Peanut allergy

Patient is 10-year-old female brought in by her mother to evaluate for possible allergies. She states that this last month she began having significant allergy troubles including lots of nasal congestion. She did have trouble this time of year last year as well, but it was not quite as severe as this year. Usually, she uses Claritin daily through the spring and summer season and it seems to be enough to keep her allergies under control. She currently complains of sneezing, itching of the nose or roof of the mouth, nose itching and rubbing, postnasal drip, colored nasal drainage, nasal stuffiness, mouth breathing, frequent throat clearing, sore throat, and snoring. They mostly occur in the spring and summer. She denies trouble with sinus infection, finger pop, TMJ, aspirin induced nasal symptoms, nasal surgery, frequent bad cold, and frequent tonsillitis. She does get frequent headaches in the temple area. It seems to be associated with increased nasal congestion. Her nasal symptoms seem to be very severe. She has used Claritin, Allegra, Benadryl, and allergy eye drops in the past with moderate to good relief. Sometimes, she will use a saline nasal spray when her nasal congestion is severe.

She denies frequent ear infection, dizziness, lightheadedness, or hearing impairment.

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

She denies any history of wheezing, lung problems, frequent coughing spells, or recurrent night cough.

She did have eczema as an infant, but this has cleared up. She now just has dry skin mostly on her arms, legs, face, and scalp. However, it is well controlled when she uses a proper moisturizer regularly.

She did have allergy evaluation when she was about six years old. She was strong positive to trees, grasses, weeds, peanuts, walnuts, and cats.

ASSESSMENT:
1. Peanut allergy.
2. Allergic rhinitis.
3. Allergic conjunctivitis.
4. History of atopic dermatitis.

PLAN:
1. At this time, I do want to be very careful about ingesting any peanut product. I did give her an EpiPen and showed her how to use it and gave her a fair anaphylactic worksheet to help identify anaphylactic reaction. We did discuss how to avoid peanut product as well.
2. I do want her to get some blood work done for peanut component panel, so we can further identify her peanut allergy and how severe it may be.
3. I do feel she is safe to eat all other tree nuts at this time including walnuts that she was negative on testing today and can tolerate all other nuts fine.
4. I do want her to try fluticasone nasal spray one spray each nostril daily as well as Zyrtec orally daily for her allergy symptoms. If we have trouble maintaining her allergy symptoms with regular use of nasal spray, then she may want to pursue allergy immunotherapy for long-term management, reduction of medication needs, and prevention of atopic march towards asthma.
5. I will contact the mother with results of peanuts and we will follow up regularly.

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