Screener

Author: tdower Posted: December 22nd, 2021 Category:

1. How old are you?

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2. How long have you had Chronic Hives?

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3. Have you been diagnosed by a medical doctor with Chronic Urticaria (Chronic Hives)?

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4. Do you know what triggers your hives?
Mark all that apply:

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5. Do you continue to have symptoms of Chronic Urticaria (e.g., hives, itching and/or swelling) after treatment with antihistamines??

Common types of antihistamines include but not limited to:
  • Brompheniramine (Dimetane®)
  • Cetirizine (Zyrtec®)
  • Chlorpheniramine (Chlor-Trimeton®)
  • Clemastine (Tavist®)
  • Diphenhydramine (Benadryl®)
  • Fexofenadine (Allegra®)
  • Loratadine (Alavert®, Claritin®)
  • Desloratidine
  • Levocetirizine
  • Rupatadine
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6. Are you pregnant? Or, plan to be pregnant in the next 16 months?

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7. Do you have any of the following conditions? Mark all that apply:

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8. What is your zip code?

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