Caitlin Whyte (Host):  In today’s world, with every sneeze, cough or tickle of the throat; many people wonder, do I have COVID? For the millions of allergy sufferers around the country, this question becomes a little more complex. Allergies, or COVID or perhaps, cold or flu. Well, today, we’re going to break down all of these ailments with similar symptoms with Dr. Sara Narayan, an Allergist with
Allergy West affiliated with Emerson Hospital. This is Healthworks Here. I’m your host Caitlin Whyte. Dr. Narayan, I’m actually so happy we’re discussing this topic because I truly have self-diagnosed as having COVID so many times in the last six months. So, let’s jump right into it. How can I tell if I have allergies or COVID or something else?

Sara Narayan, MD (Guest):  Yeah, so I think that’s sort of one of the big questions these days. I think first of all, everybody’s heard so much about COVID-19 and we’re sort of in the midst of our fall allergy season and so I think a lot of people have that same question. COVID-19 is a contagious respiratory virus. It’s caused by an infection with the new coronavirus and seasonal allergies are caused by an abnormal immune response to things in our environment. And so seasonal allergies are typically triggered by airborne pollens that lead to allergy symptoms. Classic allergy symptoms include stuffy, runny nose, sneezing, itchy, watery red eyes and post nasal drip. And COVID-19 and seasonal allergies share many symptoms but there are also some key differences.

Some symptoms that are definitely more common with COVID-19 include fevers, chills, muscle and body aches, new loss of taste or loss of smell, nausea, vomiting, diarrhea. Whereas some symptoms that are more common with seasonal allergies include itchiness. Itchy eyes, watery eyes, itchy nose and a lot of sneezing. And there are also some symptoms that can be found with both viral illnesses such as COVID-19 and seasonal allergies. And some of these common symptoms can include coughing, shortness of breath, difficulty breathing, fatigue, headaches, sore throats, congestion, or stuffy nose and runny nose.

And so one of the things about fatigue is that with viral illnesses and in particular COVID-19, the fatigue tends to be much more intense. It tends to be much more rapid onset. Whereas fatigue that we often see with seasonal allergies tends to be a little bit more subdued, a little bit more mild, it tends to be more of a gradual onset as the pollens increase throughout the season. Typically, allergies don’t cause fever, don’t cause chills, don’t cause significant body aches, whereas typically COVID-19 we don’t see the itchiness, the watery eyes, the sneezing. Coughing, shortness of breath are common symptoms of both allergies and COVID-19 and so although they are not actually allergy symptoms, many people with seasonal allergies also have asthma and asthma is often triggered by allergies. And allergic asthma can cause coughing and wheezing and shortness of breath especially with allergy flares.

So, another sort of point other than those specific symptoms, is that most people with allergies have a prior history of allergy symptoms. Often during specific times of the year and so this history can be really helpful in differentiating some of these similar symptoms as well. So, if you know that you have a history of allergies in the fall; and you’re starting to have similar symptoms that you’ve had in the past and especially during a similar time; then I think it’s easy to say that those are most likely related to your allergies. Although truly people can develop new allergies at any time and so just because you don’t have a history of allergies in the past, doesn’t 100% rule out allergies.

One other point to make is that also allergy symptoms often respond well to allergy medications. And so, typically using different allergy antihistamines, different nasal steroid sprays, allergy eye drops are very effective often in treating allergy symptoms. That’s not always the case, sometimes allergy symptoms do not respond like we want them to or like we hope they will. But often, they do and so I think that response to allergy medications can be a really good clue as well.

Host:  Now I sneeze, and my nose runs a lot during the fall and spring seasons anyways, should I be concerned that I might have COVID?

Dr. Narayan:  So, I guess what I would say about that is that if you have seasonal allergy symptoms and your symptoms are consistent with your typical symptoms; you really shouldn’t be concerned about COVID. I think if you have an action plan from either your allergist or from your physician, I think it’s important to follow that action plan. I think it’s important to help control your allergy symptoms as well as you can not only so that you’re feeling well, you can function well, you’re not having disruptive symptoms but also that so that there isn’t that confusion about are these symptoms related to coronavirus which is what so many of us are thinking about at this time. However, if your allergy symptoms aren’t responding to your typical treatments or if you’ve developed other symptoms such as the fever, the chills, the sore throat, the significant body aches, loss of sense of smell, vomiting or diarrhea; then you should let your physician know and consider getting tested or at least talk to them about sort of what the next steps would be.

Host:  Is it possible to have COVID and regular allergies at the same time?

Dr. Narayan:  Absolutely. I mean people – a lot of people have allergies but people with allergies can get sick as well.  People with allergies can get viral infections. If you develop any of the symptoms that we just spoke of such as the fever, the chills, the sore throat, the significant body aches, the loss of sense of smell; I think it’s really important to contact your physician and talk with them about what the next steps would be. If you have been exposed to someone with some of those similar symptoms, that would be concerning for COVID or if you have been exposed to someone that has had a positive test for COVID in the recent past; then I think that’s another reason to contact your physician. Different steps could be an office visit in-office, a Telehealth office visit, possibly obtaining a COVID test but I think that would be a – those next steps would be really important to talk to your physician to make sure that you’re being evaluated appropriately.

Host:  So, if I’m feeling all of these symptoms, how can I tell if I should be tested for allergies or COVID?

Dr. Narayan:  So, in terms of testing for COVID, I think it’s important to – if you have any of those concerning symptoms that we’ve mentioned a number of times, the fever, the significant coughing and shortness of breath, the loss of smell, the significant body aches; if you have been around a known COVID positive person or someone else was sick symptoms; I think it’s important to contact your primary care, consider having  a COVID test if they think it’s appropriate, definitely quarantine yourself so that you’re preventing exposure to others.

In terms of allergy testing, if you have a history of allergy symptoms or if you have new symptoms that are consistent with possible allergies then testing can definitely help provide some concrete information and confirm allergies and help to guide treatment. Allergy testing is simple. It’s fairly quick. Most of the time, when we do allergy testing; we do something called a scratch test or a prick test which can be done in our office. Sometimes, we’ll do a test called an ImmunoCAP or a blood test looking for allergy antibodies called IGE to different environmental allergens. But the scratch test is generally our go to test. And so that is fairly easy to get scheduled in our office in order to have that testing done. People do need to be off antihistamine medications for a week beforehand. But typically, we do small little scratches on the skin with the allergen extracts for each of the specific allergens that we’re looking for. And within about 15 minutes, we can tell which allergens may be triggering your symptoms and this information can definitely help to guide treatment.

Host:  So, what is your best tip to reduce the symptoms of allergies which are especially frustrating and confusing during this pandemic?

Dr. Narayan:  Sure, so there are a number of allergens that can be contributing to allergies right now in the fall. Those allergens include a number of different pollens. So, we classically think about ragweed but there are other weed pollens that are in our environment right now. Also in the fall, people can have allergies that are triggered by different outdoor molds and also dust mites and different pet danders. So, dust mite and pet danders tend to be more yearlong allergens rather than causing symptoms that are just flaring in the fall. But often, in the fall when it starts to get chilly or we turn on our heat, we shut our windows, we’re spending more time indoors and so that’s when sometimes we do have more exposure to dust and to dust mites and do have more direct exposure to our pet danders. And so that’s something to at least think a little bit about.

And so, when we’re trying to decrease allergy symptoms, or decrease allergy exposures; really there’s three different ways that we have to treat allergies. We can focus on our environment and try to decrease exposure to the different allergens that we’re allergic to. We can use a variety of different allergy medications to help control symptoms. And then we can talk about something called allergy shots. And so, in terms of some of the environmental controls for pollens, we often recommend that people keep their household windows closed. We recommend that they shower at night before bed to help rinse pollen out of their hair, off of their skin so they are not brining it into bed with them. Definitely more frequent washing of the sheets and the blankets and the bedding during this time of year can be helpful in case allergens do get into bed.

I often recommend to people when they come in from being outdoors, taking a damp cloth and just wiping off the face, and washing the hands to remove any pollen or irritants from the face where it could directly be contributing to symptoms. People can consider having or using an air filter indoors to help filter pollens that might come indoors. Also avoiding activities that might stir up pollen such as mowing the lawn, raking the leaves. When people come inside from being outdoors, definitely can consider showering right at that moment and changing your clothes, once again, to remove the pollen from your clothing, from you hair, so that you’re not carrying it around the house with you.

And even people that might not be allergic to their pets, sometimes pets can go outdoors and bring pollen inside on their coats. And so, I often recommend keeping a cloth by the door or a towel and just wiping the pets down so that they are not bringing that pollen into the house with them. During the fall, wet decomposing leaves are also a really good source of mold allergens. And so, sometimes giving someone else the job of raking leaves can be helpful, not only to decrease pollen that might be stirred up but also to decrease mold exposure.

In terms of allergy medications, there’s a number of different allergy medications that are out there and really everybody kind of responds a little bit differently to everything and so, it’s important to talk to your physician about what might work best for you. But we often will use long acting antihistamines such as Zyrtec, Allegra, Xyzal, Claritin, and their generic equivalents to help treat allergy symptoms. These can sometimes contribute to drowsiness and a feeling of dryness, but they are usually very well tolerated. Typically, they are taken only once a day and they can be very helpful in controlling allergy symptoms. Also, we often will use nasal steroid sprays. Some examples of those include Flonase, Nasacort, Rhinocort, Flonase Sensimist, fluticasone. And I definitely find that these nasal steroid sprays are probably the most effective allergy medications for most people. They really help to decrease the inflammation in the nasal cavities. They help to decrease the mucus production, the itchiness and nasal congestion. And so, that combination, the long-acting antihistamines and the nasal steroid sprays are often very effective in helping people to control their allergy symptoms.

If eyes are something that typically affect you, itchy, watery, swollen eyes; there are available some over the counter antihistamine eye drops that can be very effective when used as well. And so, if you have an allergy action plan from either your primary care physician, or you allergist; I think it’s really important to follow that and follow those medications. I do feel that it’s really important to start your allergy medications early. Often, starting these medications before your symptoms start, can help prevent inflammation and it’s definitely more effective and easier to prevent inflammation that to get rid of it once it’s there. And it’s important to use these medications daily. Often, people will take a medication for a day and if they’re feeling better, they’ll stop using these medications. And so definitely daily use can help to keep that inflammation down and help really to keep your allergies under control during this season.

And also, if allergy medications either are not helping with your symptoms, if your symptoms are really disruptive and they’re really not responding to the standard allergy regimen; then you could consider the option of allergy shots or allergy immunotherapy. Which is a great long term treatment. It’s very effective for most people. it really is helping to desensitize your body or help your body to act in a more normal way to these different environmental allergens. And can not only help to decrease allergy symptoms but can often help to decrease the need for different allergy medications. And so, if your allergy medications are not working and your allergy symptoms are not well controlled, I think it’s really important to contact your allergist or if you don’t have one, talk to your primary care physician about being referred to an allergist so that we can do our best to help keep your allergies under control.

Host:  Now wrapping up here Dr. Narayan, is there anything else you want out listeners to know about differentiating between all of these symptoms this year?

Dr. Narayan:  I think just really being on top of your allergy plan. I think keeping allergies under control as much as possible. If allergies are not well controlled, trying to be in contact with your allergist or your primary care physician to really get on top of it and if there are other symptoms that might be more concerning for viral illness or for COVID in particular; then I think talking to your primary care right away about what the next steps would be. We are taking new patients at Allergy West and would be happy to work with you to help control your allergies and asthma and to help you feel better both during this really difficult time that everybody is dealing with, with COVID-19 and just in general. It’s important to keep allergies and asthma under control so that people can function better and feel better and just have a better quality of life.

Host:  Well thank you so much for your time Dr. Narayan and for clearing all of this up. I know I’ll feel a little bit more confident next time I feel a sniffle or a scratchy throat coming on. Visit www.emersonhospital.org for more information and to find an allergist, physician and COVID-19 testing information. Contact Allergy West at 978-619-5447 or visit their website at www.allergywest.com. And thank you for listening to the Healthworks Here podcast. Subscribe to this podcast on your favorite podcast source including Apple Podcasts, Google Play Music and Spotify. I’m your host Caitlin Whyte. We’ll catch you next time.