Allergies, Asthma and COVID-19: How to Differentiate Symptoms

Northwestern Medicine
Ear, Nose, Throat April 13, 2020

Attribute to: Amiinah Kung, MD, allergy and immunology at Northwestern Medicine Central DuPage Hospital

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When is it allergies? When is it COVID? What’s the difference in symptoms?

With the worldwide COVID pandemic coinciding with the onset of spring season in most of the United States, allergies can be difficult to distinguish from the viral illness. Allergic rhinitis, or seasonal allergies, can cause sneezing, nasal congestion, runny nose, post-nasal drip and itchy or watery eyes. With COVID-19 the primary features tend to be fever, cough, and shortness of breath. The main point I use to distinguish viral illnesses from allergies is usually fever; allergies don’t cause fever. Although COVID patients don’t necessarily have a fever right off the bat, this is present in a majority of the people who are infected. It seems nasal symptoms are fairly minimal with COVID-19, although many people can report symptoms that are like the common cold, so this can’t be a distinguishing factor.

What about cough? Can this be due to allergies?

A cough can happen with allergies. This is often from increased mucous and postnasal drip. The cough can be annoying, but with the right medicines, it can be controlled. However, the cough is more worrisome if you have asthma. Asthma is a condition where there is inflammation in your lungs which can cause obstruction and trouble breathing. The cough then also comes with wheezing and chest tightness. These symptoms can be confused for COVID-19 infection. The cough from COVID infection is generally more severe, and also comes with shortness of breath.

What can trigger asthma symptoms?

We do know that viruses can trigger asthma symptoms in other patients, but so can allergies, exercise and irritants such as tobacco smoke or strong-smelling chemicals. The most important thing for asthmatics to do at this time is to be consistent with their asthma medications and be aware of their triggers. For allergies, it may also mean taking a daily antihistamine for prevention. If there are smokers in your household, asking them to stop or to smoke outdoors would help. And with all the extra cleaning we are all doing these days, making sure there is good ventilation in the room is important.

Do anti-histamine over-the-counter medicines work, or do you need a prescription?

For the most part, you can manage a lot of your allergy symptoms with over-the-counter (OTC) medications. Generally, OTC works pretty well. There are 24-hour, non-sedating medicines and nasal sprays that are available to people without seeing a doctor. I would recommend trying these medications if you start to feel any sneezing, a runny nose, congestion, postnasal drip or a sore throat. If the symptoms improve, then it was likely allergies rather than anything more serious. These medications can be taken every day and are very safe.

When is allergy season and how long will it last? What can I do about it?

Spring in the Chicagoland area often starts by mid-March and continues through the end of June. Fall season often starts in August and continues through October. The tree pollen counts are rising now, as you can see the buds coming up on the trees, and grass pollen is not far behind. I don’t like to tell people to stay indoors, but this year it’s a good strategy for avoiding allergies and COVID-19. I also recommend keeping windows closed even though the weather is getting nicer. Pollen counts are higher in the early morning and late evening, so limit your activities outside during those times. It’s going to be those dry, windy days that seem to cause a lot of symptoms for people. If you are staying outdoors, showering after you come back inside to get some of those pollens off can help. And another warning, your pets can bring them inside as well. Pollen counts can vary from day to day. There are local pollen counts with weather reports that may be helpful.

If someone is really confused about their symptoms, what would you advise?

Taking your temperature is a good start, if you have a thermometer at home. A cough, if it’s mild, doesn’t mean you have to rush off anywhere. With the lack of availability with tests, we have to save them for those who are more severe or are at greater risk with other health concerns. The allergy medicines are worth trying first, and if you have inhalers that have been prescribed by a healthcare provider, you should start with these. If these medications don’t seem to be working, then getting in touch with your doctor is important. Allergists are doing virtual visits, so if you have questions, we’re available to help you distinguish some of these symptoms. Or even your primary care provider – everyone is available by telemedicine which is great; we can help people over the phone so that you don’t have to come out to the ER or urgent care and risk getting infected. The best thing people can do is to stay at home, practice physical distancing, and wash your hands frequently.

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