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Allergies or Sinus Infection? An ENT Explains the Link and How to Determine the Difference

May 24, 2021

If you’ve had a stuffy or runny nose lately, it’s probably due to that pesky coat of pollen covering nearly everything outside.

Early spring, when tree grass pollen peaks, kick-starts what can be a difficult summer for many. Grass pollen follows shortly after, and then ragweed in the fall. Seasonal difficulties can vary from one person to the next. Seasonal allergies come and go, but what about when it feels like they don’t?

Seasonal allergies can worsen symptoms of sinus infections and may make them last longer, explains Dr. Elina Toskala, MBA, MD, PhD, Jefferson Health otolaryngologist and allergy & immunology specialist.

What do allergies stem from?

Allergies are triggered by an overactive immune response and hypersensitivity to certain substances, says Dr. Toskala, be it pollen, dander, mold and/or dust. This reaction increases inflammation in our nasal and sinus cavities.

What do sinus infections stem from?

Sinus infections are viral or bacterial. In some cases, they are secondary to an upper respiratory virus, such as the common cold. Because the mucosa, or tissue that lines the nasal cavity, is so disturbed, it makes it easier for bacteria to “settle in,” adds Dr. Toskala.

However, recently, chronic rhinosinusitis has been looked at as a multifactorial (with various causes) inflammatory disorder. “It’s almost like an asthma of the upper airways,” describes Dr. Toskala.

How do they overlap?

Contrary to popular claims, allergies don’t weaken immunity, says Dr. Toskala. It’s inflammation that makes people more susceptible to sinus infections. Both can persist simultaneously and make each other much worse. Proper treatment for each, as separate conditions, is incredibly important.

How can you tell the difference?

First, look at the symptoms: 

Both allergies (when severe) and sinus infections can cause nasal congestion; post-nasal drip; cough; pressure in the face and sinuses (more common in sinus infections); runny nose (more common in allergies); and hyposmia (partial loss of smell). However, tell-tale symptoms of allergies are itchy eyes and nose, says Dr. Toskala. For sinus infections, they’re hyposmia, pressure, and, sometimes, discolored mucus (from a bacterial infection).

How long symptoms last is also a key differentiator.

As mentioned above, seasonal allergies eventually end. Some people are allergic to grass, tree, and weed pollen, making the duration of their allergies last around six months, from spring to fall, continues Dr. Toskala. Others only have one or two of these allergies. Non-seasonal allergies, such as dust and/or dander (if you have pets), can last year-round.

Acute sinus infections typically resolve within 2-3 weeks, continues Dr. Toskala. Chronic infections, on the other hand, become a life-long condition that need continuous management.

The good news is you don’t have to figure this out for yourself, says Dr. Toskala. When you have persistent symptoms of upper airway troubles, tell your doctor. “ENTs can perform nasal endoscopies — similar to every other endoscopy you’ve heard of. To diagnose sinus infections, we look for polyps; for allergies, we look for watery, swollen nasal lining.”

How to manage and prevent symptoms:

For allergies, baseline treatment involves a nasal steroid spray and/or oral antihistamines. Some medications are available for specific seasonal allergens. For year-long allergies that don’t respond to medication, allergy shots or sublingual (“under the tongue”) tablets or drops are may be beneficial, as they can greatly reduce the need for medication and reduce symptoms long-term, says Dr. Toskala.

For sinus infections, oral or topical steroids can help decrease inflammation, and, when needed, antibiotics for infections. Surgery may be needed for the best possible resolution of symptoms, explains Dr. Toskala. “Sinus surgery today is minimally invasive and highly effective at opening up the sinuses, so that the inflamed lining can be better treated. If you have polyps, they may be removed. Improvement is significant, but ongoing medical treatment will also be required to keep them from coming back.”

In addition to medical intervention, everyday remedies and behaviors can help a lot. Dr. Toskala suggests the following:

  • check your local pollen count regularly
  • start your medication as soon as the season starts
  • maintain a well-balanced diet high in minerals and vitamins (especially C, D, and zinc) to support immune health
  • keep pets out of the bedroom and bathe them more frequently
  • keep your windows closed
  • keep your air conditioning filters clean and change them annually
  • keep fewer carpets and more hardwood/tile floors (which hold less dust)
  • try saline rinses, or salt-water nasal sprays, to clear the nose and sinuses of pollen and/or thick mucus

When you should see an ENT:

When you aren’t able to manage your symptoms with over-the-counter medicines, and your symptoms are hindering your quality of life, it’s time to reach out.

“Many people, unfortunately, become used to struggling to breathe through their nose; they don’t realize it impacts so many other aspects of their health, such as sleep, exercise, and even the ability to taste our food,” said Dr. Toskala. “Don’t ignore your symptoms. A healthy nose helps us live a healthy life!”

For more information on ENT/Otolaryngology services offered at Jefferson Health in New Jersey, click HERE.