Dayton Ear, Nose
& Throat Surgeons, Inc.

John H. Boyles, M.D.         James J. Howard, M.D.         William E. Rogers, M.D.

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Inhalant Allergy Questionnaire

Am I allergic?

To find out, simply answer the 15 Yes or No questions below by clicking the Yes answer for any question you feel describes your situation. When you are finished, click the Submit button at the bottom of the page.

1. Do you have postnasal drip? Yes   No
2. Do you have nasal congestion? Yes   No
3. Do you have recurrent sinus infections? Yes   No
4. Do you have asthma or wheezing? Yes   No
5. Are your symptoms worse indoors? Yes   No
6. Are your symptoms worse outdoors? Yes   No
7. Do your symptoms increase with the return of cold weather? Yes   No
8. Do you have irritation or itching of the eyes? Yes   No
9. Are your symptoms worse while dusting or sweeping? Yes   No
10. Are your symptoms worse on humid evenings? Yes   No
11. Are your symptoms seasonal? Yes   No
12. Are your symptoms worse in basements? Yes   No
13. Are your symptoms worse in barns? Yes   No
14. Are your symptoms worse in certain homes? Yes   No
15. Do you react to animals? Yes   No