As the fall allergy season gets underway, the more typical symptoms that allergy-sufferers feel may be somewhat heightened by awareness of the COVID-19 pandemic.
Aaron N. Pearlman, M.D., FACS, attending otolaryngologist at Weill Cornell Medicine, helps sort out what to expect this season, the signs and symptoms, and what options patients with allergies may want to discuss with their specialists.
In the fall, the most typical seasonal allergies are to pollens from some grasses and weeds--they may note increased sneezing, itchy eyes, runny nose and nasal congestion. Patients with more severe allergies may feel lower respiratory symptoms such as shortness of breath, cough, and wheezing. (Those who suffer from indoor allergies to molds, dust, and animal dander will continue to be affected in all seasons.)
COVID-19 is a complex disease caused by the SARS Covalent 2 (SARS-CoV-2) virus. The spectrum of symptoms of those infected with SARS-CoV-2 can be none (asymptomatic carrier) to severe respiratory compromise and death.
Patients with seasonal allergies usually are aware that they have a history of temporarily associated symptoms of sneezing, itchy eyes, clear runny nose, nasal congestion, and sometimes wheezing and mild cough. Taking over the counter medications, such as oral antihistamines, can help alleviate symptoms.
People suffering from symptomatic COVID-19 most commonly have cough, fever, and shortness of breath. These symptoms typically begin to worsen over time, and may be most severe during the second week of infection.
Though symptoms such as cough, wheezing, and loss of smell and taste may overlap in COVID-19 and allergy patients, in those with COVID-19, the acute loss of smell and taste is not associated with nasal congestion. The allergy patient is more likely to have nasal congestion and a secondary difficulty with smell.
Patients who suffer from seasonal allergies should monitor their symptoms for changes that are inconsistent with their prior experiences in past seasons. If they experience a fever, significant cough, or worsening shortness of breath, they should consider getting tested for COVID-19.
Additionally, a patient with an acute loss of smell and taste without nasal congestion should be suspicious for COVID-19 and should consider getting tested for it.
At this time, there is no reason to think that patients with seasonal allergies are more likely to be infected with COVID-19. More data is needed to make any association.
Mask wearing may help people with allergies protect from allergic exacerbations by decreasing the amount of pollen particles that are inhaled and contact the respiratory system. In the past, it’s been recommended that people with dust allergies wear a mask when cleaning their homes. So, it’s not hard to extrapolate that recommendation to the outside world in the current environment. Of course, the patient should wear the mask appropriately over both their mouth and nose.
High-efficiency particulate air (HEPA) filters and purifiers are used to decrease the amount of free air particles down to about 0.3 micrometers in diameter. Though these filters are often recommended for patients who suffer from allergies, the subjective and objective improvement in symptoms have been mixed.
In COVID-19, it is still unclear whether they’re helpful. It may be possible that aerosolized particles could be less than 0.3 microns and not captured by the filter.
Most important, though, is to properly clear SARS-CoV-2 by ventilating the purifier to the outside world. If the purifier returns air back into the same space, this is not adequate. But if air can be moved outside through a HEPA filtration system, this may be beneficial to clear a room of particles, including the virus that causes COVID-19.
Patients should manage allergies with a medical professional. Seasonal allergy sufferers can keep the windows closed and use air conditioning to decrease allergens entering the home. They also should be diligent about cleaning household surfaces and linens.
If lifestyle modifications are not enough to manage symptoms, they may need to consider medical therapy, including oral antihistamines, nasal steroid sprays, nasal antihistamines, leukotriene inhibitors, cromolyn sodium, or even oral steroids. Long-term therapies, including allergy shots, also may be considered.