Urticaria

Introduction

Dear [Referring Doctor's Name], I had the pleasure of seeing [Patient First Name], a [Patient Age]-year-old [Patient Gender] at the allergy clinic. [He/She/They] was referred for an allergy assessment in the setting of hives.

History of Presenting Illness

[Provide a detailed narrative of the patient's experience with hives, including the duration from onset to resolution, frequency of episodes, and any associated symptoms such as lip or eyelid swelling. Describe any treatments used, including specific medications and doses, and their effectiveness. Note any consultations with dermatologists or allergists, and any history of contact dermatitis, eczema, or hives. Identify any precipitating factors such as stress, NSAID use, viral infections, new medications, or new skin care/hygiene products. Assess the severity of symptoms and note any absence of pain, scarring, bruising, or prolonged duration beyond 48 hours. Confirm the absence of systemic symptoms like fevers, weight loss, sweats, or joint pain.]

Allergy Review

[insert the following text: The patient has no prior history of asthma, eczema, medication allergies, venom allergies, or IgE-mediated food allergies]

Past Medical History

[List the patient's past medical history and number them.] For example: 1. [Condition 1] 2. [Condition 2] 3. [Condition 3]

Medications

[List the patient's current medications and number them.] For example: 1. [Medication 1] [Dosage and Frequency] 2. [Medication 2] [Dosage and Frequency]

Medication Allergies

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

Social History

[Provide details about the patient's social history, including smoking, alcohol use, occupation, and any relevant lifestyle factors. Provide details about extended health benefits.]

Environmental History

[Describe the patient's living environment, including details about their home, heating, pets, frequency of bedding washing and any potential allergens.]

Family History

[List relevant family medical history, particularly related to allergies or respiratory conditions.]

Physical Exam

BP: [Insert BP], HR: [Insert HR] BPM [Insert the following text without editing it: [insert patient's name] appears well. Head and neck examination was normal. 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.

Skin Test Results

[Insert the following text: Environmental Allergens: Positive skin test to dust mites, cat, dog, tree pollens, grass pollen, molds and weeds. Negative skin testing to dust mites, cat, dog, tree pollens, grass pollen, molds and weeds. Both histamine and saline control are appropriate.]

Impression and Plan

[Insert the following text: Chronic spontaneous urticaria: [Patient's First Name] has chronic spontaneous urticaria (CSU). CSU is an autoimmune disease that affects 1% of the population and leads to the activation and release of histamine, causing hives and angioedema. Fortunately, CSU is a benign and self-limited condition, and 80% of patients will have symptom resolution by two years. CSU is not an allergic disorder, and symptoms are not a result of any food, drug, or environmental allergy. CSU triggers include NSAIDs, alcohol, and stress. Avoidance of triggers will help reduce symptoms. Pharmacological therapy focuses on managing symptoms of itch, angioedema, and hives. Non sedating antihistamines are the staple of treatment, and they can be at four times the recommended dose. I prescribed Cetirizine 20 mg PO QD. If symptoms are not controlled, they can use 20 mg PO BID (maximum dose of 40 mg in 24 hours). They can return for consideration of second-line treatment such as Xolair (anti-IgE monoclonal antibody). I have given the patient a UAS7 score form, that they should fill at home. CSU patients are not at increased risk of anaphylaxis, and they do not require an epinephrine autoinjector.

Impression and Plan

[Insert the following text: Chronic spontaneous urticaria: [Patient's First Name] has chronic spontaneous urticaria (CSU). CSU is an autoimmune disease that affects 1% of the population and leads to the activation and release of histamine, causing hives and angioedema. Fortunately, CSU is a benign and self-limited condition, and 80% of patients will have symptom resolution by two years. CSU is not an allergic disorder, and symptoms are not a result of any food, drug, or environmental allergy. CSU triggers include NSAIDs, alcohol, and stress. Avoidance of triggers will help reduce symptoms. Pharmacological therapy focuses on managing symptoms of itch, angioedema, and hives. Non sedating antihistamines are the staple of treatment, and they can be at four times the recommended dose. I prescribed Cetirizine 20 mg PO QD. If symptoms are not controlled, they can use 20 mg PO BID (maximum dose of 40 mg in 24 hours). They can return for consideration of second-line treatment such as Xolair (anti-IgE monoclonal antibody). I have given the patient a UAS7 score form, that they should fill at home. CSU patients are not at increased risk of anaphylaxis, and they do not require an epinephrine autoinjector.

Closure

I appreciate the opportunity to participate in [Patient First Name]'s care, and I hope my suggestions are helpful. If any questions arise, please feel free to contact my office.