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dermatitis, over active tear ducts3.Dry skin – Differential: eczema, atopic dermatitis, thyroid disease, chapped/windburnPLAN:LABS:CBC w/ differential – check for bacterial/viral infection, eosinophilia.CMP: electrolyte, kidney function and liver function abnormalities (dry skin).TSH: to check for thyroid disease d/t dry skin.IgE – elevated in patients with seasonal allergic rhinitisPulmonary Function Test: to assess for airway disease d/t other atopic conditions noted and historyTreatment:1.Flonase – 1 spray each nostril once per day.2.Loratadine 10mg one tablet daily.3.Patanol 0.1% Ophthalmic Drops: 1-2 drops each eye three times per day as needed for eye redness, itchiness and irritation.4.Nasal saline irrigation to wash irritants, allergens and post nasal drainage from nasal/pharyngeal passages.5.Wear a mask during outdoor activities to limit inhalation and mucus membrane exposure to irritants/allergens.6.Wash cotton bedding once per week in 120 degrees Fahrenheit water.7.Drink plenty of water.8.D/C Mucinex OTC.
9.Refill of Epi-Pen 2 Pak for anaphylaxis d/t insect sting allergies. Inject one pen into upper, outer thigh and hold for 10 seconds. After use, call 911 or go to ER immediately. If after 10-15 minutes, symptomsreturn or worsen, use second pen.Follow upin 3 weeks to assess symptom and treatment managements and review test results. Patient to monitor symptoms and call sooner if symptoms change or worsen. Go to ER or call 911 for urgent/emergent needs. Also schedule annual examination in 6 months.