Is it Allergy or a Cold?

It’s winter and  the season for runny, stuffy noses, coughing and hacking, and scratchy, sore throats – but not necessarily from allergies.  A question that comes up a lot this time of year is  how to tell the difference between allergies, a sinus infection, and a cold? This is, of course a trick question because a cold IS a sinus infection, technically speaking.  Most cold viruses not only affect the nose and throat but also the sinuses.  What about telling the difference between an allergy attack and an infection?  This can be a challenge at times but there are clues. Typically, allergies cause more itching and rarely pain and mucous is usually clear.  With an upper respiratory infection, drainage can be discolored, the throat can be raw and sore, and you may have a fever.   Also, allergies are not contagious and the fact that 70% of your school or office is home sick with the very same awful symptoms you just came down with might suggest a bug rather than a pollen problem.

This time of year, the primary allergen in the air is pollen from evergreen trees such as Juniper.   So knowing what you are allergic can help us interpret your symptoms.  For example if you are not allergic to Juniper, then respiratory symptoms during the winter are not likely to be allergy related, unless of course your aunt came to visit for christmas and brought her six cats.

You might ask: If it is not an allergy but an infection, then an antibiotic is needed to get better right? Antibiotics are one of the most important discoveries of our modern era.  They have saved millions of lives and turned the nightmare of a devastating infection in a child to a routine affair easily treated by a prescription from the family doctor.  But as miraculous as antibiotics are, they are worthless in the treatment of viral infections, and viral infections are the most common cause of respiratory infection in children and adults.

This however, has not stopped antibiotics from being routinely prescribed for cold viruses.  But how do we know if it is a cold virus and not a bacterial infection and one that would respond to an antibiotic and make me feel better in hours rather than days?  For the most part, a cold causes a lot of uncomfortable symptoms for the first 2-3 days, symptoms plateau around day 4-5, and then slowly improve, usually resolving completely by day 7-10. A cold may lead to a bacterial sinus infection but this rarely occurs in the first week of symptoms. Therefore, the major consensus guidelines for doctors suggest that antibiotics are rarely helpful and not recommended for most patients with typical cases of upper respiratory infection lasting less than 4 weeks.

So how successful are prescribers at following these guidelines? A recent study reported in The Journal of Allergy & Clinical Immunology (JACI),  reviewed the overall national use of antibiotics for adults with sinus infections.  Study data were taken from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2006-2010, from the U.S. Department of Health and Human Services, and included antibiotic prescriptions associated with outpatient visits made by adults diagnosed with acute or chronic sinusitis. Over the five year study period, sinus infections  accounted for 11% of all primary diagnoses for ambulatory care visits  for which  antibiotics were  prescribed, more than any other diagnosis.  There were 21.4 million estimated visits associated with a primary diagnosis of acute sinus infection, and 47.9 million estimated visits associated with a primary diagnosis of chronic sinus infection.

Antibiotics were prescribed in 86% of acute sinusitis cases, in spite of established clinical practice guidelines recommending against the use of antibiotics for typical acute sinus infections.

No one wants to be sick and when we are ill with a cold we want to get better as soon as possible.  And although the approach: ”better to be safe than sorry and take an antibiotic at the first sign of symptoms rather than wait several weeks to see if it will get better on it’s own” may seem reasonable,  the potential consequences associated with excessive and unjustified use of antibiotics, including allergic reactions, severe adverse side effects, unnecessary costs, and increasing bacterial resistance, cannot be justified.

Both physicians, who want to help and may be afraid to say no, and patients, who may have unrealistic expectations, are to blame for the growing problem of inappropriate antibiotic use.   However, while most of us have grown up in the age of wonder drugs, we are now at risk of entering a new and very scary time called “the post antibiotic era”.    A place were no pill or shot will save us from foes that we have long thought vanquished.

So if you have a cold:  get plenty of rest, avoid public places when possible so that you don’t infect others, and give it time.  If you do not see any improvement in a week or so or if symptoms are getting significantly worse, see your doctor.