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Is that cough just allergies, or the coronavirus? Symptoms can overlap

With tree pollen season in full swing, some allergy symptoms could overlap with those of COVID-19. Dr. Punita Ponda, an allergist, discusses the potential confusion.    Credit: Randee Daddona; Charlie Eckert

Allergy sufferers this spring pollen season have more than a stuffy nose and red eyes to worry about: Some allergy symptoms overlap with symptoms of the COVID-19 infection.

Nasal congestion, sneezing, coughing, inflamed eyes, fatigue, sore throats — and for some, shortness of breath — have made many allergy sufferers wonder if something else is going on.

“It’s very unfortunate that COVID hit at the same time as allergy season was taking off, and it has made the diagnostics of each harder,” said Dr. Punita Ponda, an allergist with the Northwell Health System. From the beginning of the pandemic, she has seen “patients who had been to the emergency room multiple times because they were having what they thought were COVID symptoms … They finally came to us and we figured out it wasn’t COVID, it was allergies."

And at the same time, she said, patients who came to her with what they thought were allergies were instead instructed to self-isolate when they didn’t test positive for allergies or respond to treatments. They weren’t tested for the coronavirus as tests were difficult to obtain.

Long Island is in the midst of tree pollen season, while grass pollens will appear in June through August and weed pollens will follow into the fall. 

Dr. John F. Byrne, an allergist in private practice in Riverhead who consults for Peconic Bay Community Hospital, said with mild COVID-19 cases there may be symptoms that mimic a “cold” or allergy such as runny nose, nasal congestion and mild cough.

However, he said, in the absence of fever or severe cough or shortness of breath, “these symptoms are not strongly suggestive of COVID-19, but should be discussed with your doctor nevertheless to determine the best testing and treatment course.”

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“It needs to be stressed that we do not see fever with allergy,” he said. “If there is fever, it strongly suggests underlying infection.”

More problematic are patients who suffer from both allergies and asthma, he said. Their allergy symptoms may worsen in pollen season, with shortness of breath, wheezing, cough and chest tightness that mimics COVID-19 symptoms.

“Fortunately to this point, asthma has not revealed itself to be a strong risk factor for severe manifestations of COVID-19, as originally was feared," he said.

Parents of children with a rash or hives should consult a physician, he said, as these may be symptoms of a serious inflammatory syndrome following exposure to the virus that causes COVID-19. And he advised those experiencing worse or longer symptoms than normal to call their doctor.

“I never recommend self-diagnosis, as there are too many nuances,” he said. “If it’s mild that's fine. But if it's ongoing and not responding to treatment, they should interact with their primary doctor and allergist.” 

Both doctors said wearing the masks or face coverings now required in public spaces to slow the spread of the coronavirus could also benefit pollen allergy sufferers.

“I guess that‘s the silver lining,” said Ponda, who is associate division chief in the division of allergy and immunology at Cohen Children’s Hospital.

“Pollen flies around and you can breathe them in. The mask is a barrier that limits the exposure in the nose and mouth to those pollens, so yes it can be helpful,” she said. “It’s not going to be foolproof, but it will be better.”

She also advised pollen allergy sufferers to stay indoors with the windows closed from 5 to 10 a.m., when pollen is most abundant in the air, and to take pre-bedtime showers to rid the skin of allergens.

While many allergic symptoms are eased with over-the-counter medicated nasal sprays, eye drops and antihistamines, those who rely on allergy shots should continue to get them, the doctors said.

Given the number of people infected with the coronavirus who are asymptomatic or only mildly affected, Byrne said, he allows only one patient in his office at a time and performs drive-up allergy injections in his building’s rear parking lot, where he administers the shot through the car window.

Patients must wait after receiving shots to be observed for adverse reactions, he said.

Ponda said her office has lengthened the intervals between injections for those who rely on them to control their symptoms, while first screening patients, taking temperatures, wearing protective equipment and keeping patients socially distanced in the waiting rooms.

She said that some allergy sufferers experience a worsening of their symptoms near the end of pollen season, after prolonged exposure to the allergens, but that symptoms ease as the pollen dissipates.

That is, of course, if they are not also allergic to the grass pollens or pollens from plants like ragweed that follow.

Ponda said that according to the Centers for Disease Control and Prevention, in the past 12 months 7.7% of the U.S. population had nasal hayfever-type allergic symptoms, while skin testing showed 12% of the population had allergies, including some that presented as skin issues. 

Ponda said that while middle-aged people and especially women after childbirth could develop allergic symptoms, most people will have experienced symptoms for much of their life.

“It is not impossible, but if you have never had allergies throughout your life, you do have to think of other things as cause for the symptoms as well,” she said.

Allergies vs. COVID-19

  • Some allergy symptoms can overlap with symptoms of COVID-19, including runny nose, sneezing, coughing, itchy red eyes, fatigue and shortness of breath.
  • Fever is a symptom of infection, not allergies. If fever or body pain are present, assume you are not having allergy symptoms.
  • Wearing a face mask outdoors can help prevent pollen from getting into your nose and mouth and help ease symptoms.
  • Consult a doctor if your child has a rash or hives. And call a doctor if your allergy symptoms are not mild or responding to usual treatments, or if you’ve never had allergy symptoms before.

Points to remember

  • Spring is tree pollen season, while grass pollens appear in June through August.
  • Weed pollens from plants like ragweed appear from mid-to-late August through October.
  • Continue with allergy shots if you rely on them, but if you have recovered from a COVID-19 infection you may have to wait before resuming them.

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