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Welcome to your online clinic!
In order to answer your inquiry in the best possible way, we ask you to send us
meaningful photos
of your skin problem and to fill in the
questionnaire
below in as much detail as possible
Which medication have you taken?
How often?
several times a day
1x/day (regular)
more than 1x/week
less than 1x/week
Since when?
a few days
over a week
over a month
over a year
since DD.MM.YYYYY
Have you taken the above-mentioned medication(s) before?
yes
no
Did you tolerate the medication well at that time?
yes
no
How did you react during taking the medication?
What was the medication/medications used for?
When did the reaction occur?
In the last 5 years.
In the last 5-10 years.
10-20 years ago.
More than 20 years ago.
From when to when was the medication administered/taken?
How long did you take the medication before the reaction occurred?
Onset of symptoms after the first dose.
Onset of symptoms during the course of the therapy.
Onset of symptoms after the end of the planned therapy.
How quickly did the reaction occur after the last dose of the medication?
Onset of symptoms within 2-6 hours.
Onset of symptoms within one day to one week.
Onset of symptoms after more than one week.
I don't remember.
Symptoms?
Hives/urticaria.
An other rash on the body
Swelling of the face/lips/tongue
Blisters or skin peeling on the body
Involvement of mucous membranes (skin in the mouth or genital area)
Yellow pimples/red spots all over the body
other
Beschreiben Sie bitte die anderen Symptome
Upload at least 1 photo, preferably 3 or more.
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Accompanying symptoms
Dizziness/circulatory issues.
Itching all over the body.
Stomach cramps or vomiting / nausea or diarrhea.
Shortness of breath.
Scratchy throat.
Loss of consciousness.
other
Which ones?
What treatment did you receive for the reaction?
I don't remember.
Antihistamine tablets (e.g., Cetirizine, Telfast, Bilaxten).
Cortisone tablets (e.g., Spiricort).
Cortisone cream.
Infusion in the hospital (antihistamines/cortisone).
Intramuscular adrenaline.
other
What did you receive?
Were you hospitalized for the treatment of the reaction?
yes
no
With necessary treatment in the intensive care unit (ICU).
With the need for a one or more day hospital stay.
Monitoring in the emergency department without a stay on the inpatient ward.
Have you received antibiotics again since then?
yes
no
Which one?
How often?
several times a day
1x/day (regular)
more than 1x/week
less than 1x/week
Since when?
a few days
over a week
over a month
over a year
since DD.MM.YYYYY
Did you tolerate them well?
yes
no
Do you have an allergy passport?
yes
no
Do you have any other drug allergies/intolerances?
yes
no
Which ones?
Have these drug allergies/intolerances been clarified?
yes
no
Do you suffer from hives (urticaria)?
yes
no
Do you suffer from swelling on the body/face (angioedema)?
yes
no
Are allergies known in your family?
yes
no
Who suffers from these allergies?
Father
Mother
Siblings
Children
What kind of allergies are they?
Atopic dermatitis
Allergic asthma
Hay fever
Food allergies
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