Sinus headaches

Patient comes in for a recheck. We actually have not seen her since last year. The last visit was May 22, 2015. She did move to Seattle for a few months and was trying to relocate there since her kids were out of the house but decided that she did not like the traffic so she moved back here. She has been seeing Dr. for many years prior and has been on allergy immunotherapy through him as well as through other allergy clinics in areas. She states that she always does very well with allergy immunotherapy but when she stops it she has recurrence in symptoms. She has been currently off of the immunotherapy for one year and she thinks that the last time she was on it she was on it for at least four to five years here through Dr. and now would like to restart the immunotherapy because she continues to have troubles. She currently take antihistamines Allegra daily and uses Flonase nasal spray one spray each nostril daily to help with her allergy symptoms. This does help however it does not make her symptoms go away completely. She has been off her antihistamines for a week today so that she could pursue skin testing and restart the immunotherapy. It looks like she started her allergy immunotherapy in 2007 with Dr. and was on it to 2009 and then she had it transferred to different clinic. I do not believe she has had any other breaks in immunotherapy other than this last year.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Sinus headaches.
4. Food hypersensitivities.
5. Mild persistent asthma.

PLAN:
1. At this time, I do feel patient would like to begin allergy immunotherapy again that this could be good treatment for her so we will go ahead and begin that. She will come in twice a week till we reach her maintenance dose and then she will proceed to monthly shots.
2. She does use Singulair, Symbicort and Ventolin for her mild persistent asthma and this has been well-tolerated. She has not had any breathing troubles.
3. She will continue using Flonase and antihistamine, Allegra for her allergy symptoms until the immunotherapy begins to be more effective.
4. We will follow up regularly with.

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