Mother's Class

 Essay upon Mother’s Course

Allergy Assessment Type

Name____________________________________ Age__________ Sex_______________ Date__________________

We. Chief Problem: ___________________________________________________________________________________ 2. Present Illness: _____________________________________________________________________________________ III. Collateral allergic symptoms:

Sight: Pruritus________Burning _______Lacrimation_______

Swelling _______Injection ______Discharge ________

Ears: Pruritus _______Fullness _______Popping _______Frequent infections ___________ Nasal area: Sneezing ______Rhinorrhea______Obstruction ________

Pruritus_______Mouth-Breathing _______________Purulent Release ______________ Can range f: Soreness _______Postnasal Discharge __________________

Palatal Pruritus _________________Mucus each morning ___________________ Upper body: Cough __________Pain _____________Wheezing _____________

Sputum _________Dyspnea __________

Color ___________Rest ______________

Amount _________Exertion ___________

Pores and skin: Dermatitis___________Eczema_____________Urticaria ____________

IV. Friends and family Allergies ____________________________________________________________________________________

Versus. Previous hypersensitive treatment or perhaps testing __________________________________________________________________ Prior Skin area Testing ___________________________________________________________________________________ Medications: AntihistaminesImproved ___________________Unimproved ___________________

BronchodilatorsImproved ___________________Unimproved ___________________

Nostril dropsImproved ___________________Unimproved ___________________

HyposensitizationImproved ___________________Unimproved ___________________

Duration ___________Antigens _____________Reactions _______________

AntibioticsImproved ___________________Unimproved ___________________

CorticosteroidsImproved ___________________Unimproved...

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