Our unusually mild winter has led to a lovely early spring. Cherries, magnolias, and forsythias are brightening the neighborhoods where we hunker down and hope the coronavirus will pass us by. Their beauty is welcome, but for many, the annual botanical awakening brings bad news: allergies.

This year’s early tree pollen season brings a new worry. How can allergy sufferers tell whether they have allergies or the coronavirus? There’s some overlap in symptoms that could easily fuel anxiety.

“The timing right now is as awful as you can imagine,” said Tarun Kapoor, an internal medicine specialist who is senior vice president of clinical integration for Virtua Health. Patients are saying, “I’ve never had allergies in March.”

Some people are unlucky enough to be allergic to things inside their houses, like dust mites, pets or mold. They can have allergies all the time. If you’ve had symptoms for weeks, it’s unlikely the coronavirus, experts said.

This time of year, tree pollen floats around in the air and becomes “highly aerosolized,” said Joanna Johnson, an allergist who is chief of pulmonology and asthma at St. Christopher’s Hospital for Children. The pollen tends to get in people’s eyes and noses, where it causes itchy eyes, sneezing, and runny nose. It can also cause an itchy throat and make asthma worse, which can lead to wheezing.

The coronavirus can cause a variety of symptoms. The big three are cough, fever, and shortness of breath, but not everybody gets all of those. Some people also report achiness, fatigue, gastrointestinal upset, sore throat, conjunctivitis, and loss of the sense of smell. Runny nose, but not sneezing, is reported in a small percentage of cases, said Mitchell Grayson, an allergist at Nationwide Children’s Hospital at Ohio State University. He added that a fellow doctor in New York told him he’s seeing young adult patients with runny noses who are testing positive.

Unlike many other viruses, such as rhinovirus, adenovirus, flu, and SARS, the coronavirus does not tend to exacerbate asthma, Johnson said.

For her, two important differentiators are itch — that’s not a coronavirus symptom — and fever, which is not an allergy symptom.

During an exam, she said, the mucous membranes of people with allergies tend to look pale blue and swollen. Those of people with infections look irritated and are usually red.

Johnson said people with a long history of allergies know how their symptoms feel. “It’s an entirely different feeling than when they’re sick,” she said.

Tarun Kapoor is senior vice president of clinical integration for Virtua Health.
Courtesy of Virtua Health
Tarun Kapoor is senior vice president of clinical integration for Virtua Health.

Kapoor said one thing that can help people know whether symptoms are caused by the coronavirus or allergies is understanding how the body is affected by each.

The coronavirus focuses on the lungs, and it causes a cough that emanates in the lungs, he said. Allergies are more likely to cause symptoms that start in the head, things like a sense of fullness in the sinuses and ears, post-nasal drip, sneezing, and runny nose. The cough associated with allergies is more likely to be triggered higher in the throat by post-nasal drip, he said.

Kapoor and Johnson said they didn’t know whether the sore throats from the coronavirus and allergies feel different.

Kapoor said that if you feel better when you’re in a house with filtered air than you do outside, you probably have allergies.

If you have allergies and are wheezing for the first time, Kapoor said, that’s a symptom that should prompt a call to a doctor. One of the small silver linings of the pandemic, he said, is that it has led health systems to make telemedicine far more available.

Grayson said it is not necessarily easy to tell mild cases of allergy and the coronavirus apart. Not all people with the coronavirus get a fever. “It’s more complicated than I had hoped,” he said. “If somebody says, ‘I have a runny nose and a cough,’ I don’t know without testing them.” Most people with those symptoms aren’t getting coronavirus tests now.

It is clear, he said, that muscle aches are not an allergy symptom, and sneezing and itchy, watery eyes do not seem to be coronavirus symptoms, although conjunctivitis can be.

Allergies will likely last much longer than the coronavirus, but that doesn’t help you know whether you should self-quarantine when your symptoms start. He said allergy medicines like antihistamines probably won’t be much help against the coronavirus.