Diagnostic role of fractional exhaled nitric oxide in pediatric eosinophilic esophagitis, relationship with gastric and duodenal eosinophils

Table 1 Atopy screening questionnaire

Atopy screening questionnaire
(1) Has the patient ever been allergy tested?
Yes
No
(2) Has the patient ever been on allergy shots?
Yes
No
(3) In past 12 mo, has the patient had the following symptoms lasting for > 4 wk at a time? (Check all that apply)
Itching of eyes or nose
Sneezing
Stuffiness of nose
Seasonal or year-round runny nose
Eye itching/tearing/redness
(4) What seasons are the above symptoms most noticeable? (Check all that apply) Spring
Summer
Fall
Winter
Year-round
(5) Has the patient ever had one of the following? (Check all that apply)
Doctor diagnosed “allergic rhinitis”
Doctor diagnosed “allergic conjunctivitis”
(6) In past 12 mo, has the patient had any of the following skin symptoms lasting > 4 wk at a time? (Check all that apply)
Itchy skin
Red skin
Bumpy skin
Rash on the face, or at the elbow, or knee joints, behind the ear, tops of feet, wrists
Rash that you have put steroid cream on (hydrocortisone, triamcinolone)
(7) Has the patient ever had doctor diagnosed “eczema”?
Yes
No
(8) Has the patient ever had doctor diagnosed “reactive airways disease,” “asthma,” or “chronic bronchitis?”
Yes
No
(9) In the past 12 mo, has the patient ever required the use of an inhaler or nebulizer?
Yes
No
(10) In the past 12 mo, has the patient had any of the following respiratory symptoms that have lasted > 2 wk at a time? (Check all that apply)
Wheeze
Shortness of breath
Difficulty breathing
Sputum production
Chest pain/tightness
Cough
Nighttime wakening from cough
Exercise that required the use of an inhaler to help breathe
(11) Has the patient taken any of the following medications in the past year? (Check all that apply)