Rosacea

Patienrt comes in today for a recheck on his allergy immunotherapy. We first saw him in July 2013. At that time he was skin tested significantly positive to grasses, trees and weeds but negative for animal dander and dust mites. He states that the allergy immunotherapy has very much helped his symptoms he has been on it since 2013 every two weeks at 0.5 mL of his 1-20 vial. He states that if he does miss a dose or is late on his dose he can tell with having refractory allergy symptoms. He uses Zyrtec as needed for any allergy symptoms as well as Alaway eye drops as needed. He states today that he does have some rhinorrhea occasionally but nothing compared to what it was like before he started immunotherapy. He wife is a nurse and is very helpful in helping him determine if his rhinorrhea and other sinus congestion complaints are from allergies or upper respiratory infection. He denies any concerns with allergy immunotherapy and would like to continue every two weeks. I did encourage him to try well controlled season to extend his frequency on every four weeks to see if he can get as equal amount of relief on this extended dosing schedule. I would leave that to him if he would like to do so.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Rosacea.

PLAN:
1. We will continue allergy immunotherapy 1 to 20 vial 0.5 mL every two weeks. He is welcome to try extending to every four weeks to see if he has equal benefit on this extended schedule.
2. I encourage him to use Zyrtec as needed for any allergy symptoms or for any local reactions due to the immunotherapy.
3. I also encouraged him to use a nasal spray such as Flonase as needed for any increasing rhinorrhea that may be allergically stimulated.
4. We will follow up annually to ensure that patient continues to have good relief with his immunotherapy.

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