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Identify your allergies

Allergies can impact on your daily routines and for some people they are a major burden to deal with. Identifying your allergy and knowing its trigger is the first and most crucial step in managing your allergies.

Monitoring your allergy symptoms and general patterns will help you and your doctor in diagnosing an allergy. Start with our simple worksheet. Just select the answer that seems most appropriate and select the Print button when you are finished to create a print-out that you can take to your doctor.

CHOOSE THE MOST APPROPRIATE ANSWER

	What symptoms do you suffer from? Sneezing Itchy skin Runny nose Hives Itchy eyes Rash Watery eyes Fatigue
	When do your symptoms occur?   When I am indoors/ at home or at work   When I am outdoors   When I am exposed to pets
	I suffer more during:   The day   The night   Both
	Do you wake up with symptoms in the morning? Yes No
	Do you think you suffer from food/ drink allergies? Yes No
	How many weeks in the last 12 months have you experienced hay fever and/or allergies? One only 10-19 Two 20-29 3-4 30+ 5-9
	And, how long do the symptoms usually last? Less than a day Up to 2 weeks 1-2 days 3-4 weeks 3-4 days Longer than 4 weeks 5-7 days I have allergy symptoms all the time
	Please indicate whether you agree or disagree with each of the following statements taking into account your personal beliefs and attitudes. My allergies dictate how I feel about my day and what I can do in it. Agree Neutral Disagree
	My allergies make me feel low and give me a negative outlook on life. Agree Neutral Disagree
	I feel I am at the mercy of my allergies. Agree Neutral Disagree
	My allergies affect me but I don't give into them. Agree Neutral Disagree
	I have no hesitation in taking something for my allergy; I just want to feel better. Agree Neutral Disagree
	I always treat my allergies as soon as the first symptoms appear. Agree Neutral Disagree
	I try to put up with allergy symptoms as long as I can before I give in and take something. Agree Neutral Disagree
	How severe are each of the following hayfever or allergy symptoms you experience?  Please allocate each symptom as very severe, fairly severe, not severe or is it something you don’t experience when you have hayfever or allergies. Runny nose Severe Not severe Don't Experience
	Sneezing Severe Not severe Don't Experience
	Itchy nose Severe Not severe Don't Experience
	Headache Severe Not severe Don't Experience
	Fuzzy head  Severe Not severe Don't Experience
	Sinus pain Severe Not severe Don't Experience

Thank you

Thank you for completing this allergy health questionnaire. Your answers will help you and your doctor identify the type of allergic sufferer you are and the best treatment options. Select the Print button to print out a copy to discuss with your pharmacist or your doctor.