Are you aged 18 and above?

Have you previously experienced an allergic reaction to any antihistamine, such as cetirizine, loratadine or fexofenadine, or are you lactose intolerant?

Are you pregnant or breast feeding, or intending either whilst on this medication?

Have you been diagnosed with any of the following?

• Epilepsy
• Kidney or liver disease
• Heart conditions, including a fast or irregular heartbeat, or angina?

Are you currently taking any oral medication for hayfever/ allergies?

Are you aware that:

• There is a small chance that antihistamine tablets can cause drowsiness and impair driving (even those classified as ‘non-drowsy’)?
• You should stop taking antihistamine tablets and speak to your GP if your symptoms do not improve after 2 weeks of starting treatment?
• You should not take: Indigestion remedies (such as antacids) or Ulipristal (emergency contraception or treatment for fibroids) 2 hours before or after taking an antihistamine?

Do you agree with the below:

• The treatment is for your own use
• You will contact us and your GP should you experience any side effects from the treatment, if your condition changes or if your medical circumstances change.
• You will read the patient information leaflet supplied with your medication
• You have completed this questionnaire yourself and fully understand all the information
• Your responses are honest and accurate, and you understand that this is necessary for a safe medical assessment
• You agree to the terms & conditions, privacy policy, & data sharing policy