I'm allergic to:

Please choose all allergens that you do not tolerate.

A) Gluten
A.1) Wheat
A.2) Rye
A.3) Barley
A.4) Oats
A.5) Spelt
A.6) Kamut
A.7) Hybridised strains
B) Crustaceans
C) Eggs
D) Fish
E) Peanuts
F) Soybeans
G) Milk
H) Nuts
H.1) Almonds
H.2) Hazelnuts
H.3) Walnuts
H.4) Cashews
H.5) Pecan nuts
H.6) Brazil nuts
H.7) Pistachio nuts
H.8) Macadamia or Queensland nuts
I) Celery
J) Mustard
K) Sesame
L) Sulphur dioxide and sulphites
M) Lupin
N) Molluscs

Additives:

Please select all additives that you do not tolerate.

1) with colours
2) with preservatives
3) with antioxidants
4) with flavour enhancers
5) sulphuretted
6) blackened
7) with phosphate
8) with milk protein (for meat products)
9) with caffeine
10) with quinine
11) with sweetener
12) waxed

I eat / drink:

alkoholhaltig
für Kinder geeignet
scharf
vegetarisch

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