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March 07, 2023

How to tell whether congestion is caused by a cold, sinus infection or allergies

Correctly identifying the source of the symptoms is important to ensure proper treatment

Illness Colds
Cold vs. Allergies Vs. Sinus Infection Brittany Colette/Unsplash

The symptoms caused by the common cold, sinus infections and allergies overlap somewhat, but there are ways to tell the conditions apart, health experts say.

Your nose is runny and stuffy and your throat is sore. Could it be the start of a cold or a sinus infection? Or is it allergies? 

The symptoms of these conditions each overlap somewhat, but health experts say there are clear ways to tell them apart. Correctly diagnosing the source of the symptoms is important to ensure proper treatment. 

The biggest distinguishing features between a cold and a sinus infection is that a cold only lasts a short duration and is not accompanied by a fever, unlike a sinus infection. The color and thickness of the mucus in the nose also tends to differ. A thick, green or yellow mucus is an indicator of a sinus infection. 

Allergy symptoms tend to come and go depending on exposure to allergens like pollen, dust and pet dander. People with allergies often experience itchy eyes, which is not common with colds or sinus infections. Allergists say that avoiding triggers is the most effective way to reduce allergic reactions.

People who have severe allergy symptoms, recurring sinus or ear infections, asthma or nasal polyps should consider seeing an allergist for an evaluation, experts say.

To rule out COVID-19, which also causes many of these symptoms, people should take rapid tests, which are commonly sold at pharmacies. 

A cold vs. allergies

A cold is a viral infection that affects the nose and throat. Generally, people first develop a sore throat that is followed a day or two later by congestion, a runny nose or a cough. These symptoms typically only last 7 to 10 days and resolve without any treatment. People with weakened immune systems, asthma or respiratory conditions may develop bronchitis or pneumonia, according to the U.S. Centers for Disease Control and Prevention.

Anyone can come down with a cold. The best prevention is practicing good hand washing hygiene and limiting exposure to people who are sick.

Allergy symptoms are similar to those of a cold – nasal congestion and stuffy nose – but their causes are markedly different. Allergies are a reaction to allergens such as pollen, dust or pet dander, according to the American College of Allergy, Asthma & Immunology. The immune system responds to an allergen by releasing the chemical histamine. This can cause a headache, sneezing and congestion. It also can cause itchy eyes and a skin rash. 

Decongestants can help relieve congestion caused by allergies, but allergies also often are treated with antihistamines, like Benadryl and Claritin, which block the immune system from producing histamine. 

Though people can develop allergies at any age, they usually appear during childhood. People with a family history of allergies have a higher risk of developing them.

Congestion and the sinuses

The symptoms caused by a cold or allergies can lead to a sinus infection, which occurs when the sinuses get backed up. 

Sinusitis, commonly referred to as a sinus infection, is the swelling or inflammation of the tissue lining the sinuses. The job of the sinuses is to drain mucus out of the nose to keep it clean and free of bacteria. However, when they get blocked and become filled with fluid, bacteria can grow, causing an infection.

The most common symptoms of a sinus infection are post nasal drip, a stuffy nose, snot that is thick and green or yellow, facial pressure, a headache or pain in the teeth or ears, bad breath, a cough, fatigue and a fever.

Bacteria, fungi and viruses each can cause a sinus infection, but bacteria is most often the culprit. Bacterial sinusitis can be treated with antibiotics, but antibiotics are not always needed. Mild infections can be treated with decongestants, over-the-counter cold and allergy medications, and nasal irrigation. Drinking plenty of fluids also can help clear out the sinuses.

An acute infection generally starts with cold symptoms such as a runny nose, stuffy nose and facial pain. When these symptoms don't go away after 10 days, or they appear to go away and then come back worse, a sinus infection is often to blame. 

Chronic sinusitis is a condition in which symptoms such as nasal congestion, draining, facial pain and a decreased sense of smell last for at least 12 weeks. Some people develop recurrent sinusitis, in which they experience symptoms four or more times in a year and the symptoms last no longer than two weeks at a time. 

Anyone can get a sinus infection, but people with nasal allergies, nasal polyps, asthma and abnormal nose structures like a deviated septum are more prone to get them. So are people whose immune systems have been weakened from an illness or medication. Smoking also increases risk.

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