MARCH | APRIL 2019 39 I f you have ever wondered whether your symptoms of runny nose, sneezing, and congestion are due to the “common cold,” environmental allergies or even sinusitis, you are not alone. Because these three conditions have overlapping features and may occur either simultaneously or sequentially, even trained medical professionals can find it challenging to diagnose and manage these common problems. The following discussion is not intended to take the place of advice from your physician or advanced practice clinician but may be useful in guiding your decisions to seek medical attention for these annoying problems. FEATURES DISTINGUISHING COLDS, ALLERGIES, & SINUSITIS As outlined in the table below, there are a number of features shared by colds, allergies, and sinus infections. Some important distinctions and additional information to keep in mind: • Common terms for seasonal allergies (“hay fever,” “cedar fever”) are misleading. Allergies do not actually cause fever. • Allergies usually involve some degree of itch. Infections (both viral & bacterial) usually cause more pain. • Colds are caused by viruses that are easily transmitted between people. Neither allergies nor sinus infections are contagious. • Thick nasal drainage is an effect of the natural immune responses involved in allergies, viral, and bacterial upper respiratory tract infections. In other words, “snot” does not equal “bacterial sinusitis.” • Antibiotics are indicated to treat bacterial infections—not viruses or allergies. So if you can convince your doctor to prescribe antibiotics on day #4-7 of a common cold, you will feel better in about 7 days. If not, you’ll feel better in 1 week. Antibiotics won’t help. WHAT YOU CAN DO FOR YOURSELF: • Saline is your friend! Daily use of saline sprays and rinse systems sold at your local pharmacy (e.g., Simply Saline, NeilMed, Neti Pot) are very helpful in clearing the nose of allergens and thick secretions. None of the available OTC or prescription medications (e.g., antihistamines, decongestants, antibiotics) can mechanically clear the nose and sinuses. • Antihistamines help relieve runny nose and itching. Older antihistamines (e.g., Benadryl™, Chlor-trimeton™) cause considerable sedation and thus are not ideal for daytime use. Newer, non-sedating antihistamines (e.g., Claritin™, Allegra™, Zyrtec™) are somewhat less potent in relieving runny nose and itch but are more appropriate for daytime use. • Decongestants may be added judiciously. Oral decongestants (e.g., Sudafed™) and nasal decongestant sprays (e.g., Afrin™) offer substantial relief of congestion, but potential side effects (e.g., aggravation of high blood pressure associated with oral decongestants; worsening of congestion with prolonged use of nasal decongestant sprays) limit the use of these medications. • Nasal corticosteroid sprays help when used routinely. Flonase™, Rhinocort™, and Nasacort™ are now available OTC. Like other medications that were at one time available only by prescription, the package instructions recommend limiting use to 2 weeks. In truth, these medications are generally safe for daily use, but it would be wise to seek medical attention to support extended periods of use to manage chronic allergic inflammation of the nasal passages. STILL BOTHERED BY SINONASAL SYMPTOMS OR UNSURE OF THEIR CAUSE? • Schedule an appointment with your primary physician or advanced practice clinician for additional evaluation and treatment recommendations. • Find an Allergist. Find Relief™: allergist Editor’s Note: Dr. Robert Sugerman specializes in allergic respiratory disorders, food allergy, and primary immunodeficiency. He can be reached at Allergy Partners of North Texas. FEATURE TIME OF YEAR Mostly September-April FEVER ITCHY EYES/NOSE PAIN DRAINAGE CONTAGIOUS Seasonal to year-round Anytime, usually after a cold or seasonal allergies DURATION 7-14 days Days to weeks or months Weeks to months Common Never Very rarely No Common No Common Variable Common Highly No No Clear x 3-4 days followed by thick yellow-green x 7-10 days Predominantly clear, may become thick when prolonged Predominantly thick yellow-green to brown, but occasionally just clear COMMON COLD ALLERGIES SINUSITIS