Patient is 50-year-old male who comes due to his long-standing troubles with allergies. He states, that he has had allergies developed ever since he was about 12 years old and now has progressed into this chronic postnasal drip. It used to be seasonal, but now he feels that they have actually become year-round. He currently complains of nasal symptoms including sneezing, itching of the nose, nose rubbing, clear nasal discharge, post nasal drip, nasal stuffiness, mouth breathing, frequent throat clearing, sore throat, hoarseness, snoring, and heartburn. This occurs every day. He does use sinus rinses and saline sprays currently, and that does seem to help the most. He has also used fluticasone nasal spray, but not everyday. He has also used Avastin nasal spray in the past, but that does not seem to help much more, and also uses Claritin or Zyrtec as needed. It all provides moderate relief. He does complain of about one sinus infection per year and frequent bad cold. He denies nasal polyps, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, and frequent tonsillitis. He states it is moderate in severity, but chronic.

He denies frequent ear infections, dizziness, lightheadedness, or hearing impairment.

He does have eye itching, redness, and tearing. He denies dryness, burning, light hurting his eyes, yellow discharge from his eyes, swelling, or eyelid irritation. This occurs all the time.
He denies any history of wheezing or lung troubles. He does state that when he is around cats he may develop some chest tightness. He denies recurrent night cough and has occasional frequent coughing spells due to his postnasal drip. He denies shortness of breath with exertion or coughing on exertion. He has not had a chest x-ray performed in the last five years.

He denies any allergic skin problems. He has never been evaluated for allergies before.

1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Chronic postnasal drip.
4. Upper airway cough syndrome.
5. Snoring.

1. At this time, I discussed with Michael that he would certainly benefit from long-term management plan with allergy immunotherapy to reduce medication needs and to desensitize his immune system to his allergens. He is interested in pursuing this and getting his shots done at the Micron for convenience.
2. I also prescribed him a QNASL nasal spray to use one spray each nostril twice daily to see if this would benefit him more than the fluticasone nasal spray regularly.
3. I also encouraged him to use antihistamines regularly as needed including Zyrtec or Claritin especially prior to his immunotherapy injections to help reduce local reactions and help with his allergy symptoms. We will followup with his first shot.


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