of an allergy requires proper diagnosis. Whenever possible, an illness should first be diagnosed and evaluated by a physician, preferably by a family physician or the physician primarily responsible for treatment. The physician may request con­firmation or further evaluation from a qualified allergist trained in, for example, pediatrics or internal medicine. The specialist may be a clinical immunologist whose subspecialty is allergy. A patient whose illness involves only one body system may be evaluated by a special­ist in, say, diseases of the ear, nose, and throat; the chest; or the skin. In a case requiring laboratory tests, the services of an immuno-pathologist may be needed. The physician responsible for directing a person’s health care should make a diagnosis, estimate the specific causes, and prescribe a program of treatment. People tend to become allergic to substances that cannot be avoided entirely, short of withdrawing from society. Thus, the more they know about the causes, or precipitating factors, of allergies, and how to avoid them, the less the risk of recurrence. In general, the following apply to all allergy emergencies. You should know: The names of all medications known to cause an allergic re­action or have a severe side effect The allergen or allergens that caused the reaction or side effect The season or seasons in which pollen caused the symptoms that are most prevalent —for example, early spring (trees), spring and early summer (grasses), or fall (weeds and certain trees) The names and doses of all medications, professionally pre­scribed and self-prescribed, including vitamins, "health foods," and cold tablets Related families of the drugs and allergens that are known reactors You should keep a written record of Drug reactions; consider using a Medic Alert bracelet, an identity bracelet, "dog tags," or a drug-information card. Current drug therapy; everyone on steroid treatment for more than a few weeks should carry a card with a message such as: / am taking steroids [specific name and dose] on a regular basis. Do not stop dosage in case of a serious accident or major surgery. The name and phone number of your physician should also be listed. Allergens other than drags —for instance, stinging insects, dust, mold, pets, food. The location of emergency-room facilities near your home, place of work, and other places you are likely to be. Emergencies may be inadvertently self-induced. Use of the fol­lowing list will help prevent them: Take steroids as prescribed. Treat asthma adequately until it is fully resolved. Inform medical personnel about known reactions to drugs. Avoid known allergens and irritants. Do not overdose or overuse medications. It is senseless, and possibly tragic, to casually reexpose oneself to a drug, x-ray, or preparation known to have caused an anaphylactic reaction in the past. The only exception is when both a person and that person’s physician agree that not taking the substance would be more dangerous than taking it. Once the risks have been evaluated, effective preexposure-treatment measures can usually be taken. Tragedies occur when reexposure occurs because of oversight or carelessness. It is the physician’s responsibility to inquire about past reactions to drugs and solutions used in x-ray studies; it is the patient’s responsibility to provide such information. Carrying a drug-information card or wearing an information bracelet makes allow­ance for the possibility of loss of consciousness or other inability to communicate. Self-medication is especially risky for allergic people. If a certain medication causes a serious reaction, it is likely that another chem­ically similar drug bearing a different name will behave similarly. For example, penicillin is related to drugs with different names such as cephalosporin and Keflex. Ordinarily, it is not possible to learn all the drug families. You should ask your physician whether a prepara­tion about to be administered is related to the one that caused the allergic reaction. If you insist on self-medication, however, you should know as much as possible about the chemicals used in non­prescription medications and the equivalent terms of these ingredi­ents. If, in the past, aspirin caused hives, asthma, or an anaphylactoid reaction, so will acetylsalicylic acid, for it and aspirin are the same chemically. A similar situation exists in the case of foods. Merely a taste of peanuts or lobster can cause anaphylaxis in the highly susceptible person. The peanut is a legume; therefore, such legumes as peas and beans must be considered potentially hazardous. If you are allergic to crustaceans, and you know that lobster is a crustacean, you will want to avoid its close relatives, crabs and shrimps. Clams and oysters, popularly thought of as shellfish, too, are actually mollusks, differing both chemically and antigenically. Let us now consider the medical conditions on an individual basis, from emergency to nonemergency reactions.