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Allergies vs. sinus infection causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs
If you are sneezing and congested you may be wondering, is it allergies or a sinus infection? These conditions have similar symptoms so it may be difficult to figure out which is making you miserable. With a little detective work, you should be able to get to the bottom of it—and that’s a good thing, because treatments for the conditions are different.
RELATED: Is it a sinus infection or COVID?
Causes
Though they both result in nasal symptoms, the triggers for allergies and sinus infections are distinct.
Allergies
An allergy occurs when your immune system overreacts to an irritant or allergen, such as dust mites or pet dander. Your body releases histamine and leukotrienes which can cause you to sneeze, experience congestion, runny nose, itchy eyes, hives, a rash, and/or swelling. Some people may also experience asthma.
Sinus infection
When you have allergies or a viral or bacterial infection, your nose and sinuses become inflamed, meaning swollen and filled with fluid. When the fluid does not drain from your sinuses, you can have sinus congestion or blockage. When sinuses are blocked, that congested fluid can become infected by a virus or bacteria—this is known as a sinus infection.
Sinus infection typically causes symptoms that last (without improvement) more than 10 days. These symptoms include nasal obstruction, purulent (thick yellow or green) nasal drainage, and facial pain or pressure. The symptoms may also include fever. When you have a suspected bacterial sinus infection, then you need treatment with antibiotics.
Prevalence
One of these conditions is more common than the other.
Allergies
Allergies are common with over 50 million Americans living with some type of allergy (food, environmental, seasonal, contact). Over 19 million American adults are affected by hay fever or seasonal allergies (allergic rhinitis). One in five Americans are diagnosed with environmental allergies. The annual cost of environmental allergies are over eight billion dollars every year. “Allergies tend to have a waxing and waning occurrence throughout the year specifically when trees are blooming,” says Javeed Siddiqui, MD, the chief medical officer at TeleMed2U.
Sinus infection
Sinus infections (also known as sinusitis or rhinosinusitis) are also common with over 30 million Americans experiencing at least one per year. In the United States 11.6% of Americans have been diagnosed with a sinus infection at some point in their lifetime. One study found that 73 million Americans during a one-year period had to restrict their activities due to a sinus infection. The medical costs of sinus infections, not including surgeries, were almost 2.4 billion dollars.
Symptoms
The symptoms of allergies and sinus infections can be difficult to tell apart.
Allergies
Environmental allergy (hay fever) symptoms usually are triggered by the changing seasons in the spring or fall or change in environment or climate. The most common symptoms are sneezing, runny nose, itchy nose and/or eyes and nasal congestion. The congestion or postnasal drip may also cause coughing, headache, or fatigue from disrupted sleep, which can interfere with a person’s quality of life.
RELATED: How do allergies affect quality of life?
Sinus infection
The symptoms of sinus infections are similar to the symptoms of allergies. But sinus infections are caused by bacterial or viral infections. There are different types of sinus infections—acute or chronic sinusitis—based on how long you have experienced symptoms. Acute sinus infections are when you have experienced symptoms for less than four weeks. Whereas chronic sinus infections are when you have had symptoms for more than 12 weeks. One main difference between allergy symptoms and symptoms of a sinus infection is with sinus infections you may experience pain such as facial, tooth, or ear pain along with a fever. Similar to allergies, you may also have sneezing, stuffy nose, runny nose, nasal congestion, coughing, headache and fatigue.
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Diagnosis
There are tests to determine what’s causing your symptoms.
Allergies
Most allergies can be safely treated without testing, but based on your symptoms and when they occur, your healthcare provider may refer you to a specialist who is able to diagnose environmental or other allergies. The allergy specialist will perform a skin test and/or blood test.
“Allergies are initially diagnosed from symptoms of nasal congestion, sneezing, itchy watery eyes, post-nasal drip, runny nose, nasal congestion around pollen, pets, dust, and mold. As an allergist, once we identify these symptoms after taking a clinical history, we then seek to confirm the information with skin testing and/or IgE blood work,” says Nana Mireku, MD, a pediatric allergist at Family Allergy and Asthma Care in Texas.
Sinus infection
Your health care provider can diagnose a sinus infection based on your symptoms and a physical exam. If you are experiencing chronic sinus infections your health care provider may order a CT scan or a sinus endoscopy, but these tests are typically not recommended for an acute sinus infection.
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Treatments
Some medications can treat both allergies and sinus infections.
Allergies
“What I love most about being an allergist is that we have true treatments which can actually change your immune system and desensitize you to what you are allergic to,” says Dr. Mireku. “These treatments are called immunotherapy.”
There are many different options for the treatment of environmental allergies. Most allergies respond well to over-the-counter allergy medications. Antihistamine medications like Zyrtec (cetirizine), Allegra (fexofenadine), or Claritin (loratadine) can be helpful in relieving the symptoms of allergies. Sinus rinses and nasal sprays like Flonase Allergy Relief (fluticasone) can help to clear up congestion and get rid of the allergens like pollen from your nasal passageways. You could also try decongestant medications like Sudafed (phenylephrine). If you have a headache you can try using pain relievers like Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen). It is also important to drink water and use a humidifier at night.
If you have persistent allergies that do not respond to the typical over-the-counter treatments, seek the advice of your medical provider. Some people require specialized allergy treatments or shots.
RELATED: Seasonal allergy meds Q&A
Sinus infection
“I have found that recommending use of steam in an appropriate manner several times a day can be a very effective tool in reducing nasal congestion,” Dr. Siddiqui says.
There are also many options for the treatment of sinus infections. Sinus rinses, drinking water, and using a humidifier at night can also help to reduce congestion. Topical decongestants such as xylometazoline nasal spray can reduce congestion but should not be used for more than three days. If you have a headache or facial, ear or tooth pain then you might ease your discomfort with pain relievers like acetaminophen, ibuprofen or naproxen. A warm washcloth may also soothe the pain. If your inflammation is severe your health care provider may also prescribe a steroid nasal spray. You should avoid taking antihistamines as they may dry out your nasal passages, and worsen congestion. If your sinus infection is caused by bacteria, then you would require a prescription of antibiotics to treat the infection.
“Clinicians may use the duration of symptomatology greater than 7 to 10 days as a factor in determining whether an acute viral sinusitis now may have a component of a secondary bacterial infection,” Dr. Siddiqui says.
RELATED: What is Sudafed and what is it used for?
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Risk factors
Learn what predisposes you to experience allergies or sinus infections.
Allergies
The most common risk factor for allergies is genetics or if a family member has allergies. If you have asthma, you may also experience allergies. Also, there are many environmental factors that can trigger allergies such as pet dander, smoke, dust, pollen, fungus, mold, spores, chemicals, and more.
Sinus infection
If you have environmental allergies or asthma, then that is considered a risk factor for sinus infections. Another risk factor is a weakened immune system from genetic conditions, cancer or other conditions. Dry air or cigarette smoke can also cause inflammation of the sinuses leading to infections. Nasal polyps also increase the risk of sinus infection.
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Prevention
The best treatment is to avoid symptoms with the following strategies.
Allergies
“We always educate our patients on how they can decrease their exposure to their environmental allergens,” says Mireku. You can prevent allergies by avoiding the environmental triggers that cause your allergies. One way to avoid allergens is to sleep with your windows closed and use an air conditioner in the summer, making sure to change the filter regularly. Avoid having pets or having pets on furniture and in bedrooms.Taking your medication can prevent an allergic reaction. Staying hydrated, using a humidifier and nasal rinse can flush out the allergens.
“Many individuals have noticed that when they’ve relocated to different parts of the country that they have had either a waxing or waning of their allergic symptomatology and this can be attributed to a decreased exposure to the specific allergy,” says Dr. Siddiqui.
Sinus infection
If you can manage your allergies or other chronic health conditions, then your nasal passages will not become inflamed and cause a sinus infection. You can also prevent inflammation by having a moist nasal passage by using nasal rinses or a humidifier and staying hydrated. You should also wash your hands to prevent bacteria or viruses from entering your nasal passages.
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When to see a doctor for allergies or sinus infection
If over the counter medications are not relieving your symptoms and you have a fever you should see a healthcare provider to discuss alternative treatment or prescription medications to help alleviate your symptoms.
Frequently asked questions about allergies and sinus infection
How do you know if you have allergies or a sinus infection?
One main difference between allergies and sinus infections is with sinus infections you may experience pain like facial, tooth or ear pain along with a fever. Another difference that may be harder to determine is the nasal discharge with allergies is usually clear whereas with sinus infections it is usually green or yellow in color.
Can allergies feel like a sinus infection?
Allergies can feel similar to a sinus infection since in both conditions you might experience sneezing, runny nose, nasal congestion, coughing, headache and fatigue. But with a sinus infection you will probably feel “sick” or under the weather.
What can mimic a sinus infection?
There are many disorders that are similar to a sinus infection such as allergies, a cold, the flu or COVID-19.
RELATED: Is it a sinus infection or COVID-19?
Can allergies cause sinus pressure?
Allergies can cause sinus pressure from the congestion but typically don’t cause facial, ear or tooth pain.
Can sinusitis cause skin problems?
“No, sinusitis does not cause skin problems,” says Dr. Mireku.
Which food allergies cause sinus problems?
“Food allergies do not cause sinus problems,” says Dr. Mireku.
