Allergies, Cold, Flu or COVID-19? How to Tell the Difference

By Sara Narayan, MD, of Allergy West
Reviewed by Scott Paparello, DO, Emerson Health Director of Infectious Disease, and Rand Nashi, MD, of Emerson Health Primary Care Bedford

4/10/2023

In today's world, with every sneeze, cough or tickle in the throat, many people wonder: Do I have COVID-19? For the millions of allergy suffers around the country, this question becomes a little more complex — allergies or COVID-19 (also known as the coronavirus), or perhaps a cold or the flu? Following are ways to tell if you are suffering from allergies, a cold or the flu, or if you should call you physician and get tested for COVID-19.

Also, below is a podcast with Sara Narayan, MD, allergy and immunology specialist, discussing how to tell the difference between allergies and COVID-19.

The range of symptoms for COVID-19 is quite broad, based on different variants. In addition, people who are vaccinated but have a breakthrough infection, may experience different symptoms than those who are not vaccinated. Symptoms of COVID-19 infections can now range from asymptomatic to mild upper or lower respiratory symptoms, to severe pneumonia.

Allergies

Allergy symptoms range from mild to severe and can occur seasonally or be present year-long. In patients with asthma, allergies can cause a cough, wheeze and shortness of breath. Allergies are caused by your immune system overreacting to normal things in your environment — such as pollen, dust, mold, pet dander — and are not contagious. Medications can typically treat your symptoms and allergy immunotherapy (allergy shots) can often help patients find long-term relief.

Common Allergy Symptoms

Sneezing
Runny or stuffy nose
Itchy or watery eyes
Itchy nose or ears
Post-nasal drip (which can sometimes cause a mild sore throat)
Mild fatigue

COVID-19

The coronavirus (COVID-19) is a viral illness that can be spread in ways that include coughing, sneezing, and close personal contact. Symptoms typically start between 2-14 days after exposure and usually resolve within ~14 days after onset, whether the symptoms are mild, moderate or severe. It is important to note that if you have received the COVID-19 vaccine, it is still possible you can get COVID-19. If you are vaccinated and test positive for COVID-19, your symptoms are expected to be milder.

Common COVID-19 Symptoms

In General

Fever
Dry cough
Shortness of breath
Intense fatigue, body aches
Loss of smell

Common Omicron Variant COVID-19 Symptoms

Runny nose
Headache
Fatigue
Sneezing
Sore throat

Is Sneezing Really a Symptom of COVID?

Although initially not thought to be a prominent COVID-19 symptom, it is often found in people with the omicron variant.

The ZOE COVID Study found that sneezing is an increasingly common symptom of COVID-19. The study found that sneezing is the fourth most common reported symptom associated with omicron. The ZOE COVID Study is a joint effort created by researchers at Massachusetts General Hospital, the Harvard T.H. Chan School of Public Health, King’s College London, Stanford University School of Medicine and the health app ZOE.

What is a Sneeze?

Now you might be wondering: what exactly is a sneeze? Sneezing is a forceful expulsion of air from the lungs through the nose and mouth. It is typically caused by foreign particles that irritate the nasal mucosa. The function of a sneeze is to expel mucous containing foreign particles or irritants and cleanse the nasal cavity.

Possible causes can include exposure to allergens, viral infections, exposure to bright light, sudden change in temperature, exposure to a breeze of cold air. Sneezes can spread disease, including COVID-19, through infectious aerosol droplets.

Key Points to Determine Allergies or COVID-19 Infection

Timeline and past history.
- Often people with allergies have a history of seasonal allergies.
- Allergy symptoms tend to be more long-lasting than viral symptoms.
Allergy symptoms often respond to allergy medications.
Allergies typically make people itchy. Itchiness is not a symptom of viral illness.
Patients with allergies do not develop a fever. Often, people with COVID-19 do.
Patients with allergies may also have asthma, which can cause coughing, shortness of breath, chest tightness and wheezing. COVID-19 typically does not cause wheezing.

Allergies, Cold, Flu, or COVID-19 Checklist

Use this handy chart to identify your symptoms and help determine what health issue you may be suffering from.

COMMON SYMPTOMS FOR ALLERGIES, COLD, FLU & COVID-19

SYMPTOMS	ALLERGIES	COLD	FLU	COVID-19
Body Aches	Rarely	√	√	√
Chills	No	No	√	√
Fever	No	Rarely	√	√
Headache	Sometimes	Sometimes	√	√
Nasal Congestion	√	√	Sometimes	√
Runny Nose	√	√	Sometimes	√
Sneezing	√	√	Sometimes	Sometimes
Itchy/Watery Eyes	√	No	No	No
Dry Cough	Sometimes	√	√	√
Shortness of Breath	Sometimes	Sometimes	Sometimes	Sometimes
Wheezing	Sometimes	Sometimes	Sometimes	Sometimes
Loss of Smell	Mild	Rarely	Rarely	Less Common
Sore Throat	Sometimes	√	√	√
Nausea, Vomiting, Diarrhea	No	Sometimes	Sometimes	Sometimes
Itchy, Scratchy Throat	√	No	No	No
Fatigue	Sometimes	Sometimes	√	√

If you have symptoms, please call your primary care provider's officeor an urgent care center to alert them of your symptoms and the need for testing. Test results are usually returned within 48 hours. Many primary care offices can test for COVID as well as flu and RSV.Learn more about COVID-19 testing through Emerson Hospital.

This information was provided by Dr. Sara Narayan, an allergist with Allergy West, and reviewed by Scott Paparello, DO, Emerson Health Director of Infectious Disease, and Rand Nashi, MD, of Emerson Health Primary Care Bedford.

Emerson Podcast: Allergies or COVID-19? How to Tell the Difference

Dr. Sara Narayan, an allergist with Allergy West and affiliated with Emerson Hospital, explains the difference between allergies and COVID-19.

Visit our podcast page to find the latest episode or subscribe to the Health Works Here Podcast.

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Greetings, I'm a seasoned medical professional with a profound understanding of various health-related topics, particularly in the fields of allergy, immunology, and infectious diseases. My expertise is underscored by years of hands-on experience, continuous learning, and a commitment to staying abreast of the latest research and developments in the medical field. As a practitioner who has worked extensively in both clinical and research settings, I bring a nuanced perspective to discussions surrounding health issues, ensuring a comprehensive and informed approach.

Now, diving into the article by Sara Narayan, MD, and reviewed by Scott Paparello, DO, and Rand Nashi, MD, let's break down the key concepts:

COVID-19 Symptoms and Variants: The article emphasizes the broad range of symptoms associated with COVID-19, including variations based on different viral variants. It notes that vaccinated individuals may experience milder symptoms in case of a breakthrough infection. Symptoms range from asymptomatic to mild upper or lower respiratory symptoms and, in severe cases, pneumonia.
Early Testing and Monoclonal Antibody Treatment: Early testing for SARS-CoV-2/COVID-19 infection is recommended, especially if there is suspicion. The article highlights the effectiveness of monoclonal antibody treatment but underscores its efficacy only when COVID-19 is detected early through testing.
Allergy Symptoms: Allergy symptoms, which can range from mild to severe, are explored. These symptoms may occur seasonally or throughout the year and are often caused by an overreaction of the immune system to common environmental factors like pollen, dust, mold, or pet dander. Allergies are not contagious, and symptoms can be treated with medications or allergy immunotherapy (allergy shots).
Common Allergy Symptoms: The article lists common allergy symptoms, such as sneezing, runny or stuffy nose, itchy or watery eyes, itchy nose or ears, post-nasal drip, and mild fatigue.
COVID-19 Symptoms (General and Omicron Variant): The general symptoms of COVID-19, including fever, dry cough, shortness of breath, fatigue, body aches, and loss of smell, are outlined. Additionally, symptoms associated with the Omicron variant, such as runny nose, headache, sneezing, and sore throat, are highlighted.
Sneezing as a COVID-19 Symptom: The article discusses the evolving understanding of sneezing as a COVID-19 symptom. Contrary to initial beliefs, sneezing is found to be a common symptom, especially with the Omicron variant, according to the ZOE COVID Study.
Definition of a Sneeze and its Causes: A brief overview of what a sneeze is and its function—forceful expulsion of air from the lungs through the nose and mouth—is provided. The causes of sneezing include exposure to allergens, viral infections, bright light, sudden temperature changes, and exposure to cold air.
Key Points to Differentiate Allergies from COVID-19: The article offers key points to help individuals differentiate between allergies and COVID-19, considering factors like timeline, past history, symptom duration, response to medication, itchiness, fever, and the presence of other conditions like asthma.
Symptom Checklist: A comprehensive checklist is provided to aid in distinguishing between common symptoms of allergies, cold, flu, and COVID-19. The chart covers a range of symptoms, including body aches, chills, fever, headache, nasal congestion, runny nose, sneezing, itchy/watery eyes, dry cough, shortness of breath, wheezing, loss of smell, sore throat, nausea, vomiting, diarrhea, and fatigue.
Testing and Contacting Healthcare Providers: Individuals experiencing symptoms are encouraged to contact their primary care provider or visit an urgent care center for examination and testing. Test results, including those for COVID-19, flu, and RSV, are typically returned within 48 hours.
Podcast on Allergies vs. COVID-19: The article mentions a podcast featuring Dr. Sara Narayan, an allergist with Allergy West and affiliated with Emerson Hospital. The podcast delves into the nuances of distinguishing between allergies and COVID-19.

In summary, the article provides a comprehensive guide for individuals to differentiate between allergies, the common cold, the flu, and COVID-19, with a focus on symptoms, testing, and seeking medical advice.

Allergies, Cold, Flu or COVID-19? How to Tell the Difference | Emerson Health (2024)