Gastric ulcer

Patient comes in today for recheck on his acute idiopathic urticaria and angioedema. He has had this urticaria since early October and continues to struggle having control of his urticaria. Currently, he is on Zyrtec two tabs three times daily. He has been worked to get off his hydroxyzine, but he does complain of hives that erupts mostly in the morning and then go away. He does state that he continues to be very drowsy. He is not sure why since he has been off the hydroxyzine and feels that the Zyrtec may be doing so. He otherwise is feeling better being off the hydroxyzine. He does not have any troubles with oral ulcers and if he continues to improve, although he still has not gained 95% control of his urticaria. We did do some lab work to rule out any specific infections including an ova and parasite, and CBC with differential. She will get some basic serology and _____toxicology; all of these tests were negative and parasitic infection has been ruled out.

ASSESSMENT:
1. Idiopathic urticaria.
2. Gastric ulcer.
3. Allergic rhinitis.

PLAN:
1. At this time, we will switch the Zyrtec to Allegra 180 mg three times daily to see if he is less drowsy on this medication. He will contact me if he has increase in flares with the urticaria, so we can adjust the dosage.
2. We also discussed the possibility of Xolair and that we may try that in the future if he continues to have troubles with his urticaria to help resolve this.
3. He denies any more problems with joint pain or new oral ulcers.
4. We will follow up in one month to see how he is doing and prescribe Xolair if needed.

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