What to do ☐ to be started as directed below,
☐ Decongestant ☐ Nasal ☐ Oral ☐ Antihistamines ☐ Oral ☐ Nasal ☐ Eye drops ☐ NasalCrom ☐ Atrovent ☐ Nasal corticosteroid ☐
☐ Nasal corticosteroid ☐ Oral antihistamine ☐ D ☐ Nasal antihistamine ☐ Singulair ☐ NasalCrom ☐ Atrovent ☐
☐ Nasal corticosteroid ☐ Oral antihistamine ☐ D ☐ Nasal antihistamine ☐ Singulair ☐ NasalCrom ☐ Atrovent ☐
☐ Nasal corticosteroid ☐ Oral antihistamine ☐ D ☐ Nasal antihistamine ☐ Singulair ☐ NasalCrom ☐ Atrovent ☐
☐ Oral steroid
dose(s) dose(s) dose(s) dose(s) dose(s) dose(s)
dose(s) dose(s) dose(s) dose(s) dose(s) dose(s)
dose(s) dose(s) dose(s) dose(s) dose(s) dose(s)
dose(s) dose(s) dose(s) dose(s) dose(s) dose(s)
dose(s)
Symptoms medications and then follow Action A, B, or C below
isode: Action B Action A added medications
p (to Step 2-4) ach Step 5
Control ctivities
or eye symptoms Severe Episode: Action C
> Incomplete response to Action B added medications after 24 h
> Move up one more Step (to Step 2-4) > Call physician if you reach Step 5
Not Controlled
> Moderate to severe interference with activities > Daily moderate to severe nasal or eye symptoms
hours or days before exposure
times a day as needed times a day as needed times a day as needed times a day as needed times a day regularly times a day as needed
times a day regularly times a day regularly times a day regularly times a day regularly times a day regularly times a day regularly
times a day regularly times a day regularly times a day regularly times a day regularly times a day regularly times a day regularly
times a day regularly times a day regularly times a day regularly times a day regularly times a day regularly times a day regularly
☐ Call health care provider to discuss symptoms ☐ To schedule office visit ☐
☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM
☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM
☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM
☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM ☐ AM ☐ PM
times a day regularly for 3-5 days
Y
FOR INTERNAL USE ONLY
