Is it a cold, sinus infection or allergies? How to tell the difference

It can be tough to tell the difference between a cold, a bacterial sinus infection and allergies. In fact, that’s probably one of the questions people ask doctors most frequently in this country. There’s a lot of confusion about what the signs are for these conditions—from patients and their doctors alike.

Recognizing the variations between these three conditions is important. The treatment strategies for a cold are unlike those for a bacterial sinus infection. And treatment for allergies is different still than treatment for the other two.

Let’s go through the symptoms that people often are confused about, as well as the process of deciding which condition a patient may have and what we need to do about it.

Common symptoms of colds, sinus infections and allergies

Many people have been told that the following symptoms are signs of a bacterial sinus infection as opposed to a cold:

  • Facial pain and headache
  • Discolored mucus or sinus drainage
  • Severe nasal congestion
  • Fever (usually above 101 degrees)

But in reality, these symptoms don’t help us distinguish one condition from the other, at least in the first week to 10 days. Generally speaking, all of the “classic” symptoms of a sinus infection can be present in a cold.

 

All of the “classic” symptoms of a #sinusinfection can be present in a cold. via @MedStarWHC

If you’ve had these symptoms for fewer than seven to 10 days, they’re almost certainly signs of a cold virus. When people have these symptoms for more than seven to 10 days without improvement, that’s when we start thinking it might be a bacterial sinus infection. It is also very unusual for a cold, or other viral upper respiratory illness, to worsen after five days. This suggests a transition to a bacterial process. This is important because antibiotics should only be used when a bacterial process is suspected.

The symptoms of allergies don’t normally include fever or a lot of discolored sinus drainage. Classic allergy symptoms may include:

  • Cough
  • Nasal congestion/stuffiness
  • Itchy ears
  • Itchy, watery eyes
  • Runny nose, usually clear
  • Scratchy or low-grade sore throat
  • Sneezing

Some of these are similar to cold or sinus symptoms. The difference is that allergy symptoms don’t follow the course of a cold, which runs through its symptoms as the cold progresses. Allergy symptoms are more consistent than cold symptoms. There is often a pattern to the symptoms related to a change in the indoor or outdoor environment (seasonal changes, exposure pets, mold, etc.).

But people with chronic allergies over long periods of time may not have these symptoms, especially adults. These patients are more likely to have nasal congestion and post-nasal drip, much like the symptoms of a “chronic sinus infection.” Like many illnesses or life stresses, allergies can also be associated with significant fatigue.

If you have sinus infections frequently or you have chronic (persistent or long-standing) upper-respiratory symptoms, it’s often tempting to think you know what’s wrong based on the symptoms. It can be easy to mistake one condition for another if all we go on are the symptoms.

Somebody might treat “bad allergies” for months and months because of nasal congestion or blockage on one side and not get any better. Eventually, this person could find that they have a persistent sinus infection, or far less likely, a nasal tumor or some other serious condition.

Related reading: The top 3 symptoms mistaken for allergies

In general, if you have unexplained symptoms that last more than two or three weeks, talk to a doctor. It doesn’t necessarily have to be a specialist like me first. You certainly could start with your primary care doctor whenever possible.

Talk to one of our doctors about your symptoms and what the right treatment options are.

Taking the right medication for the right illness

The best thing to do for cold or sinus symptoms during the first seven to 10 days is to treat the symptoms, not the illness. You can do this with medications such as:

  • Cough medicine
  • Decongestant or saline spray for nasal congestion
  • Pain reliever

Cold viruses don’t respond to antibiotics, so taking them during the first seven days probably won’t help. In fact, taking antibiotics when they’re not needed can increase your risk for being infected with antibiotic-resistant bacteria, or other serious antibiotic related problems.

After seven to 10 days, when the symptoms are more likely to indicate a sinus infection, it may be time to ask your doctor about antibiotics. However, sinus infections can and do sometimes go away on their own, just like colds. Ask your doctor if you need an antibiotic or if the infection is likely to go away on its own without medication.

If your symptoms point to allergies, many effective medications are available over the counter to control symptoms, such as antihistamines and nasal steroid sprays. These medications work on all sorts of allergies because they suppress the body’s reactions to allergens, rather than treating the specific allergen. Some antihistamines can cause drowsiness, however, so be cautious of that when taking them. They also do not help stuffiness or pressure symptoms, so adding a decongestant plus a pain reliever as needed can help you “ride it out.”

Avoiding what ails you

Of course, the best option would be to not get sick in the first place if possible. You can help your immune system fight off viruses and infections by doing the following:

  • Get enough sleep. Most adults need at least seven hours of sleep per night.
  • Maintain a healthy diet and weight. Diets high in fruits, vegetables and whole grains and low in saturated fat are best.
  • Drink plenty of fluids (alcohol and caffeine don’t count)—dryness is the enemy of a healthy respiratory system.
  • Stop smoking. Smoking lowers the body’s immune response and makes it more vulnerable to viruses, as well as much more serious risks. Our Pulmonary Services team offers smoking cessation services if you need help to quit smoking.

Minimize your risk for catching cold viruses by avoiding people who have colds. If you have to be around them, try not to touch them without washing your hands immediately afterward. This can eliminate cold viruses before they cause sickness. If you have a cold, try to avoid close contact with other people for a few days to minimize the chance of them getting sick. If you must be around others, cough or sneeze into your elbow instead of your hand to reduce the virus’ spread.

Bacterial sinus infections aren’t contagious, so you don’t have to worry about being around someone who has one. However, the general tips listed above can help the body better fight off the bacteria that cause sinus infections before you get sick.

As for allergies, it’s a good idea to avoid known allergens if possible. Sometimes that’s not practical. Make sure to follow your doctor’s advice for reducing or eliminating your allergy exposure, and use allergy medications to keep symptoms under control.

It’s easy to mistake the symptoms of a cold for those of a sinus infection or vice versa. And it’s tempting to think we know what’s wrong with us based on how we’ve felt before. Be patient, and talk to your doctor about your symptoms. A little caution and the right plan can help you feel better fast—without taking medication you don’t need to treat an illness you may not have.

Dr. Lester is an ear, nose and throat specialist at MedStar Washington Hospital Center. He and his colleagues treat all general Ear, Nose and Throat issues, including ear procedures like Eustachian tube repairs, nasal disorders like obstructions and polyps, and throat problems, like viral infections. They also treat balance disorders and vertigo, thyroid and parathyroid disorders, hypothyroidism, thyroid cancer, nasal tumors, sinusitis, loss of the sense of smell, sinus diseases, hearing loss, goiters and allergies.

View Profile