Patient is 61-year-old female who states that ever since February 3, 2016 she has developed hives that seem to be a daily occurrence. She has only had two days since that time that has been hive free. She has used children’s Benadryl one to two teaspoons as needed to help when the hives are really bothering her and it does help clear it up. However, she is very sensitive to medication and has not been going to use this regularly. She has not had any other treatment for these. She has noticed that they do occur sort of where there is increased pressure from her clothing or in her pant line and also notes that she was extremely stressed out she states on February 2, 2016 and then the hives came so may be too distress as well. She also has significant allergies that she has all her life including nasal symptoms and ocular symptoms but have never really bothered her too much. She also has mixed connective tissue disorder, Sjogren, and they were concerned about lupus for a long time and also osteoarthritis and hypothyroidism. She is on medications for these, but still has some symptoms from those autoimmune disorders. She has not changed anything in her environment. She has not adjusted any medications or introduced new foods. She has also not moved or changed pets. She has not changed any cosmetic products or detergents or anything else in her environment.

She currently complains of nasal symptoms as clear nasal discharge, frequent nose blowing, hoarseness, itching inside ears, snoring, heartburn, and belching a lot. She also has sleep apnea and acid reflux. This occurs in springs, summer, and fall, fall being the worse time. She has had occasional sinus infection. She denies nasal polyps, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold, or frequent tonsillitis. She has used Benadryl for this in the past with little relief. She is very sensitive to medications and they seem to cause side effects to Benadryl and does not make her sleepy but other medicines do.

She denies any frequent ear infections, dizziness, lightheadedness, or hearing impairment.

She does have eye itching, tearing, dryness, light hurting her eyes, and eyelid irritation. She denies redness, burning, yellow discharge from eyes, or eyelid swelling.

She does have some mild to moderate wheezing episodes. It is more to do with thick mucus from the Sjogren’s and dairy products can trigger it. She denies other severe wheezing episodes or wheezing limiting exercise and play. She does use Mucinex. She does not use any albuterol inhalers. She denies frequent coughing spells, recurrent night cough, coughing up mucus, or shortness of breath with exercise. She never had any chest x-rays done in the last five years.

She did have eczema as a child, but does not have any troubles currently. She was evaluated for allergies in the past when she was a teenager and was significantly positive to various things. She did do some shots for a couple of years in the late 1980s for animal danders.

1. Chronic idiopathic urticaria.
2. History of mixed connective tissue disorders and Sjogren.
3. Hypothyroidism.
4. Osteoarthritis.
5. Allergic rhinitis.
6. Allergic conjunctivitis.

1. At this time, I do feel that should benefit from getting consistent dose of antihistamines to help spice the allergic portion of her immune system and all these hives to run their course and prevent outbreaks. I do want her to try using Benadryl 25 mg daily to see if this is enough to control her hives and prevent them from occurring. She may need to increase her dose to three times daily. She does want to try this with Benadryl first because this does not seem to make her sleepy and she knows that this medicine she can tolerate well. If she does get sleepy on these higher doses again, then change to Zyrtec 10 mg daily and can do Benadryl at night.
2. If she has trouble controlling her hives on these antihistamines or higher doses, then she will come back and see me so we can continue to monitor her hives outbreak. I do feel that her hives are due from more of an internal trigger with her autoimmune disorders and possible some external triggers that have chipped her over her threshold and her immune system triggering these hives. If we can control them with antihistamines, we may need to progress to Zolera treatments in the future.
3. We will follow up in one month.


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