SLIT Renewal (Grastek/Itulatek/Acarizax)

Introduction

Dear Dr. [Referring Doctor's Last Name], I had the pleasure of seeing [enter patient's name] again in our allergy/immunology clinic today for the reinitiation of [Grastek/Itulatek/Acarizax] [(Year 1/2/3)].

Interval History

[Enter patient's name] reports feeling well. [He/She/They] tolerated last season's treatment with benefit (%). There have been no changes in health and denies any new medications. [He/She/They] denies reflux symptoms. [He/She/They] denies the use of antihypertensives or beta-blockers.

Past Medical History

[List any relevant past medical history here and number them.]

Chief Complaint

SLIT Renewal

Current Medications

[List the medications, include the dosage and number them.]

Allergies

[List any known medication allergies or state 'NKDA' if none.]

Physical Exam

BP: [Blood Pressure], HR: [Heart Rate] BPM [Insert the following text without editing it: [insert patient's name] appears well. Rhinoscopy revealed mild bilateral nasal inflammation with turbinate hypertrophy. No nasal polyposis. Cardiac exam revealed a normal S1 and S2. Chest examination is clear with no wheezes or crackles. Skin examination did not reveal active eczema patches or urticaria lesions. The rest of the examination is unremarkable.]

Procedure

[Insert the following text without editing it: The patient was given the first dose of [Grastek/Itulatek/Acarizax] (Lot1: [Lot Number], Lot2: [Lot Number]) this season and monitored for 30 minutes without any evidence of IgE-mediated allergic reaction.]

Impression/Plan

Allergic rhinitis, grass/tree/dust mite sublingual Immunotherapy [(Year 1/2/3)]: [insert patient's first name] is doing well. [insert patient's first name] received his/her first tablet of [Itulatek/Grastek/Oralair] today for this season and did not experience any significant adverse side effects. S/He will continue with one sublingual tablet daily until the end of the tree/grass season (end of May/August). I have asked him/her to contact my office if there are any issues with the treatment. I would like to see him/her in one year for follow-up for renewal of Itulatek/Grastek/Oralair/to assess their response to treatment following completion. Total duration of treatment is three years.

Follow-up

1 year or sooner if the need should arise.

Closure

Thank you for involving me in their care.