Vespid allergy

Patient comes in today for annually recheck for pursing his vespid immunotherapy. He has currently been on immunotherapy for a little over one year and is doing very well. He has not had any troubles with the shots or any reactions. He has been stung by a wasp twice in the last year while he has been on the immunotherapy and has had just a normal reaction to these stings. He has not had any anaphylactic episodes since he has been on the allergy shots. He would like to continue with the immunotherapy as this is a long-term management plan that takes approximately three to five years of doing the monthly injections to achieve 99% success rate of desensitization to the vespids. He was tested positive to yellow hornet, white-face hornet and yellow jacket at the time of testing. We do pursue a mixed vespid immunotherapy for him. He otherwise has no concerns. He does have occasional allergic rhinitis particularly to certain pollens as well as cats but chooses to avoid having had them in his home. He does just fine with over-the-counter antihistamines for this as needed. He has not other concerns. He does state that he used to be working in logging when he was younger and was getting stung frequently by wasps when he was sawing trees that seemed to irritate them. He no longer does this so he has less of interaction with the vespids but still occasionally encounters them. He is quite an outdoorsman. No other changes.

ASSESSMENT:
1. Vespid allergy.
2. Allergic rhinitis.
3. Allergic conjunctivitis.

PLAN:
1. At this time, we would like to continue with the vespid immunotherapy monthly to continue desensitizing Doug’s immune systems to the vespids. We have 99% success rate if he achieves this for the next three to five years. He has no concerns about the injections. He is not having trouble, reactions, or any other side effects and consents to continue.
2. He would like to ensure that this continues to get approved though the VA. Please fax this dictation to Jennifer Ackerly-Woods, PA-C at the VAMC ______ medical records.
3. He does have over-the-counter antihistamines Zyrtec or Allegra to use as needed for breakthrough allergy symptoms or if he does get another encounter with vespid. He can use it for any local reaction. He otherwise does not have any concerns today. We will follow up annually.

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