Allergic disorders are very common among people of all ages. Check next to any of the following allergic disorders that you have experienced:
| Allergic rhinitis (persistent nasal congestion, runny nose, and/or postnasal drip) |
| Atopic dermatitis (chronic or recurrent inflammation of the skin) |
| Allergic conjunctivitis (red, itchy, watery eyes) |
| Asthma |
| Sinusitis (chronic sinus infection characterized by persistent cold symptoms, often including |
| facial pain) |
| Contact dermatitis (rash resulting from contact with an allergen) |
| Food allergy |
| Insect sting allergy |
| Drug allergy |
Next, create a record of your allergy triggers. Put a check next to any substance to which you have had an allergic reaction; if appropriate, list the specific type of substance you are allergic to (cats, spider bites, nuts, and so on). Describe the type of reaction you had.
| Allergen | Specific Type(s) | Reaction(s) |
| Poison ivy or oak | ||
| Animals | ||
| Feathers | ||
| Insect bites or stings | ||
| Molds | ||
| Dust mites | ||
| Ragweed | ||
| Pollen | ||
| Foods | ||
| Other: | ||
| Other: |
Describe any allergy tests you've undergone and any treatments you received for allergies or asthma.
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