Today, every sniffle, every cough, and every sneeze are a cause for concern. “Do I have COVID-19?” races through our minds. Madeleine R. Schaberg, MD, Director of Rhinology and Endoscopic Surgery, Mount Sinai Downtown, helps you tell the difference between allergies and COVID-19.

How do the symptoms of seasonal allergies differ from COVID-19?

The main symptoms of allergic rhinitis or seasonal allergies are itchy, watery eyes, runny nose, nasal congestion, and sneezing, while the symptoms of COVID-19 are fever, cough, body aches, sore throat, and shortness of breath. Many symptomatic patients with COVID-19 will have a fever which, in an adult, is a temperature above 99°F.

Other symptoms of seasonal allergies include post-nasal drip, facial pressure and sinus headaches, and mild fatigue. We generally do not see a significant amount of coughing with seasonal allergies, except in patients with significant post-nasal drip or allergy associated asthma. Sneezing is generally a prominent feature of seasonal allergies, but it has not been reported with COVID-19, although it may happen occasionally.

In general, the key differentiating factors between COVID-19 and allergies are fever and body aches (malaise). Typically, you do not see either symptom in allergy sufferers. While you may see some mild fatigue with allergies, the fatigue we are seeing with COVID-19 is more extreme.

Are there other symptoms that may indicate COVID-19?

Yes, in addition to cough and fever, many patients will experience a loss of smell (anosmia). We don’t typically see a loss of smell with seasonal allergies, unless patients have significant congestion of the nasal passages or have polyps blocking their nasal passages. The loss of smell that is associated with COVID-19 is thought to be due to direct damage to the olfactory nerve and specialized olfactory neuroepithelium.

It’s also worth noting that, for most people, COVID-19 is an acute illness. Patients will develop symptoms between 2 to 14 days after being exposed to the virus. Those symptoms will then last 10 to 14 days. Although symptoms may differ from person to person, they will appear in most people within the 14-day exposure window. This is true whether you have a moderate case or a severe case.

Allergies are more of a chronic issue. They will generally manifest as mild symptoms and last for the allergy season, which is typically from April to mid-June.  Compared to COVID-19, seasonal allergies, as well as allergies that occur perennially, have a much longer time course. In addition, patients will often be familiar with their typical seasonal allergy symptoms, as they often will be similar each spring.

What is the treatment for allergies?

For allergies, the first line of treatment is over-the-counter antihistamines. The main inflammatory mediator of seasonal allergies is histamine. This would include such medications as, cetirizine, loratadine, fexofenadine, and levocetirizine. There are also many over-the-counter steroid nasal sprays, which are extremely effective for allergy relief, such as budesonide, fluticasone, and triamcinolone.

If patients don’t get relief with over-the-counter medication, then an appointment with a rhinologist would be appropriate to explore possible prescription medication.

There are many prescription medications that can be extremely helpful.

I’m unsure if I am suffering from allergies or COVID-19. What should I do?

If you are experiencing mild symptoms that you are concerned may be COVID-19, there are a number of testing options available.

In-person testing is available at all Mount Sinai Urgent Care locations for walk-in or scheduled appointment.

You can also have your symptoms assessed virtually throughout Mount Sinai Urgent Care. Physicians are available for online consultations, video calls, and via text from your mobile device. Additionally, you can contact your Mount Sinai primary care physician or use Mount Sinai’s Express Online Consult Click4Care to receive virtual assessment of your symptoms.

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