Food Allergies

Hi and thanks for taking the time to complete my survey.

It's quite long, although because it is multiple choice – hopefully it should only take 10 minutes to complete, and will allow me to derive some stats from the info.

**Please read this bit, it's very important**

Please rest assured that every shred of information that is sent to me will be treated in the strictest confidence and not disclosed for any purposes other than the collation of information for the survey. After the collation of the survey results, the collated results will be made available to participants, either via email or on my blog. http://kylie.wordpress.com

No identifying information will be used in the reporting, only aggregate information will be provided unless the respondents specifically indicate otherwise.

Leave questions blank that you do not feel comfortable responding to. More than one answer to a question is expected in many cases, so that's quite ok.

If you have more than one child with food allergies please complete a separate survey for each child.

I have assumed that this survey will collect information about childhood allergies, however, please feel free to contribute if you are an adult. Your year of birth will allow me to understand you are not a child.

If you have any questions please do not hesitate to contact me via my blog on the survey page. http://kylie.wordpress.com/food-allergies/allergy-questionnaire/

Thanks for participating.
Kylie

HAVE YOU READ THE INTRODUCTION?
Yes
No

Please provide an identification name in case you want to track your survey response in the future.

What country do you live in?

In what country was the child with allergies born?

In what year was your child with allergies born?

What is your child's gender?
Male
Female

Do the parents of the child have food allergies?
1
Both
Neither
Don't know

Did the parents of the child have any of the following as children or adults?
Eczema - father
Asthma – father
Eczema – mother
Asthma - mother
Don't know

At what age did your child first present symptoms of the food allergies?
0-2 months
3-6 months
7-12 months
1-2 yrs
2-4 yrs
4-8 yrs
8+ yrs

What were the Symptoms?
Eczema
Asthma
Anaphylaxis
Hives
Facial swelling (e.g. puffy eyes)
Difficulty breathing
Stomach cramps
Vomiting
Other

If "Other", please list symptom(s)

Did you consult with a "professional" at this point?
GP
Hospital
Health Care Nurse
Pediatrician
Allergy specialist
Naturopath
Homeopath
Other
No

If "Other", please list professional

Were Food Allergies diagnosed at this point?
Yes - by GP
Yes - by Hospital
Yes - by Health Care Nurse
Yes - by Pediatrician
Yes - by Allergy specialist
Yes - by Naturopath
Yes - by Homeopath
Yes - by Other
No

If "Other", please list professional who successfully diagnosed the allergy

When the child was diagnosed as allergic to food, was it the result of
a major reaction
perseverance with different "professionals"
personal research
skin prick test
Other

If "Other", please list

If it was as a result of a major reaction, what were the symptoms?
Eczema
Asthma
Anaphylaxis
Hives
Facial swelling (e.g. puffy eyes)
Difficulty breathing
Stomach cramps
Vomiting
Other

If "Other", please list

Does the child regularly see any of the following "professionals" for their food allergy?
GP
Health Care Nurse
Pediatrician
Allergy Specialist
Herbalist
Homeopath
Naturopath
Other

If "Other", please list

What "treatment" does the child receive with the "professional"?
General health, weight, height review
Skin prick tests
Food Challenges
Review of diet, discussion with parent
Herbal remedies
Homeopathic remedies
Other

If "Other", please list

What "treatment" does the child receive/have on stand-by?
Restricted diet
Ventalin/other asthma drugs
Phanergen/other anti-histamines
Epi-pen for emergency use
Herbal remedies
Homeopathic remedies
Other

If "Other", please list

What food is and was your child allergic to:

	first diagnosed	subsequently diagnosed	allergic to now
Cashew nut
Chicken
Cinnamon
Egg
Fish (e.g. cod or salmon)
Hazelnut
Lamb
Milk
Peanut
Rye
Sesame
Shell Fish (e.g. prawn or lobster)
Soy
Wheat
Other

If "Other", please list

What method(s) was used for diagnosis?
Skin prick test
Blood tests
Food challenge (small amount of food given)
None, based on reactions
[ ] Other <tell me>

If "Other", please list

What response does the child have to the allergen?

	Eczema	Asthma	Anaphylaxis	Hives	Facial swelling (e.g. puffy eyes)	Difficulty breathing	Stomach cramps	Vomiting	Other	Don't know - never eaten
Cashew nut
Chicken
Cinnamon
Egg
Fish (e.g. cod or salmon)
Hazelnut
Lamb
Milk
Peanut
Rye
Sesame
Shell Fish (e.g. prawn or lobster)
Soy
Wheat
Other

What quantity of the allergen creates a reaction?

	Traces	<5g/5ml (teaspoon-ish)	5-15g/ml (tablespoon-ish)	<1/2 cup	>1/2 cup	Don't know – child has never eaten	Don't know	Other
Cashew nut
Chicken
Cinnamon
Egg
Fish (e.g. cod or salmon)
Hazelnut
Lamb
Milk
Peanut
Rye
Sesame
Shell Fish (e.g. prawn or lobster)
Soy
Wheat
Other

What was the term of the pregnancy?
less than 30 weeks
31-35 weeks
35-38 weeks
39-41 weeks
41+ weeks

Was the birth (tick all that apply)
Vaginal
Enduced
Epidural
Caesarian
Pethadiene/pain relief
Gas
Water Birth
Hospital
Other

If "Other", please list

Is the child from a multiple birth?
Yes
No

Did you have any unusual food cravings during pregnancy?
Yes
No

What were the cravings?

Was there food you normally ate that you could not tolerate during pregnancy?
Yes
No

Which foods?

Was the child breastfed?
Yes - exclusively
Mostly - however some formula sups in first few weeks
Mostly - however some formula sups throughout breastfeeding
No

If breastfed, at what age did your child wean?
0-2 months
2-6 months
6-12 months
12-18 months
18+ months
Child is still breastfeeding
Child not breastfed

Did what you eat whilst breastfeeding affect the child?
Yes
No

How effective are/were the "professionals" in addressing the allergies?

	Greatly helped	Helped	Hindered	No effect	Too early to tell	Don't know	Did not use
GP
Hospital
Heath Care Nurse
Pediatrician
Allergy Specialist
Herbalist
Homeopath
Naturopath
Other

How happy are you with the treatment the child receives?

	Exceptionally happy	Reasonably happy	Not Happy - I wish I could find another alternative	What treatment?	Other
GP
Hospital
Health Care Nurse
Pediatrician
Allergy Specialist
Herbalist
Homeopath
Naturopath
Other

Has/Does the child attend school/childcare/pre-school?
Yes
No

If Yes, what is their understanding about the allergies?
Brilliant - I have complete confidence
Pretty good - I feel mostly comfortable
OK - seems to be some care but not the diligence I think required
Poor - I worry all the time/have had incidents
Appauling - but I don't have other options
Other

In your opinion, does the facility have adequate training for teachers/staff?
Yes
No

Do you think there is adequate understanding about food allergies in the general community?
Yes
No

What would you like to see in the future?/ How could things be better/easier?
characters remaining

Has the child ever been victimized because of his/her allergies?
Yes
No

Do you eat out with the child?
Yes - as most families would
Yes - at selected venues of with very limited food choices
Very occasionally
Only if food is brought for the child
Never

Is your child's height:
Taller than average
Average
Shorter than average

Is your child's weight:
Lighter than average
Average weight
Heavier than average

Does your child seem more susceptible to illnesses such as colds, tonsillitis, etc?
Yes
No
Don't know

When ill does you child get an excessively high fever?

Yes
No

Do you consider your child to have "normal health" other than allergies?
Yes
No

Go for it!
Tell me anything you'd like... as long or as short as you like.
(Including suggestions for improving the survey)
characters remaining

Would you like your comments to be anonymous?
Yes
No
Don't care

Do you give permission for what you have answered above to be publicly reproduced?
Yes
No

Please provide your email address if you would like to be emailed when new results are released.

THANKS FOR PARTICIPATING
Kylie

SurveyBob

Food Allergies