Questionnaire for children allergic cabinet

FI child
Age
Address
Number of children's clinic
Tel.
D / W.
1. Allergic diseases in the past and the present in the family — the parents and close relatives (aunts, uncles, sisters, brothers).
2. During pregnancy the mother: the state of health, past illnesses, medication, presence of toxicity, industrial hazards, food.
3. Delivery (term trend, intervention). Weight and height of the child at birth.
4. The nature of feeding in the first year. (The timing of the juices in the diet, supplementation, feeding. Was the reaction to their introduction and which, after what period of time after administration?
5. Maternal nutrition during time breastfeeding. Did drugs, which ones?
6. The skin condition in a child in the first year of life: whether the rash itch? Time appearance, whether due to the introduction of supplementary feeding, feeding, taking medications?
7. Postponed child diseases (specify age) by:
   
gastro-intestinal tract
    Respiratory
    ENT
    fungal diseases
    other organs and systems
8. Migrated earlier allergies and exudative catarrhal diathesis.
9. Following initial treatment, response to introduction various medications.
10. Reactions to introduction serums and vaccines.
11. Reactions to foods.
12. Medical history: when he first appeared skin changes or asthma phenomenon? The frequency and duration of exacerbations, seasonality; time occurrence of seizures (day, night, any time of day) time year (summer, fall, winter, spring, year-round), place of attacks (home, day care, school, on the street, whatever). Than treated, effectiveness? When was the last aggravation? How is the worsening of the disease: the temperature, runny nose, cough, shortness of breath, noisy breathing, accompanied by a rash, itchy skin? What is the reason for the aggravation of the parents: the relationship with food, medication, infection, hypothermia, physical activity, contact with animals?
13. Living conditions: the house (stone, wood, new, old), room (dry, wet, warm, cold), heating, the presence of the apartment carpets, pets, birds, aquarium, color (when purchased), area, number of living, baby bed (mattress, pillow, blanket)
14. Age and occupation of parents before birth.

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