When COVID-19 meets allergy season

Jack could not help feeling self-conscious as he removed his face mask to wipe his nose. He had been sneezing and sniffling on his entire walk to work. Although it was a beautiful day to be outdoors, he could not enjoy the weather, as he had been becoming increasingly unsettled by how other passersby were warily looking at him. He knew they were probably concerned that he had contracted COVID-19, and Jack was slightly worried about the similarities between his symptoms and those experienced by COVID-19 patients. However, Jack did not panic as he knew there was another possibility that could explain his symptoms: Seasonal Allergies.

After a long year of lockdown measures, many are hoping to be outdoors as summer arrives. However, for those experiencing seasonal allergies, they may find themselves wondering whether their sniffles are typical of allergies or something more insidious. In the context of the COVID-19 pandemic, differentiating between the two respiratory conditions can be challenging. However, there are marked differences between the signs and symptoms of seasonal allergies and COVID-19 that could help guide your next steps.


Symptoms: COVID-19 vs. seasonal allergies

Symptoms of seasonal allergies that may overlap with those of COVID-19 include cough, shortness of breath, difficulty breathing, fatigue, headache, sore throat, congestion, and runny nose. However, symptoms that are common markers of seasonal allergies include sneezing, itchy eyes, and watery eyes. In contrast, COVID-19 could result in fever and chills, muscle aches, nausea, vomiting, loss of smell or taste, and/or diarrhea, which are usually absent in patients experiencing seasonal allergies. Saskatchewan Health Authority has created a one-pager infographic “COVID-19 Symptoms in Comparison to Seasonal Allergies” where you can refer to for further information www.saskhealthauthority.ca


Testing: COVID-19

If you are in doubt of what you are experiencing or if you have not encountered seasonal allergies in the past, take an online self-assessment. Health Canada offers a COVID-19 Self-Assessment Tool (at https://ca.thrive.health/covid19/en) and provinces/territories have also established province/territory-specific online self-assessment tool, where patients can use for self-assessment and accessing province/territory-specific COVID-19 information and resources. The self-assessment tool will recommend next steps, including whether one may need further COVID-19 diagnostic test (or not). The molecular or polymerase chain reaction (PCR) lab testing is the gold standard for diagnosis of COVID-19, but rapid test devices, such as point-of-care and self-testing devices are emerging and becoming more accessible in the community. Despite the fact that these rapid tests have a lower sensitivity for detecting the COVID-19 virus when compared to the gold-standard PCR lab tests, they do play a role in supplementing diagnostic testing, for example, in high-risk populations and/or geographical regions. Further information related to point-of-care and self-testing devices is available at the Government of Canada website at www.canada.ca


Management: Seasonal allergies

If you have experienced seasonal allergies in the past and are familiar with the symptoms, an array of options can help manage the condition. Over-the-counter products, such as oral antihistamines can reduce sneezing and itching. Oral decongestants or temporary use of nasal decongestants can provide quick relief for a stuffy nose. However, consulting a healthcare professional, such as a physician or a pharmacist, before self-selecting a medication off the shelf is always important and highly recommended. For instance, some oral antihistamines, such as diphenhydramine, may cause more drowsiness than antihistamines in a different generation, such as desloratadine. While drowsiness may alleviate certain bothersome seasonal allergy symptoms, it could be disruptive when it occurs during working hours or potentially dangerous if you need to operate a car or machinery that requires attention and alertness. In addition, if you are taking other medications, seeking advice from a healthcare professional prior to self-selecting over-the-counter medications can help prevent potential drug-drug interactions. Special considerations also exist for children, pregnant or breastfeeding women, older adults, and people with chronic or immunocompromised conditions, impaired liver or kidney functions, etc.

Besides medications, preventative measures also have an important role in management. Irritants such as tobacco smoke and insect sprays may aggravate allergy symptoms. If you know the cause of your seasonal allergies, the best strategy is to reduce your exposure to the allergen(s). Since avoidance may not always be possible, there are self-management options that may be helpful. For example, try to decrease outdoor activities during the spring/allergy season, especially on windy days. Showering and washing your clothes after returning home can prevent allergens from remaining indoors and prolonging your exposure to the irritants. Lastly, wearing a face mask during your outdoor activities may also help prevent you from seasonal allergies. HealthLinkBC “Hay Fever and Other Seasonal Allergies” is an online resource where you can find further information on symptoms, prevention, and management of seasonal allergies.

Annie Yao and Peter Zhang are combined PharmD/MBA students at the Leslie Dan Faculty of Pharmacy and the Rotman School of Management, University of Toronto; Certina Ho is an Assistant Professor in the Department of Psychiatry and the Leslie Dan Faculty of Pharmacy, University of Toronto.