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AF.41. Ajeesh Karosh - Mr Nicholas Brihman


Dr Mathias Brown

Royal Lake Hospital

Yamba Dr, Garran ACT, 2605



22 June 2020

Dear Dr Brown,

Re: Mr Nicholas Brihman, aged 61

I am referring Mr Brihman, who has been positive for a-gal, requires your expert assessment and management.

On 16 August 2019, Mr Brihman initially presented to hospital with facial edema, and associated ailments. After the assessment, angioedema has been diagnosed. Therefore, he was recommended with an epinephrine auto-injector, tablet diphenhydramine 50 mg. In addition, he has been instructed to eliminate spicy foods and other trigger factors. Subsequently, he was re-visited with exacerbated angioedema. One the next day, he has been tested positive for seasonal allergies. For that reason, his previous prescribed medication refrained, and IgE skin prick test was advised. Today, SPT test is done, which confirmed positive for IgE antibodies to a-gal.

Mr Brihman is a single man and is a traveller and blogger. He has had hypertension since 2001, and is on tablet lisinopril, perindopril, and ramipril. He has a history of tick exposure, which was removed a year back. He smokes cigarettes, and drinks alcohol seldom. All medication list is attached with this letter for your kind review.

Pertaining to the above-mentioned information, kindly provide your further evaluation and treatment. Close monitoring his condition and further advice would be profoundly beneficial.

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

Yours sincerely,

Head Nurse


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