Summer is a bountiful time for good weather and outdoor living and relaxation, but for those of us with lingering seasonal allergies, it can also be a time riddled with sniffles, itchy, watery eyes, fatigue, and headaches. This year, we have the double headache of trying to figure out whether our runny nose and cough are early symptoms of coronavirus or a seasonal allergy flare-up.
Trying to decipher between the two is getting easier thanks to the growing body of data we now have on the novel coronavirus, but some of us may still worry, and that’s completely understandable. If you are experiencing anxious thoughts about the virus or life in general, look after yourself by learning how to manage anxiety.
Luckily, there isn’t as much crossover when it comes to coronavirus symptoms vs seasonal allergies as there is with the flu. In fact, there’s one key difference: fever. In short, seasonal allergies do not cause fever. A recent study showed that the two most common coronavirus symptoms are a new cough and fever. If you don’t have a way to reliably take your temperature, read our guide to the best digital thermometers.
To help us understand the difference between coronavirus symptoms vs seasonal allergies, we spoke to allergist Dr Andrew Murphy, MD, FAAAAI (Fellow of the American Academy of Allergy Asthma and Immunology). As a member of the American Academy of Allergy Asthma and Immunology, Dr Murphy is licensed to provide treatment to patients with allergies and other immune system conditions. This is what he had to say…
COVID-19 vs seasonal allergies
How can a person tell if they have seasonal allergies or COVID-19?
“The biggest differences between COVID-19 and seasonal allergies are that fever and GI symptoms would suggest that COVID-19, or some other pathology, is in play. Whereas itchy, watery eyes or nose and sneezing would suggest allergy is more likely. Allergy will not cause a fever, so any upper respiratory symptoms that have a fever would suggest another cause.
“Seasonal allergy will not cause major GI symptoms either. Some patients with a lot of post nasal drip may have an upset stomach, but they will not develop significant vomiting or diarrhea.
Pollen count awareness: paying attention to pollen counts in your area may help you determine if your symptoms are due to seasonal allergies or COVID-19.
Become sneeze aware: typically, allergy sneezes happen in bouts where you can't stop sneezing. People with COVID-19 are typically not experiencing such a non-stop sneeze.
Allergy medicine routine: take medicine consistently and as prescribed by your doctor. Of all the years, it is very important to treat seasonal allergies because your symptoms may be mistaken for coronavirus.
"Shortness of breath and cough are more complex symptoms that can be caused by a myriad of diseases – germane to this conversation is asthma and COVID-19. Cough is generally caused by post nasal drip, asthma and reflux (there are other diseases that can cause cough, like malignancy, but in an otherwise healthy individual without a smoking history or other symptoms, these are the top three diagnosis). Certainly cough, wheezing and shortness of breath can be symptoms of asthma, and one can have a seasonal flare of asthma.
"Cough and shortness of breath can also be presenting symptoms of COVID-19. So it is very difficult to say that these two symptoms alone would suggest allergy more than COVID-19. To understand the difference clinically, a detailed history by the physician would be required – if a patient is having itchy, runny, watery nose and eyes and now has a cough, but no other symptoms, then this may suggest allergies.
"If a patient has a new onset cough and shortness of breath, while this could certainly be asthma (and allergy induced asthma), one needs to carefully consider other diagnosis, including COVID-19."
The following infographic from the American Academy of Allergy Asthma and Immunology shows which coronavirus symptoms overlap with seasonal allergies…
For those worried that they might mistake a COVID-19 cough for seasonal allergy, what advice would you give?
“This is a tough one to clinically discern. Significant allergies can cause nasal congestion and post nasal drip which can lead to cough, and asthma can make one feel short of breath and produce a cough. It will be the physician’s detailed history that will help lead them to the correct diagnosis.
“For example, if one has a history of seasonal allergies and now is experiencing these symptoms in the absence of fever, GI symptoms, other general viral symptoms, and is not high risk for exposure to COVID-19, and has been home for the past three weeks, then one would tend to think this is more allergy related.
“In asthmatics, it can be even tougher as they will cough and get short of breath, which obviously can overlap with COVID-19 symptoms. A detailed history will help drive the diagnosis in the correct direction. If they are concerned, they need to contact their physician for advice.”
What treatments are there for seasonal allergies, and how could a person treat them without masking potential COVID-19 symptoms?
“First off, treatment for allergies will not make one more susceptible to COVID-19, and as best as we can tell, allergic diseases do not appear to place one at increased risk to get COVID-19. Avoidance of allergens is always ideal but that is not always practical – pollens can’t be controlled, and now with stay at home recommendations in effect in many places, indoor allergens (cat, dogs, and so on) may become more problematic.
You can buy seasonal allergy medication from a variety of drugstores and retailers including Walgreens, Rite Aid and Target in the US, and pharmacies and retailers like Boots, Amazon and Chemist Direct in the UK. Speak to your doctor or allergist before taking allergy medication, and always take it as directed by your healthcare professional.
“The treatment of allergies during this pandemic should continue as per usual. Patients should not stop their allergy meds, especially asthmatics, without consulting their physician first. The basic premise of treating allergic disease is tripartite: avoidance, medicine, and immunotherapy. Obviously avoidance is the ‘easiest’ and probably cheapest, but not always ideal. Pollens are very challenging to avoid and most patients will not get rid of their pets.
“Antihistamines (orals or topically in the nose and eyes) are used to control symptoms like sneezing and itching. Topical nasal steroids can be used to control symptoms like nasal congestion, and with regular use may decrease sneezing and itchiness.”
What about nasal sprays or allergy shots?
“Allergy shots or allergen immunotherapy (AIT) is traditionally used when avoidance and medicines are not helpful; patients are tired of poly pharmacy (using numerous medications); they are having complications of using medications; are having complications of their allergic disease that is not controlled by medications.
“This significant difference between medication and AIT is that avoidance and medication just address symptoms, while the goal of AIT is to induce fundamental immunologic changes such that the patient does not see an allergen (pollen, etc) as an allergen anymore, and symptoms are improved. ‘Cure’ is probably too strong of a word to describe AIT, but certainly the goal is long-term modification of the immune response to allergens.”
Are there seasonal allergy drugs that people should be mindful to not overlap?
“In general, allergy medicines appear to be well tolerated. I try to direct patients away from sedating antihistamines like Diphenhydramine (Benadryl) as there are better choices for oral antihistamines, like Loratadine, Fexofenadine, Cetirizine – these are all once daily and, with the exception of Cetirizine, generally non-sedating.”
What should a person do if they’re unwell and can’t tell if it's allergies or the coronavirus?
“As a general statement, if a patient is feeling unwell they need to contact their physician. If they are really ill, have trouble breathing, short of breath and are in trouble, then they need to go to the Emergency Department. There is a lot of information out there right now – almost too much. I have suggested to patients to pick one or two reliable websites and stick with them: CDC and AAAAI, as well as country or state health departments.”
Coronavirus symptoms vs seasonal allergies: accessing telemedicine
The AAAAI has also produced guidance for allergy patients looking to seek telemedicine during the COVID-19 pandemic. Telemedicine connects you to a medical professional via video or phone, so as a patient you can see your allergist remotely.
During a telemedicine appointment your physician will evaluate, diagnose and treat you, including dispensing prescriptions and lab orders as needed. According to the AAAAI, common conditions suitable for telemedicine consultancy include hay fever allergies, rashes, eye allergies and sinusitis. The AAAAI has also produced a ten-step guide to preparing for your telemedicine appointment, which includes the following:
- Prepare your medical history
- Prepare paperwork ahead of time – including a list of medications you take
- Obtain vital signs – including taking your temperature, and any pictures of rashes or conjunctivitis you have questions about
- Write down important questions ahead of time
You should also be prepared for copays, as some health insurance companies deem a telemedicine appointment comparable to an in-person visit, and so these could be subject to the same co-pays and payments. If you have ongoing prescription medication costs and don’t have coverage, you may also want to check out our guide to the best Medicare Part D plans.
How to protect yourself when outside
The CDC updated coronavirus guidelines for summer and beyond include measures for keeping yourself safe when taking part in outdoor activities with people outside of your household. They also include a list off COVID-essential items that you should keep on your person at all times. These include:
- A cloth face covering
- Hand sanitizer (at least 60% alcohol base)
- Tissues (for sneezing and coughing into)
If you don't have the time or materials to make your own cloth face coverings, there are plenty of reusable face masks online for you to buy. Make sure they follow CDC guidelines for mask use, which means they should fit snugly without restricting breathing, cover your nose and face, and have secure fastenings or ear loops.
Face masks are no substitute for social distancing measures and hand hygiene, so stay at least six feet away from any person outside of your household and regularly wash your hands for at least 20 seconds with soap and water. Use hand sanitizer in outdoor situations until you can get to a sink to wash properly.