Irritable bowel syndrome

Patient is 29-year-old woman who states that she has all kind of different types of allergies and she states currently she is having bad troubles with her seasonal allergies including watery eyes, runny nose, sneezing, clear nasal drainage, postnasal drip, nasal stuffiness, frequent throat clearing, sore throat, and hoarseness. It has been progressively getting worse and the older she gets. She also has been having hard time with bread products when she works with bread in her kitchen that she works out and causing her eyes and nose to go crazy like with seasonal allergies. She also develops this rash on her skin when she did contact with wheat products or if her allergies are very bad. She uses a steroid cream for this and it helps, but it does seem to be associated with her allergies. She states that her allergies are the worst in spring and summer and get better throughout the fall and winter.

She does get frequent sinus infections as well. She has had one for the last few months. She states she has used three different rounds of antibiotics for this and it is finally clearing up and states that her nasal drainage is mostly clear. She has had a deviated nasal septum surgery in December of 2015. She also has frequent bad cold and frequent tonsillitis three times this last year. She gets frequent headaches and TMJ. She denies nasal polyps. She does take patient as needed and Flonase and does not use this regularly, but it does help moderately when she does.

She does have frequent ear infection three this last year. She has dizziness, lightheadedness, or hearing impairment.

She does have some eye itching, redness, tearing, burning, light hurting her eyes, and eyelid irritation. She denies dryness, yellow discharge from eyes and eyelid swelling. This occurs a lot of the time.

She denies any history of wheezing or lung troubles. She denies frequent coughing spells, recurrent night cough, coughing up mucus. She has not had chest x-ray within the last five years.

She does have eczema that seems to flare-up when her allergies are bad or if she is in contact with wheat products. She has never been evaluated for allergies before.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Possible atopic dermatitis.
4. Concern for food allergies including wheat and egg yolk.
5. Possible gluten intolerance.
6. Irritable bowel syndrome.

PLAN:
1. At this time, we did discuss that she is not exhibiting allergies to any specific foods today, but she may have gluten intolerance or an irritable bowel syndrome that is causing her troubles. We did discuss the FODMAP diet as well as gave her a recommendation of a book to read to cut balance resolution to help repopulate her microbiome with healthy bacteria and to utilize probiotics if this seem to help her.
2. We will have her come back for her skin testing to seasonal allergies to evaluate her for allergic rhinitis and conjunctivitis and possibly pursue allergy immunotherapy if she is a candidate due to the fact that the medications do not work very well for her.
3. We will follow up for skin testing and I will also refer to Idaho Gastroenterology Associates to evaluate her irritable bowel syndrome and her concern for celiac disease.

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