Rhinitis Clinic Consult Note

Chief Complaint

Rhinitis

Template

Dear [Dr./Mr./Ms.] [referring physician last name], Thank you for referring this [age] year-old patient for evaluation of environmental allergy. He was seen in the allergic rhinitis rapid access clinic at [hospital]. (Text flanked by "**" are headers and should be bolded.) **History of Presenting Illness:** Rhinitis (Do not hallucinate.) Symptoms: [include rhinitis symptoms such as rhinorrhea, nasal congestion, sneezing and ocular pruritus] (list symptoms separated by ",") (do not include symptoms not about the nose or eyes) Duration: [include duration of rhinitis symptoms] Seasonality: [perennial/seasonal - [seasons]] Triggers: [include triggers of rhinitis symptoms] (include only what is reported by the patient, not results of skin testing during the encounter) Otolaryngologist evaluation: [yes/no] [include name of otolaryngologist and findings by the otolaryngologist on endoscopy] Treatment attempted: Oral antihistamines - [oral antihistamine drug_name and degree of benefit if relevant] Intranasal corticosteroids - [nasal spray drug_name and degree of benefit if relevant] Antihistamine eye drops - [antihistamine eye drop drug_name and degree of benefit if relevant] Asthma Symptoms: [include symptoms of asthma, such as chest tightness, dyspnea, wheezing and coughing] Duration: [duration of asthma symptoms and time of diagnosis if relevant] Triggers: [include triggers of asthma such as infection, environmental allergy and irritants] (include only what is reported by the patient) Pulmonary function testing: [yes/no] [include date and results of the pulmonary function test or spirometry if relevant] Nocturnal symptoms: [yes/no] None Function limitation: [yes/no] None Rescue inhaler use: [include frequency of rescue inhaler such as Ventolin or salbutamol use] Exacerbations: [include number of exacerbations in duration of time] Current treatment: [list current asthma treatment medications] [narrate history of other allergic complaints not mentioned above] **Past Medical History:** (bullet point format) [include all significant medical conditions] [Otherwise healthy.] **Medication Allergy:** (bullet point format) [include medication allergy and their corresponding reactions] **Current Medications:** (bullet point format) [Include the name, dosage, frequency, and route of administration for all current medications, including over-the-counter drugs and supplements.] No medications. **Family History:** [Include any relevant family history of allergic and atopic conditions, such as eczema, asthma, food allergy and environmental allergy.] No family history of atopy. **Social and environmental history:** Pets: [list number of pets of each type/No pets.] No pets Smoking: [include smoking history] Non-smoker Extended health benefits: [yes] None **Physical Examination:** HEENT: oropharynx was clear [include other head, neck, ear, nose and throat physical exam findings] Chest: no wheezing **Skin Testing:** Inhalants: Positive reaction to: [dust mite/cat/dog/tree pollen/grass pollen/weed pollen/mold] (include wheal size in mm if stated) Negative reaction to: [dust mite/cat/dog/tree pollen/grass pollen/weed pollen/mold] (list all by default if not specified) Histamine control was [positive/negative] **Assessment and Plan:** (bold each diagnosis) Allergic rhinitis. [Skin prick testing today was unreliable, and I will further investigate with sIgE testing.] Avoidance measures were reviewed, and written information provided. Non-sedating antihistamines, nasal corticosteroids, and antihistamine eye drops can be used for symptom relief. Prescription for: [prescription names] was provided. [Pronoun] is a good candidate for immunotherapy if symptoms become medically refractory, or if allergy modifying therapy is desired. Based on the pattern of sensitization, [pronoun] is a candidate for [subcutaneous/sublingual] immunotherapy. [Pronoun] will contact my clinic directly for follow-up if [pronoun] become interested in immunotherapy. [Pronoun] is interested in pursuing sublingual immunotherapy. [Pronoun] is a candidate for [Acarizax (dust mite)/Itulatek (birch/tree)/Grastek (timothy/grass)]. A sublingual tablet is administered daily from home. A typical course of therapy is for 3 years, which has evidence of ongoing benefit after discontinuation for at least 2 years. The benefits and risks, including of oral pruritus, anaphylaxis and eosinophilic esophagitis were discussed. The first dose of each allergen must be administered in my clinic due to an elevated risk of anaphylaxis. [They will return in follow-up for initiation.] [Pronoun] is interested in pursuing subcutaneous immunotherapy. There is typically 6-9 months of weekly build-up injections, followed by monthly maintenance injections. Benefit is expected within 1-2 years. A typical course is 3-5 years, after which there should be lasting effect. Risks include life-threatening anaphylaxis were discussed. A prescription has been prepared. Once the serum is available, a follow-up visit will be arranged for first injection. [Pronoun] can then continue to receive injections with me, or with yourself if you agree. Non-allergic rhinitis. [Skin testing today did not clearly identify sensitization to an aeroallergen.] [Requisition was provided to further investigate with sIgE testing.] Rarely, localized IgE production can occur. The differential diagnosis for non-allergic rhinitis is broad, including structural causes, irritant rhinitis, vasomotor rhinitis. Nasal steroids can continue to be used for symptom relief. If no clear sensitization is found, referral to an otolaryngologist will be considered in follow-up. Asthma [, well/poorly controlled]. [Pre- and post-bronchodilator spirometry requisition was provided.] Recommended treatment: [Symbicort 200mcg PRN/Salbutamol PRN/Symbicort 200mcg 1 inh BID + PRN/Flovent 50/125/250mcg 1 inh BID/Alvesco 200mcg 1 inh daily/Atectura 80/160/320mcg 1 inh daily/Breo 100/200mcg 1 inh daily/Enerzair 160mcg 1 inh daily.] [Written asthma action plan was provided.] Poorly controlled asthma is a contraindication for immunotherapy. Routine vaccination, including with influenza, COVID-19 and RSV, is recommended if applicable. [[Pronoun] is a candidate for biologics given frequency of exacerbations. Requisition was provided for screening bloodwork to determine eligibility.] Follow-up. (bold) [[Patient first name] will call to initiate follow-up if symptoms are poorly controlled, or if he becomes interested in immunotherapy.] [I plan to see [patient first name] for review of investigations [in person/via telehealth].] [I hope to see [patient first name] in [duration] for reassessment, if you agree.] [No definitive follow-up plans, but I am happy to reassess as the need arises.] Thank you for the opportunity to be a part of [pronoun] care. Please do not hesitate to contact with any questions or concerns. (do not include signature)