Is It Pollen, Or Is It COVID?

It’s a gorgeous spring day in May. Trees are flowering, flowers are flowering, and I can’t go a day without antihistamines.

I suffer from springtime pollen allergies and asthma, common things that can cause congestion and a cough. This has been anxiety-provoking for me at times, as it has been for many of my patients, as we all have our sneeze attack moments and we wonder:

Is it allergies, or is it COVID-19?

Yup, at least a few times since mid-March, I’ve been all snug in bed, drifting off to sleep, when suddenly I sniff or cough and my itchy eyes pop open and I worry: What if it’s the virus? What if I’ve been downplaying my symptoms and I’m going to work and spreading infection? OMIGOD OMIGOD

If I’m lying awake at nighttime wondering, you can bet a lot of other people are as well. If you do a search on “Allergies vs COVID” you’ll get alot of hits, including this excellent article by my colleague over at Harvard Health Blog and a very nice overview at Self magazine. And a hundred more.

Soooo this is an issue. What do we need to know in order to reassure ourselves and be able to fall asleep?

Well, let me tell you through story. Back in mid-April, I went on a run through town. I came upon these beautiful flowering trees, as well as many many more:

When I got home, I was stuffy and sneezey and wheezy and my eyes were itchy, really itchy. Soon, they were so itchy I wanted to scratch them out of my head. I rubbed them so much– I could NOT help myself– and developed swollen blebs in the whites of my eyes (AKA conjunctival chemosis, which is pretty gross to look at):

This has happened before, and no over-the-counter allergy eye drop really works once I get to this point. Nope, this involved a call to the ophthalmologist, who scheduled a video tele-visit same-day, and without much ado, prescribed steroid eye drops. Good old ophthalmic prednisolone. Love.

I only needed the steroid eye drops for a day or two, then I switched to over-the-counter ketotifen eye drops, which is basically a prescription- strength antihistamine for your eyeballs. I also started taking double antihistamine pills, meaning something non-drowsy for daytime (like loratadine, AKA Claritin) and something sedating for nighttime (like diphenhydramine, AKA Benadryl). And a nasal steroid (like fluticasone, AKA Flonase). And using my inhalers.

I go into these details because everything I experienced is everything you need to know. If you have some mild congestion or cough, and you also have itching of the eyes or nose or inner ears or throat, this makes your symptoms more likely to be due to allergies. Itching is a very allergic symptom. If you have all that and it responds to these over the counter measures– the ketotifen eye drops, fluticasone (or other nasal steroid) nasal spray, and a cocktail of antihistamines, then it’s probably allergies. If this happens to you every spring then it’s probably allergies.

BUT. Here’s the big but. Early on in the infection, COVID-19 symptoms can be quite mild. So if you don’t usually suffer from allergies, call your doctor. I’ve gotten this call oh, about a million times this spring, pollen being especially heavy this year, of course, seeing as we’re in the midst of a respiratory virus pandemic. Of course it’s also got to be a bad year for allergies.

AND if you have a fever, especially a high fever (like, over 101 degrees), or chills, or flu-like body aches, or a violent cough, shortness of breath, severe fatigue, diarrhea, or a mysterious loss of smell and taste, or a combination of all of these, then please call your doctor and seek consultation and care (and seriously, testing for COVID-19, too).

If you’re pretty sure you have allergies but you can’t shake your cough you may have a bit of asthma as well. In normal times, I’d suggest that you call your doctor so they can listen to your lungs and see if you have any wheezing, especially on a forced expiration breath. Nowadays, primary care doctors can’t easily bring patients into clinic for this sort of simple assessment, but they might prescribe an albuterol inhaler to trial. If it helps with the cough it’s probably some mild asthma.

Basically, when in doubt, call your doctor, of course. But sometimes, the answer to Is it pollen or is it COVID-19? is pretty straightforward.