• ''The selection of appropriate diagnostic tests is fully dependent on the clinical history presented by the patient in question. It therefore follows that diagnostic tests should be ordered only after a careful history and physical examination have been obtained" (Kaplan, 1985).

  • "The degree of success that will be achieved in the treatment of a patient's allergies will be proportional to the exactness of the history obtained" (Weiss and Rubin, 1980).

  • "It is of utmost importance to begin with a thorough, perceptive general medical history…. If the general history suggests an allergic disease, one must ascertain what factors are important in producing the difficulty of the individual patient. The history is the major approach in making this assessment, and the most important clinical skill to be learned in evaluating allergy patients is to acquire facility in asking discerning questions so that logical deductions can be made about the cause of the patient's difficulty" (Korenblat and Wedner, 1984).

  • "The purposes of the medical evaluation are to establish the diagnosis, to estimate the severity of the illness, to determine responses to previous treatment, to identify possible complications, and thus to guide appropriate further management. A thorough medical history is the most helpful tool in achieving these objectives in the field of allergy" (Bierman and Pearlman, 1988).

In spite of universal agreement about the primary importance of a patient's allergy history, the same textbooks from which these quotations were taken (and others) devote little or no space to this topic (Tables 5-1 and 5-2). Furthermore, review of the allergy literature reveals no discernible research on the subject.

Allergists use a variety of methods to obtain a history, including (1) an open-ended, nondirected question-and-answer session, (2) a series of questions ordered according to a formal protocol to ensure completeness, (3) a structured questionnaire history completed by the physician, or (4) a structured questionnaire history completed by the patient. Many allergists use a combination of these methods.

The use of particular history formats or questionnaires depends on the purpose of the examination—for example, whether it is the clinical evaluation of an individual patient or an epidemiological study of a general or selected population (e.g., that of a particular building, factory, or industry). A commonly used format for evaluating a patient's medical history contains the following eight components:

  1. Chief complaint—This includes (a) the reason for the patient's visit, such as referral from a primary physician, need for treatment of a current problem, potential need to avoid an allergen (e.g., penicillin, cat), or disability evaluation, and (b) a concise definition of the symptom or complaint



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