Symptom Record Keeping Instructions

Symptom Record Keeping Instructions

After a Reaction Occurs, When Able, Record the Following as Best Remembered:

• Write down all FOODS EATEN 4 HOURS PRIOR TO REACTION. Such as breath mints, gum, drinks, snacks, meals, all food item ingredients and anything put in mouth. This includes toothpaste, dental floss, mouthwash etc. When possible save the entire food package not just the ingredients. Write down approximate times when food/drink was eaten or if there were other exposures such as breathing in a suspect food vapors or touching a suspect food.
• ANY ACTIVITY 24 HOURS PRIOR TO REACTION Such as clearing land, walking at the mall, exercising, etc…. GIVE APPROXIMATE TIMES FOR EACH ACTIVITY.
• ANY MEDICINES (over-the-counter, prescription, herbals, vitamin/mineral supplements) Taken 24 hours prior to symptoms and approximate times taken.
• LIST ALL MEDICINES taken for a reaction.
• If you have been ill one to five days prior to the reaction, please write down the type of illness and any medicines taken.
• Choose an easy recording method one that is convenient. This may be 3X5 cards, spiral notebook (any size), or a 3 ring binder. Some individuals have chosen to use an envelope for each reaction. The envelope can hold food packages along with other information. Call the Clinic with questions.