Allergy and Immunology Follow-up

Liam Tremblay is a 28 year old male seen today, 15/10/2023, for follow-up of allergic rhinitis and mild persistent asthma.

Background History

Pt has a known history of perennial allergic rhinitis, mild persistent asthma, and mild atopic dermatitis. Sensitized to house dust mite (D. farinae, D. pteronyssinus) and cat dander on previous testing. Started on sublingual immunotherapy (SLIT) for dust mites 6 months ago. Past medical history is otherwise unremarkable.

Interval History

Since my previous review of 12/04/2023, he has tolerated dust mite SLIT well with only mild, transient oral pruritus during the first 2 weeks. Adherent to daily therapy. Reports a significant reduction in morning nasal congestion, rhinorrhea, and sneezing. No asthma exacerbations, ER visits, or systemic corticosteroid requirements in the interim. Currently feels well. Uses salbutamol PRN less than once weekly, primarily prior to exercise. Adherent to daily maintenance controller therapy. No nocturnal awakenings.

Physical Exam

Vitals: BP 118/74 mmHg, HR 68 bpm, RR 14/min, SpO2 99% on RA. General: Well-appearing, NAD. Anterior rhinoscopy reveals mildly pale inferior turbinates with minimal clear secretions and no significant obstruction or polyps. Chest is clear to auscultation bilaterally with good air entry and no wheezes, rales, or rhonchi. Skin shows dry patches in the antecubital fossae bilaterally without active erythema or excoriations.

Skin Prick Testing

Deferred today as sensitization profile is well-established on prior testing (12/04/2023: Histamine 6 mm, Saline 0 mm, D. pteronyssinus 8 mm, D. farinae 7 mm, Cat 5 mm).

Spirometry (% Predicted)

FEV1 3.95 L (94% predicted), FVC 4.80 L (96% predicted), FEV1/FVC ratio 0.82. Normal baseline spirometry; no significant bronchodilator response required today.

Impression/Plan

Liam Tremblay is a 28 year old male being followed for allergic rhinitis, mild persistent asthma, and mild atopic dermatitis.

1. Allergic Rhinitis: Well-controlled on current regimen. Continue standardized house dust mite allergen extract (Acarizax®) 12 SQ-HDM SL daily. Continue fluticasone furoate (Avamys®) 27.5 mcg/spray 2 sprays intranasally daily and cetirizine (Reactine®) 10 mg PO daily PRN.
2. Asthma: Stable and well-controlled. Continue budesonide/formoterol (Symbicort® Turbuhaler®) 200/6 mcg 1 inhalation BID maintenance, and 1 inhalation PRN for relief. Reviewed inhaler technique and asthma action plan.
3. Atopic Dermatitis: Quiescent. Continue regular emollient use and betamethasone valerate 0.1% ointment topically BID PRN for flares.
4. Follow-up: Return to clinic in 6 months for repeat clinical evaluation and spirometry, sooner PRN.

This note was prepared with assistance from an AI scribe. Consent was obtained before the session began.