Table 1 Template of the questionnaire used

1

Gender

• M

• F

2

Age (years)

• <20

• 21-40

• 41-60

• >60

3

Race

• Caucasian

• Asian

• South American

• Arab

• Other………….

4

Which symptom mainly prompted you to go to the pharmacy?

• Rhinitis (sneezing, runny nose, itchy nose, stuffy nose)

• Cough

• Conjunctivitis (burning eyes, itchy eyes, photophobia)

• Dyspnea (short breath)

5

How long before your visit to the pharmacy did the symptom appear?

• < 5 days

• 5-10 days

• 11-30 days

• > 30 days

6

The problem was already diagnosed by a physician?

• Yes

• No

7

Did you received a physician prescription for your symptoms?

• Yes

• No

8

Which medications do you usually take?

(multiple answers allowed)

• Topical nasal decongestants

• Systemic antihistamines

• Topical antihistamines

• Topical steroids

• Systemic steroids

• Topical anticholinergics

• Topical Cromones

• Antibiotics

• Antileukotrienes

• If you can not specify the class, indicate commercial names

9

Do you use or have used complementary/alternative medicines (e.g. homeopathy, acupuncture, herbs) for your rhinitis/asthma?

• Yes

• No

10

Do you use or have used allergy vaccines?

• Yes

• No

If yes:

• Sublingual route

• Subcutaneous route

11

If for this problem you usually care alone, why do you?

• It is a trivial problem

• It’s not worth to talk to the doctor

• The doctor underestimates

• Just consult the pharmacist

12

Do your symptoms affect your everyday life?

• Not at all

• Moderately

• Heavily