AA.19. PAVANI THUPAKULA - NICHOLAS BRIHMAN

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Dr Mathias Brown

Royal Lake Hospital

Yamba Dr

Garram ACT 2605

Canberra

Australia +61351240000

22 June 2020

Dear Dr Brown,

Re: Mr Nicholas Brihman, aged 61

Thank you for seeing Mr Brihman, who has been diagnosed with red meat allergy or alfa-gal syndrome, he is referring to you for further assessment and appropriate management as his primary care provider under quarantine for covid 19.

On 20 June 2021, Mr Brihman presented to hospital with complaining of recent, recurrent episodes of angioedema over an eight-month period.

Three to four hours after eating a large meal, he developed irritation of the left eye, sinus pressure, numbness and tingling in the mouth. Also reported swelling of the lips, throat, tongue and constricted airway as well. IgE skin prick test performed for commercial extracts of beef, pork, lamb, chicken, turkey and milk as well as cat and dog dander which revealed hypersensitivity reaction to cat dander, showing 3-5 mm wheal with flare. Blood tests showed positive for IgE antibodies to alfa-gal with serum assay.

Mr Brihman is a traveler and blogger and he had a history of tick bite a year ago. He prefers to eat steak and barbecued pork. All immunizations had He has had history taken. He has had history of mild persistent child hood asthma and intermittent adult asthma. He has had hypertension Since 2001 for which he was commenced on tablet lisinopril, perindopril, Ramipril and ibuprofen.

Mr Brihman diagnosis was confirmed along with the history of tick bite and angioedema after high protein meals. It would be greatly appreciated if you could provide necessary treatment based on his symptoms.

If you require any additional information, please do not hesitate to contact me.

Yours sincerely,

Charge Nurse

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