Seasonal and perennial allergic rhinitis

Patient is 79-year-old female who comes in for her yearly checkup of allergy immunotherapy. She states that she has had little bit of increase in swelling at the shot site and chronic drippy nose that seems to come and go depending on seasonal variations and temperature changes. She has been on the allergy immunotherapy for quite some time since 2009 and it seems as though it has done as much as it can do for her. So, we will try to stop the allergy immunotherapy and see if she has recurrence in symptoms or if she maintains control without it. She does state that her allergies do see much better from the shots and she does have some occasional allergy outbreak causing runny nose otherwise it is pretty well controlled. She has always had a hypersensitive immune system. She has been on prednisone for decades that may have suppressed her immune system that may be partly why we did not get as good of a response. She is currently on Humira and had a pneumonia infection this year that led to hospitalization otherwise nothing else changed and she has no concerns.

ASSESSMENT:
1. Mixed rhinitis.
2. Seasonal and perennial allergic rhinitis.
3. Allergic conjunctivitis.
4. Rheumatoid arthritis.
5. Fibromyalgia.

PLAN:
1. At this time, we will discontinue allergy immunotherapy and see if she gets along fine without it as she has been on it since 2009 and it has probably done as much as it will do for her.
2. I encouraged her to use Atrovent nasal spray 0.06% as needed. If she does note certain triggers that increase her runny nose, I encouraged her to use this medication 30 minutes before doing these activities and see if that helps.
3. She can also use Zyrtec as needed for any breakthrough allergy symptoms.
4. We will follow up as needed. If she does not have any concerns, then she will be working with her rheumatologist for her other disorders.

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