As millions of Americans experience quintessential symptoms from the annual pollen deluge—coughing, sneezing, runny nose—allergists are reminding patients to consider all the signs before dismissing COVID or assuming they have it. Complicating matters are increasingly heightened pollen counts and new in-home allergies for remote workers.
Dr. Stacy Silvers, an Austin-based allergist, says that in 2020 and 2021, COVID was easier to distinguish from seasonal allergies because COVID symptoms were more severe. Now, with more mild variants emerging, it’s trickier to tell the difference.
“Symptom-wise, with Omicron we’re now seeing more sneezing and runny noses that we used to associate mainly with allergies,” he says. “And people don’t have as high fevers with the variants, which was a very easy differentiating factor.”
To help make the distinction, the Centers for Disease Control and Prevention shared a graphic outlining the symptoms of COVID and highlighting those that overlap with seasonal allergies. (See below.) One telltale distinction is fever.
“With allergies we never see fever, despite the misnomer ‘hay fever,’” Silvers says.
Both COVID and allergies can cause coughing and difficulty breathing. Similarly, you might experience a nasal discharge or a loss of taste or smell with both. But only COVID will cause a fever, body aches, and shortness of breath. There is just one symptom allergies present with that COVID doesn’t: itchy or watery eyes.
“Itchiness is not a hallmark sign,” says Clifford W. Bassett, M.D., the founder and medical director of Allergy & Asthma Care of New York.
In situations where it’s unclear what condition is causing your symptoms, allergists suggest a rapid COVID test. “It is not safe to distinguish those symptoms yourself,” says Michael Blaivas, MD, chief medical officer of Anavasi Diagnostics. “There is just too much overlap in common symptoms between allergies and the current manifestations of COVID. Fever may be more likely with COVID than allergies, but can still occur in the case of sinus infections.” Then, of course, there’s the possibility of a perfect storm where you have allergies and COVID at the same time, Dr. Blaivas says. A COVID test is the most reliable way to get a definitive answer.
A worse-than-usual allergy season
“In general, pollen counts are getting higher and higher and they’re lasting longer and longer, and the prevailing thought is that is due to climate change,” Dr. Silvers says. “With more CO2 in the air and warmer weather, plants have the opportunity to pollinate longer and more.”
Dr. Leonard Bielory, professor of medicine, allergy, immunology, and ophthalmology at Hackensack Meridian School of Medicine, coauthored a 2021 study comparing pollen trends from 1990 through 2018. The study showed an increase in pollen concentration over time as well as a lengthening of pollen seasons, due to human-caused climate change.
Allergy season is marked by pollination of trees and grasses; it begins in early March and lasts through the fall in most regions throughout the country. This year in particular will be bad for certain regions.
“Because of the combination of optimal growing conditions, sunlight, temperature, and rain, the Southeast and Northwest are predicted to have the worst allergy seasons with prolonged pollen production,” Dr. Blaivas says.
An increase in-home allergens
To compound it all, many who began to work remotely in 2020 have developed new allergies to their home environments. Thousands also adopted pandemic pets, introducing new allergens into the living spaces they now inhabit around the clock.
For some, symptoms of pet allergies didn’t set in immediately. Dr. Silvers says it can take time for pet dander to build up in the home, delaying symptom onset until well after the pet has become part of the family.
“It’s awful making that diagnosis because they’ve become attached to the pets,” he says. “The idea of rehoming the animal is heartbreaking.”
In those situations, Dr. Silvers usually begins patients on meds and suggests immunotherapy. Dr. Bielory also suggests wearing a mask to prevent both allergy symptoms and COVID.
“You don’t inhale the stuff, you don’t sneeze, you don’t wheeze,” he says.
Many of Dr. Silvers’s patients who were diligent about wearing N95 masks both indoors and outdoors early on in the pandemic reported having more mild seasonal allergies as well.
If you’re concerned about other allergens in your home, Dr. Silvers suggests mattress covers to reduce dust mites in your bedding. As far as over-the-counter meds go, he says steroid nasal sprays, like Flonase, are the best bet. If that doesn’t work, immunotherapy might. Of course, to avoid outdoor allergens getting into your home, keep your windows and doors closed.
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