Clinical Immunologist's Note

ID: 45-year-old teacher Reason for referral: Persistent asthma and eczema, worsening over the past 6 months History of presenting illness: The patient reports increased frequency of asthma attacks and eczema flare-ups, particularly during spring. Symptoms include wheezing, shortness of breath, and itchy skin. Aggravating factors include pollen exposure and stress. The patient has tried antihistamines and topical corticosteroids with limited relief. Past medical history: 1. Diagnosed with asthma at age 10, eczema since childhood. Hospitalized twice for severe asthma attacks. Medications: Albuterol inhaler, cetirizine, hydrocortisone cream Allergies: Allergic to peanuts, dust mites, and pollen. Previous diagnosis of asthma and eczema. Environment: Lives in a house with a cat, works in a school with potential exposure to chalk dust. Family history: Mother has asthma, father has hay fever. Social history: Non-smoker, occasional alcohol use, enjoys gardening. Objective: BP: 120/80 mmHg, HR: 78 bpm, Oxygen saturation: 98%. General examination shows mild pallor, no lymphadenopathy. Skin examination reveals eczema patches on arms and legs. Respiratory examination shows mild wheezing. Investigations: Skin prick test positive for pollen and dust mites. Pulmonary function test shows reduced peak flow. Assessment & Plan: 1. Allergic or Immunologic Issue or Condition: Likely diagnosis of allergic asthma and eczema exacerbated by environmental allergens. Plan includes starting montelukast for asthma control, continuing current medications, and introducing subcutaneous immunotherapy for pollen. Educate on allergen avoidance, including using air purifiers and reducing cat exposure. Follow-up in 3 months to assess treatment response. Additional Notes: Educated patient on the importance of adherence to treatment plans and lifestyle modifications. Advised on dietary changes to avoid peanuts and strategies to minimize dust exposure at home. Addressed concerns about potential side effects of new medication.