IMMUNOTHERAPY

What’s the best way to manage your allergies?

Dealing with allergies can be confusing, because there are a lot of options and each individual responds to allergens differently. But if your allergies are not under control, it may be time to talk to your allergist about allergen immunotherapy, a long-term solution that involves allergy shots and/or tablets.

This tool is designed to help you and your doctor compare the benefits, risks and alternatives of allergy medications (pharmacotherapy) to allergen immunotherapy. It begins with a series of questions to focus in on your current allergy symptoms and challenges as well as questions that highlight your treatment preferences and any lifestyle constraints that may limit your ability to adopt one treatment option over the other. The tool also contains more information about allergies, medications and environmental controls typically used to address allergies.

Once you’ve completed the questions, you and your doctor will examine and discuss the pros and cons of allergen immunotherapy so that together you can decide on the best treatment option for you.

Please answer every question.

1. Are you satisfied with the relief you get from your current treatment plan?Yes No

2. Are you able to control your exposure to allergens:

• At homeYes No

• At workYes No

• OutdoorsYes No

3. Are you concerned about allergy medications and their side effects?Yes No

4. Are you concerned that your nasal allergies will develop into asthma or that your asthma will worsen over time?Yes No

5. Are you looking for a long-term solution that changes your immune system rather than a short-term solution, such as medications that reduce or alleviate symptoms?Yes No

6. Can you tolerate treatment by injection (needles)?Yes No

7. Can you dedicate time to go to a doctor’s office for treatment once a week?Yes No

8. Are you interested in treating only the worst allergen you react to and not other allergens which you have less of a reaction to?Yes No

9. Are you willing to accept the low risk that you may have an allergic reaction to an allergy shot?Yes No

10. Are you willing to take allergy medicine at home that may have a low risk of causing an allergic reaction?Yes No

11. Do you have health insurance?Yes NoPrint your responses for review with your doctor

12. Did you make sure to print this form?Yes