Allergy Action Plan - Self-Screening Tool for Seasonal Allergies


	YES	NO
FAMILY HISTORY
1. At least one of my parents has allergies.
2. I have been treated for allergies before.
CURRENT SYMPTOMS
3. I have itchy, watery eyes.
4. I have an itchy nose or throat.
5. I sneeze frequently.
6. I have a runny nose lasting more than 10 days.
7. I have a stuffy, congested nose lasting more than 10 days.
OTHER FACTORS
8. My symptoms reappear at the same time every year.
9. My symptoms appear outdoors only.
10. My symptoms appear indoors and outdoors.
11. My symptoms appear all year long.
12. My symptoms appear indoors only.