DEAR MAYO CLINIC: Every year I am plagued by springtime allergies. But in the last few weeks I have been experiencing congestion, runny nose and a persistent cough. How can I determine whether this is a cold, allergies or something more? When should I seek medical care?

ANSWER: As the seasons shift, it can be harder to distinguish between the symptoms of the common cold, COVID-19, the flu and allergies, since all can have similar symptoms. This can lead to confusion as to when to seek medical care.

COVID-19 is caused by SARS-CoV-2, and the flu comes from a strain of the influenza virus. The common cold most often is caused by rhinoviruses. These viruses all spread in similar ways — by tiny particles that originate from the lips and nose when a person sneezes, coughs, sings or touches a surface. For instance, germs can get picked up from a surface —like a phone or computer keyboard — and then be transmitted into the mouth, nose or eyes.

The most common symptoms of COVID-19 are fever, cough and tiredness. But there are many other possible signs and symptoms, which may include sore throat, runny or stuffy nose, diarrhea, nausea or vomiting. Most colds will not include diarrhea, nausea or vomiting. And fever is rare with the common cold.

Allergies, on the other hand, are not caused by a virus but rather by immune system responses triggered by exposure to allergens, such as seasonal tree or grass pollens. Sneezing and runny noses are two symptoms of allergies. Itchy skin, a scratchy nose or eyes, and tearing eyes also might potentially be symptoms of an allergy.

Timing of your symptoms and duration can help you determine what is ailing you.

While COVID-19 symptoms generally appear two to 14 days after exposure to SARS-CoV-2, symptoms of a common cold usually appear one to three days after exposure to a cold-causing virus. And as far as duration, typically, a cold or virus will run over 10 days to two weeks. Many patients who have been recently diagnosed with COVID-19 are continuing to report symptoms that are lasting several weeks and months.

If you know you have allergies, the best way to prevent issues is to avoid your known triggers. If you're allergic to pollen, stay inside with windows and doors closed when there's a lot of pollen in the air. If you've been outside, take a cool shower and change clothes. Avoiding your known triggers is the best way to prevent issues once you come indoors. And stay on top of allergy medications. Allergies usually abate when you avoid a trigger and take allergy medications, such as antihistamines or nasal sprays.

If you are experiencing certain symptoms, however, such as a cough that lingers or congestion and sinus pain, it may be worthwhile to connect with your primary care clinician to rule out whether you may have another condition, such as a sinus infection or bronchitis. Colds are the main cause of acute sinusitis. Most episodes resolve in about a week to 10 days, but if you have ongoing bouts of congestion and face pain, you could have chronic sinusitis. Multiple treatment options are available, including over-the-counter allergy medication, nasal sprays, steroids and antibiotics. If allergies are causing your symptoms, you also could benefit from visiting with an allergist to see if additional medical therapy is available.

Seek immediate medical attention if you are coughing up blood, experiencing pain or have shortness of breath. — Compiled by Mayo Clinic staff

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Related Articles 

• Mayo Clinic Q and A: Is it allergies or a sinus infection? published 3/14/23
• How to prevent flu, RSV and COVID-19 during busy holiday season published 12/19/22
• Consumer Health: Why flu vaccination is more important this year than ever published 12/8/22
• Early increase of flu, RSV viruses affecting children — when to seek medical help published 11/10/22
• Cold, flu or allergies? Overlapping symptoms make it a challenge to know when to seek medical care published 9/21/22
• Mayo Clinic Q and A: Springtime allergies published 5/11/22
• Mayo Clinic Q and A: Myths about catching a cold published 2/10/22

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DEAR MAYO CLINIC: I have had allergies since childhood, suffering during both the spring and fall seasons. This past month, however, I am experiencing more congestion and mucus, and I even have some facial pain. I’m beginning to wonder if my symptoms are really from allergies or if they may be caused by a sinus infection instead. How can I tell the difference?

ANSWER: Allergies and sinus infections often are mistaken for one another. But they are two separate conditions. By paying close attention to the specific symptoms you have, you can usually identify which one is more likely to be causing the problem.

When someone has allergies, it means their body is negatively reacting to allergens, such as pollen, dust mites or pet dander. This reaction happens when the immune system releases certain substances, such as histamine, into the bloodstream. This leads to allergy symptoms, which may include itching, sneezing, sinus pressure, nasal congestion and discharge. Although allergies can produce many of the same symptoms as a sinus infection, the condition is different.

A sinus infection, also called sinusitis, affects the cavities around your nasal passages. The infection causes your sinuses to become inflamed and swollen. The swelling makes it hard for your sinuses to drain, and mucus builds up. You become congested and have trouble breathing through your nose. Sinusitis often causes thick nasal discharge. In addition, you may experience headaches as well as pressure around your eyes, cheeks, nose or forehead. Though more uncommon, cough and a sore throat can accompany sinusitis, too.

One of the telltale signs to discern if you have allergic rhinitis or a sinus infection is if you have itchy, watery eyes along with other symptoms. Itchiness is rarely a symptom of a sinus infection. Contrary to popular belief, the color of your mucus does not help tell the difference between allergies or sinus infections.

Given that you have noted seasonal allergies, pay attention to the timing of your symptoms. This also may help decide if they likely are caused by allergies. For example, tree pollen is most common in the spring. Grass pollen is common in late spring and early summer, while ragweed pollen is prevalent in the fall. Mold and fungi spores are usually more plentiful in warm-weather months. Of course, the seasons may be different, depending on the region of the country where you live.

Finally, medication response also can help you determine if you need additional medical care. For allergies, over-the-counter medications, such as antihistamines, can be quite effective in relieving allergy symptoms, particularly itching and a runny nose. You also may try adding an over-the-counter nasal corticosteroid daily to help with allergy symptoms. These nasal sprays help prevent and treat nasal inflammation and congestion, especially if you have seasonal allergies and use them just as the allergy symptoms begin.

If you suspect your nasal congestion and other symptoms are the results of sinus problems rather than allergies, you just may need to be patient. In most cases, viruses cause sinusitis. These viral infections usually go away on their own within a week to 10 days. Self-care measures, such as extra rest and fluids, saline sinus rinses, and over-the-counter pain relievers and decongestants, can help. But if symptoms are persistent or severe, antibiotics may be needed to treat the infection.

If your symptoms are increasing, do not improve with current therapy or last for more than two weeks, you could benefit from a visit with your primary care clinician or an allergist. There are other options to help alleviate symptoms and address ongoing allergies or recurrent sinusitis. — Dr. Jacqueline Squire, Allergy and Immunology, Mayo Clinic, Jacksonville, Florida

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Related Articles 

• Mayo Clinic Q and A: Sinusitis and treatment options published 10/2/22
• Mayo Clinic Minute: How to get hay fever relief from fall allergies published 9/27/22
• Mayo Clinic Minute: How to manage hay fever allergy symptoms published 5/4/22
• Mayo Clinic Minute: How to get spring allergy relief published 4/8/22

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Rebecca Bough had resigned herself to the fact that the chronic stuffiness and decreased senses of smell and taste she'd been living with were never going to go away. But then a Mayo Clinic care team helped change all that.

As she lay in the bathtub of a New York City hotel room — trying to keep the sound of her coughing from waking her husband while trying to get some sleep for herself — Rebecca Bough wondered if this was what her life had now become.

Rebecca's health issues had begun about a year and a half before with what she calls "chronic stuffiness" that made her sound like she always had a cold. Her symptoms had stumped eight doctors in her home state of Arkansas. Each told her she was suffering from allergies or a heightened case of asthma. And they'd each prescribed medications in an effort to bring her some relief. "But it would only work for a day or two," Rebecca says.

Meanwhile, Rebecca's symptoms progressed to a point that they were doing more than just mimicking the sound of a cold. "I eventually lost my sense of smell and also had a decreased sense of taste," she says.

Worse, though, was the coughing. "Over time, it started to reduce my quality of life," Rebecca says. "I started coughing day and night, and that led to social life changes of no longer being able to go out to dinner with my husband, be around friends or exercise. I would get headaches often, and the coughing would become so intense that it would cause me to fracture my ribs on several occasions."

As painful and difficult as the situation was for Rebecca, she wasn't the only one suffering from the effects of her symptoms. "It made it hard for others to be around me," she says. "It especially made it hard for my husband to sleep at night because I'd cough for several hours straight."

During that night in the hotel room in New York City, after she pulled herself from the bathtub, Rebecca walked over to a window and stared out at a city filled with millions of people going about their normal lives. She wished more than anything that she could be one of them. "I remember thinking, 'Am I the only one in the world with this problem?'" Rebecca says.

Pinpointing the problem — and the solution

Determined to have that question answered, Rebecca decided to take her health into her own hands by scheduling an appointment at Mayo Clinic. But she admits that she was worried.

"I was scared they were going to tell me all of the same things I'd heard before," Rebecca says. "That it was allergies or asthma, and that there was nothing they could do to help me."

Within a few minutes of sitting down with pulmonologist Vivek Iyer, M.D., at Mayo Clinic's Rochester campus, however, Rebecca says all of that began to change. "He did a very thorough examination and suspected I was suffering from a severe case of rhinosinusitis, as well as severe, persistent asthma," Rebecca says.

"They went over everything, outlined the pros and cons, and after examining me and looking at my test results, said I'd be a good candidate for (sinus surgery)."

Rebecca Bough

Dr. Iyer prescribed a new asthma medication that would allow Rebecca to stop taking the oral steroids she'd been on. He also recommended she consult with an otorhinolaryngology specialist for further evaluation. Soon after, Rebecca met with Garret Choby, M.D., and Linda Yin, M.D., in Mayo Clinic's Department of Otorhinolaryngology. The two physicians not only confirmed Dr. Iyer's preliminary diagnosis, but they let Rebecca see it for herself.

"They put a camera in my sinuses, so that I could see exactly what was going on and exactly what the problem was," Rebecca says.

More than that, though, they told Rebecca exactly how they would fix it. "They both recommended endoscopic sinus surgery," Rebecca says. "They went over everything, outlined the pros and cons, and after examining me and looking at my test results, said I'd be a good candidate for it."

Living and breathing easily again

"When I first saw Rebecca, she was, honestly, pretty miserable," Dr. Choby says. "She was suffering from severe nasal polyps. Like many other patients with nasal polyps, she also had significant inflammation in her lower airway and her lungs. In combination, these were contributing to her chronic cough, asthma, and decreased senses of smell and taste."

A CT scan revealed that Rebecca's sinuses also were blocked completely on both sides. "In light of this, we recommended endoscopic sinus surgery, so that we could not only remove the polyps but also maximally widen her sinus openings," Dr. Choby says. "This allows for optimal sinus drainage and improved delivery of the topical medications she'd need after surgery, which are one of the most important parts of the surgery from our standpoint."

"My entire patient experience from start to finish was wonderful, and I now know firsthand why Mayo Clinic was recently named the best hospital in the world."

Rebecca Bough

Given all she and her loved ones had been through to that point, Rebecca readily agreed to the recommendation and scheduled the surgery with Dr. Choby for the following morning. Once the surgery was complete, Rebecca says it didn't take long for her to realize she'd made the right decision.

"I felt better immediately after the procedure. Even better, I can now taste food again, my headaches are gone, and my sense of smell is also starting to come back," Rebecca says. "My entire patient experience from start to finish was wonderful, and I now know firsthand why Mayo Clinic was recently named the best hospital in the world. My only regret is that I didn't make an appointment sooner."

HELPFUL LINKS

• Learn more about nasal polyps and chronic sinusitis.
• Check out the Department of Otorhinolaryngology (ENT)/Head and Neck Surgery.
• Connect with others talking about chronic sinusitis on Mayo Clinic Connect.
• Explore Mayo Clinic.
• Request an appointment.

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• Drink fluids.
  Water or juice will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, as they can be dehydrating. Drinking alcohol can also worsen the swelling of the lining of the sinuses and nose.
• Moisten your sinus cavities.
  Drape a towel over your head as you breathe in the vapor from a bowl of hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
• Apply warm compresses to your face.
  Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
• Rinse your nasal passages.
  Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses. If you make your own rinse, use water that's contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water and leave open to air-dry.
• Rest.
  This will help your body fight infection and speed recovery.
• Sleep with your head elevated.
  This will help your sinuses drain, reducing congestion.

Take these steps to help reduce your risk of getting acute sinusitis:

• Avoid upper respiratory infections.
  Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals.
• Manage your allergies.
  Work with your health care provider to keep symptoms under control.
• Avoid cigarette smoke and polluted air.
  Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.
• Use a humidifier.
  If the air in your home is dry, such as it is if you have forced-air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

When to see a health care provider

Most people with acute sinusitis don't need to see a health care provider but you should seek medical care if you have any of the following:

• Symptoms that don't improve in a few days or worsen
• A persistent fever
• A history of recurrent or chronic sinusitis

You may have several episodes of acute sinusitis, lasting less than four weeks, before developing chronic sinusitis.

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

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How sharing kindness can make you healthier and happier
Research shows that learning and practicing loving kindness can profoundly affect your attitude, outlook and health. It also can rewire your brain to be more present. These three simple practices will get you started.

EXPERT ANSWERS
What treatments are available for sensitive teeth?
When you have sensitive teeth, certain activities, such as brushing, eating and drinking, can cause sharp, temporary pain in your teeth. Sensitive teeth are typically the result of worn tooth enamel or exposed tooth roots. Sometimes, however, tooth discomfort is caused by other factors, such as a cavity, a cracked or chipped tooth, a worn filling, or gum disease. Learn about treatment options for sensitive teeth from Dr. Thomas Salinas, a Mayo Clinic prosthodontist.

Is ear candling a safe way to remove earwax?
Ear candling involves placing a lit, hollow, cone-shaped candle into the ear canal. Research shows that ear candling is ineffective at removing earwax and instead can push earwax deeper into the ear canal. Learn more from Dr. Charles Beatty, a Mayo Clinic otolaryngologist.

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Health-boosting nutrients
Antioxidants, such as vitamin C, vitamin E and carotenoids, may protect cells from damage caused by free radicals. Other naturally occurring antioxidants include flavonoids, tannins, phenols and lignans. Plant-based foods are the best sources, including fruits, vegetables and their juices; whole-grain products; nuts; seeds; herbs and spices; and cocoa.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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Myth or Matter-of-Fact: You can tell whether or not you have sinusitis by the color of your mucus discharge.

Listen to the program on Saturday, March 26, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

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Myth or Matter-of-Fact: You can tell whether or not you have sinusitis by the color of your mucus discharge.

Listen to the program on Saturday, March 26, at 9:05 a.m. CDT.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

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July 22, 2011

Dear Mayo Clinic:

Can doctors tell if a sinus infection is bacterial or fungal? I've heard that some chronic infections can be related to a fungus.

Answer:
Using lab tests, doctors can differentiate between a sinus infection that's caused by bacteria and one caused by fungus. Most acute sinus infections aren't caused by fungus. Sometimes, they're due to bacteria. More often, though, they result from viruses, like those that cause colds or other respiratory tract infections. Fungal sinus infections are rare and are mainly seen in people whose immune systems aren't working normally, such as those who have had chemotherapy or an organ transplant.

The second part of your question about chronic infections being associated with a fungus is actually related to another topic: chronic sinusitis. Some people who have sinus symptoms, such as a stuffy nose, nasal drainage and a decreased sense of smell, assume they have a sinus infection. If the symptoms appear after a cold, that may be true. An infection caused by bacteria, can often be effectively treated with antibiotics. Viral infections typically go away without treatment. And once an infection is gone, symptoms usually fade. But if nose and sinus symptoms persist longer than 12 weeks, the condition is classified as chronic sinusitis. Probably what you've heard about is that some research has linked chronic sinusitis to fungus.

Doctors used to believe that chronic sinusitis was a bacterial sinus infection that couldn't be effectively treated. But then it was found that steroids — medications used to reduce inflammation — could temporarily clear sinusitis even in patients who didn't take antibiotics. Because steroids won't usually clear an infection, the logical conclusion was that, more likely, the problem was something causing inflammation in the sinuses.

The key question is: What drives the inflammation of chronic sinusitis? Various causes have been proposed, including allergies, irritants, an immune reaction to fungus, a reaction of the immune system against a toxin made by bacteria, and persistent inflammation of bone.

What you've heard about fungus being related to sinusitis is likely due to research done at Mayo Clinic that started more than 10 years ago. That research pointed to the possibility that, in some people, a fungus in the air may lead to chronic sinusitis. These people appear to have a change in their immune systems — possibly triggered by a previous cold or other respiratory infection — that causes part of their defense system, called eosinophils, to attack the fungus.

Eosinophils are one of the major types of disease-fighting white blood cells. Eosinophils usually attack parasites and aren't usually active when your body is fighting a viral, bacterial or fungal infection. But for reasons that are still under investigation, in some situations the body's immune system is altered slightly, and a certain protein in the fungus appears to the immune system to be just like a parasite. So, eosinophils attack it. Actually, the 'problem' is just a mild-mannered fungus that most people have no reaction to when they breathe it in. But the resulting immune response in the people who are affected can cause the inflammation and symptoms of chronic sinusitis.

If you have chronic sinusitis, no matter what the underlying cause, treatment is available to relieve symptoms. For example, saline nasal spray may be used to rinse nasal passages and decrease the presence of triggers. Nasal corticosteroid sprays can be helpful in reducing inflammation. When sinusitis is severe, oral or injected corticosteroids may be necessary to decrease symptoms. It is also possible to get a bacterial infection on top of the inflammation, and that can be treated with antibiotics.

If you have ongoing sinus symptoms and suspect chronic sinusitis, see your doctor for an assessment of your condition and a treatment plan that fits your situation.

— John Pallanch, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

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