today. She is pursuing a bariatric surgery in the future and is trying to rule out other etiologies of her abdominal complaints.

She also complains of seasonal allergies since she was very young. Nasal symptoms includes sneezing and itching of the nose, nose rubbing, clear nasal discharge, postnasal drip, clear nasal drainage, nasal stuffiness, mouth breathing, frequent throat clearing, sore throat, decreased smell, decreased taste, snoring, and belching a lot. She states that these symptoms are very much year round, but worse during the time when they are cutting hay which is late summer. She has had sinus infections in the past, but not frequently and once they are required long-term antibiotic use. She also gets frequent headaches. She complains a lot of sore throat especially after eating and is unsure if this is an infection or due to food allergies. She denies any frequent ear infection, frequent bad colds, and has never had history of nasal surgery.

She also has exercise-induced asthma, but sometimes limits her exercise and play. She is not exercising at this time and therefore feels that she does not need any inhaler, although I have encouraged her to having inhaler as needed in case she would like to try to pursue more exercise and able to use it prophylactically before exercise to help reduce her symptoms. She does admit to shortness of breath with exercise, coughing with exertion, and coughing with doing various tasks.

She denies any allergic skin problems, any eczema, or atopic dermatitis. She does not have a history of getting hives from anything she ingests or other idiopathic causes of hives. She has never been tested for allergies in the past.

ASSESSMENT:
1. Concern for food allergy.
2. History of angioedema.
3. Medication allergies.
4. Exercise-induced asthma.
5. Allergic rhinosinusitis.
6. Sjogren’s syndrome.
7. Fibromyalgia.
8. Abdominal pain unspecified.

PLAN:
1. At this time, I have given her an EpiPen to work emergency use if she ingests pineapple and feel as though she has throat closing, hives all over her body, and swelling. She can also use her EpiPen for any adverse reactions to any medication or anything that causes life-threading swelling and she is instructed to go to the emergency room if she realizes to that.
2. We will perform RAST test for pineapple to further identify an allergy to pineapple.
3. We encouraged possible antibiotic testing to penicillin and cephalosporins as well as other that we can test in the office to help reduce her allergy list of medications in case she needs them in the future. She would like to postpone this testing because she is mainly here for just testing her food allergies.
4. She will return in one week to do her seasonal allergy testing. We are unable to do all seasonal allergens and foods at one time, so she would like to return to do any skin test for grasses, trees, weeds, and molds. At that time, we will review her results of her RAST tested pineapple. We will follow her up in one to two weeks’ time to pursue this skin testing.

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