Strep infection

Patient is 7-year-old girl, who currently complains of nose rubbing and nasal stuffiness that most commonly occur in August and September. She has never had a sinus infection in the past or any frequent headaches, bad cold, or frequent tonsillitis. She currently uses fluticasone as needed and occasionally as needed with moderate relief. She does not have a history of frequent ear infection.

She does complain of eye symptoms including itching, redness, tearing, dryness, burning, light hurting eyes, eyelid swelling, and eyelid irritation. She uses Pataday as that seems to help her eye symptoms. It is becoming more frequent and recurrent.

She denies any history of lung infections causing wheezing or chest tightness or problems of asthma-like symptoms in the past.

She does have some allergic skin problems including atopic dermatitis on the back of her knees and on her elbows. These also sometimes erupt on her face and eyelid as well. She is not using any medicated creams to resolve this.

She has never been tested for allergies in the past.

ASSESSMENT:
1. Atopic dermatitis.
2. Rhinitis, allergic with vasomotor.
3. Urticaria.
4. Strep infection.
5. Allergic conjunctivitis.

PLAN:
1. At this time, we will continue using Flonase for her nasal symptoms. I have encouraged them to use one spray each nostril once daily to see if there are consistent treatment with the Flonase helps with the nasal symptoms.
2. Pataday one drop each eye daily to help reduce her eye symptoms.
3. We will try using triamcinolone ointment 0.25% for her atopic dermatitis in the back of her knees and elbows or anywhere else on her body. Her mother uses a cream for her eyelid and did not want to use any type of steroid cream near her eye at this point.
4. We will follow up in two weeks’ time to see how the atopic dermatitis is resolving and to see how her allergic symptoms are controlled with the Flonase and Pataday eye drops. We do have a suspicion of an allergy-based etiology of her symptoms although the skin testing was negative. We encouraged the mother that we could pursue testing again in a few years when patient is little older for more accurate results.

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