SLIT Start

Introduction

Dear Dr. [Referring Doctor's Name], I had the pleasure of seeing [Patient's Full Name] at the allergy and immunology clinic today for the first dose of sublingual immunotherapy: [Dust mite/tree pollen/grass pollen] ([Medication Name]).

Interval History

[Patient's Name] reports feeling well today. [He/she/they] denies flu-like symptoms or asthma symptoms. [They/She/He] denies use of a betablocker or antihypertensive medications. [He/she/they] denies recent dental procedures.

Past Medical History

[List any relevant past medical history of the patient and number them.]

Medications

[List current medications the patient is taking and number them.]

Chief Complaint

SLIT Start

Allergy Review

[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.]

Intervention

The risks, benefits and duration of sublingual immunotherapy were reviewed. She/He tolerated the first dose of [Medication Name] (Lot1: [Lot Number 1], Lot2: [Lot Number 2]) in my clinic today and monitored for 30 minutes without reaction. The following information is provided for reference: General Information 1. Typical treatment duration of therapy is 3-5yrs 2. Treatment starts 3 months before the tree/grass season until the end of season (Oct/Nov-May, Jan/Feb-Aug) 3. Tablet is taken sublingually (underneath the tongue) once a day 4. No eating or drinking 5 minutes afterwards 5. Most common side effects are itching of the mouth, lips, tongue, or throat 6. Do not double dose if you forget to take a dose. Instead take the next dose at next scheduled time. 7. Stop treatment if you develop an open mouth lesion 8. Stop treatment if you develop a serious upper respiratory tract infection

Precautions

Notify us if you have the following and STOP treatment: 1. If you have a reaction to sublingual immunotherapy while on treatment 2. Become pregnant or breastfeeding (for female patients) 3. On betablocker or ACE-inhibitor (blood pressure medications) 4. Stopped treatment for more than 7 days (will need observation for next dose) 5. Uncontrolled asthma or asthma exacerbation 6. New diagnosis of severe esophageal problems or diagnosis of eosinophilic esophagitis.

Impression and Plan

[Provide a summary of the clinical impression and the plan for ongoing management.]

Impression and Plan

[Provide a summary of the clinical impression and the plan for ongoing management.]

Follow-up

1 year or sooner if the need should arise.

Closure

Thank you for involving me in their care.