Allergy Self Assessment Questionnaires
The following self-assessment questionnaire helps determine the presence of symptoms that commonly raise suspicious of allergies. A significant number of “Yes” answers the following questions would indicate further testing and/or consultation with a doctor.
- Do any blood relatives suffer from allergy syndromes (hay fever, asthma, skin rashes, and severe reactions to drugs or insect stings), food allergies, addictive disorders (alcohol or drug abuse, compulsive eating), diabetes or low blood sugar, arthritis, headache, or digestive disorders? Were any blood relative hyperactive, learning disabled or bed wetters as children?
Yes No - Did your mother experience severe stress during her pregnancy with you? Was your birth difficult or complicated?As an infant, did you have any problem tolerating bottle formula or breast milk? Did you problem with weight gain, colic, or vomiting?
Yes No - Were you difficult in infancy and or childhood often crying or irritable, overactive or underactive? Did you have problem sleeping, trouble learning, or paying attention at school?
Yes No - As a child, were you often sick, plagued by ear infections, sore throats, swollen glands, colds bronchitis, croup, stomach aches, constipation, diarrhea, or headaches?
Yes No - As an adult, are you always tired even through you get enough sleep (six to eight hours)?
Yes No - Do you frequently have puffy eye? Wrinkles or dark circles under your eyes? Itchy, red, watery, burning, painful or light-sensitive eye? Blurred vision? Baggy, swollen eyelids?
Yes No - Do you often have a stuffy, watery, runny nose? Sneeze several times in a row? Rub nose upwards or wiggle nose? One cold after another, without feeling sick? Nosebleeds? Excessive mucus?
Yes No - Do you have asthma or wheezing? Do you cough or wheeze with laughter, exercise, cold air, cold drinks, at night, or when it’s damp outside?
Yes No - Do you have skin rashes such as eczema or atopic dermatitis? Itchy rashes or hives, especially in arm or leg creases? Cracked toenails or fingernail? Acne? Dandruff? Loss of hair?
Yes No - Do you have recurrent earaches? Fluid behind your eardrums? On and off hearing trouble? Ears popping or ringing? Flushed, red earlobes? Dizziness? Itchy ears? Drainage from ear?
Yes No - Do you suffer from digestive problems? Swelling or soreness of face and lips? Itchy roof of mouth? Canker sores? Bleeding gum? Bad breath? Nausea and stomach aches? Excess gas, diarrhea, or constipation? Belching? Itchy rectal area? Ulcers? Colitis?
Yes No - Do you have difficult gaining or losing weight? Binge eating?
Yes No - Do you have repeated bladder infections, difficulty urinating, or water retention?
Yes No - Is your pulse or heartburn irregular after eating?
Yes No - Have you ever had seizures?
Yes No - Do you have sinus problems, earaches, or sore throats? Headaches, dizziness, convulsion? Insomnia? Leg or muscle aches, back pain, swollen or stiff joints, arthritis? A constant low grade fever, feeling flushed or chilled, excessive sweating fainting spells?
Yes No - Do you have dark circles under your eyes, a pale complexion, a bloated or puffy face?
Yes No - Are you a picky eater? A binger?
Yes No - Do you feel like you are high one moment, low the next, with depression appearing for no reason?
Yes No - Do you have trouble concentrating, sometimes feeling confused and spacy? Are you hyperactive, overly nervous, frequently anxious, quick to anger?
Yes No - Does a chance in your surroundings or the seasons change how you feel?
Yes No
For more information on how to treat bronchial asthma and protect your loved ones to suffer bronchial asthma again. Please go to The Asthma Relief Report.
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