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- Have you been diagnosed with seasonal allergies or any other allergic disease?
- What kind of allergic disease have you been diagnosed with?
- Do you suffer from more than one type of allergy? (e.g. inhalation and food allergy)
- Have you ever had allergy skin tests?
- On a scale of 1-5, how would you rate the severity of your allergic symptoms?
- Which are your most common allergic symptoms?
- Do you get itchy, red eyes often?
- How often do you experience a stuffy nose?
- How often do you get a runny nose?
- Are you taking oral antihistamines?
- If so, how often do you use oral antihistamines?
- Are you relieved after taking allergy medications?
- Are you using allergy conjunctivitis eye drops when your eyes start to feel red and itchy?
- At what time of the day do you most persistently experience allergic symptoms?
- Do you agree with the statement: “Allergic symptoms negatively affect my quality of life and hinder my daily functioning”?
- Have you ever been hospitalized for allergies?
- At what time of the year do your allergic symptoms increase the most?
- Has anyone in your family been diagnosed with any allergic disease?
Home Allergic conjunctivitis
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Allergy symptoms can make everyday functioning difficult. Answer a few questions below and see how many people, like you, struggle with allergies.
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Have you been diagnosed with seasonal allergies or any other allergic disease?
Roof
No
I was sick only as a child
What kind of allergic disease have you been diagnosed with?
food alergy
contact allergy (e.g. to nickel, dyes, cosmetics or plastics)
inhalation allergy
drug allergy
allergy to insect venom
Do you suffer from more than one type of allergy? (e.g. inhalation and food allergy)
Roof
No
I do not know
Have you ever had allergy skin tests?
Roof
No
I don’t remember
On a scale of 1-5, how would you rate the severity of your allergic symptoms?
1
2
3
4
5
Which are your most common allergic symptoms?
Itchy, watery eyes
Sneezing, runny nose
Cough
Dyspnea, breathing problems
Rash and other skin lesions
Digestive system ailments
I am not experiencing allergic symptoms
Do you get itchy, red eyes often?
No, I don’t have these symptoms
Yes, sometimes
So very often
How often do you experience a stuffy nose?
Once a week or more
2-3 times a month
Several times a year
Once a year or less
How often do you get a runny nose?
Once a week or more
2-3 times a month
Several times a year
Once a year or less
Are you taking oral antihistamines?
Roof
No
Used to be yes, but now I do not accept
If so, how often do you use oral antihistamines?
Once a week or more
2-3 times a month
Several times a year
Once a year or less
Not applicable
Are you relieved after taking allergy medications?
Yes, a lot
Yes, but not much
No
Not applicable
Are you using allergy conjunctivitis eye drops when your eyes start to feel red and itchy?
Yes, always
Yes, but only sometimes
No
At what time of the day do you most persistently experience allergic symptoms?
Morning
Around midday
In the afternoon
In the evening
I am not experiencing allergic symptoms
Do you agree with the statement: “Allergic symptoms negatively affect my quality of life and hinder my daily functioning”?
I strongly disagree
I rather disagree
I tend to agree
I definetly agree
Have you ever been hospitalized for allergies?
Roof
No
I don’t remember
At what time of the year do your allergic symptoms increase the most?
wiosna
Lato
Autumn
Winter
Has anyone in your family been diagnosed with any allergic disease?
Roof
No
I do not know
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