Skip to main content

Table 2 Baseline questionnaire

From: ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

Q1: I have rhinitis: yes/no

Q2: I have asthma: yes/no

Q3: My symptoms (tick)

 Runny nose

 Itchy nose

 Sneezing

 Congestion (blocked nose)

 Red eyes

 Itchy eyes

 Watery eyes

Q4: How they affect me: my symptoms (tick)

 Affect my sleep

 Restrict my daily activities

 Restrict my participation in school or work

 Are troublesome

Q5: Medications

Q6: Are you currently receiving immunotherapy (a small dose of the thing you are allergic to, usually taken as an injection or placed under your tongue)? yes/no

 If YES to Q6 (Q7 and Q8)

Q7: What allergy is this?

 Grass pollen

 Parietaria pollen

 Birch pollen

 Other pollen

 Dust mite

 Animal

 Cypress tree pollen

 Don’t know

 Add allergy

Q8: How do you receive your treatment?

 Injection

 Tablet under the tongue

 Drops under the tongue

 Spray under the tongue

 Other