Sneezing. Runny nose. Sore throat. When these symptoms start, you might suspect you're coming down with a cold… or is it allergies?

When it comes to cold vs. allergy symptoms, it can be difficult to distinguish between the two. These conditions are both quite common: American adults average one to two colds yearly, according to the Centers for Disease Control and Prevention, while allergies are the sixth most common cause of chronic illness in the U.S., according to the American College of Allergy, Asthma and Immunology.

Once you know which condition is causing your symptoms, you can better manage it — and your expectations. Keep reading to learn how to tell the difference between allergies and the common cold.

Allergy Symptoms

Allergy symptoms occur when the immune system reacts to specific substances known as allergens. Common allergens include pollen, pet dander, dust and grass.

Allergies are unique because of the great range of reactions and sensitivities. Some people have no allergies at all, while others have severe or even life-threatening reactions to certain allergens. When exposed to an allergen that someone is sensitive to, their immune system goes through a two-stage reaction:

• First stage: The initial stage involves the action of immune cells that release histamine. This leads to early symptoms, typically occurring within the first 30 minutes of exposure. Early symptoms often include an itchy nose and throat; runny nose; sneezing; and watery eyes.
• Second stage: The continued action of immune cells causes inflammation. This leads to late symptoms that begin hours after exposure and persist for as long as the exposure to the allergen continues. Late, longer-lasting symptoms include nasal congestion, coughing, sore throat and fatigue. They typically subside slowly once the individual is no longer exposed to the allergen.

Cold Symptoms

The common cold is caused by a viral infection, primarily rhinovirus. Similar to allergies, cold symptoms result from the immune system's reaction to the virus, triggering an inflammatory process.

Cold symptoms usually last seven days but can persist for up to two weeks. Symptoms include sneezing, stuffy nose, runny nose, sore throat, muscle aches, headache, coughing, post-nasal drip, watery eyes, and generally feeling unwell. Fever is a possible symptom but not a common one.

Important Differences: Cold vs. Allergy Symptoms

While allergies and colds have overlapping symptoms, key differences can help identify and treat them, per guidance from the American Academy of Family Physicians.

• Seasonal nature: Depending on the allergen, allergies tend to be more common in the spring and summer months, while colds are more prevalent during winter and spring. However, both can occur at any time.
• Symptom differences: Mild muscle aches are common with colds but do not occur with allergies. Itchiness and sneezing are more frequent with allergies compared to colds.
• Duration and recurrence: Cold symptoms typically resolve on their own within one to two weeks. In contrast, allergy symptoms can last for as long as you're exposed to the allergen. Also, allergy symptoms can keep coming back if you keep coming into contact with the allergen. For instance, you might notice allergy symptoms coming back every time you mow the grass.

Should You See a Healthcare Provider?

Most adults and children can manage the common cold symptoms or allergies without seeing a healthcare provider. Numerous effective over-the-counter (OTC) treatment options are available. A pharmacist can help you choose an OTC cold or allergy relief medicine that's safe for you.

That being said, there are instances when medical attention is necessary. If your symptoms show no improvement after 10 days or worsen after three days, it's recommended to consult a healthcare provider. Immediate medical attention is warranted if you have trouble breathing, a prolonged fever, dizziness or dehydration due to severe vomiting or diarrhea.

Treatment for OTC Allergy Relief

If someone knows the allergens that bother them, they can take steps to minimize their exposure to the allergen. For example, people allergic to pollen can try to stay indoors when pollen counts are high. When complete allergen avoidance isn't possible (which it often isn't), OTC treatment options are available.

Allergy relief medications work by targeting the immune system's inflammatory process. The most highly recommended OTC allergy medications are antihistamines, available in oral, eye drop and intranasal forms. These drugs work to reduce or help prevent allergy symptoms by blocking histamine, a chemical released during the allergic response. They are safe for most adults. As well, most antihistamines are safe for children ages six and older. Conveniently, many antihistamines offer once-daily dosing.

Examples of OTC oral antihistamines include:

• Cetirizine (Zyrtec, Children's Zyrtec)

• Diphenhydramine (Benadryl, Children's Benadryl Allergy)

• Fexofenadine (Allegra, Children's Allegra)

• Levocetirizine (Xyzal, Children's Xyzal Allergy 24HR)

• Loratadine (Claritin, Alavert)

   

Examples of OTC antihistamine eyedrops include:

• Alcaftadine (Lastacaft)
• Ketotifen (Alaway, Zaditor)
• Olopatadine (Pataday)

An antihistamine nasal spray is also available without a prescription: azelastine nasal (Astepro).

If a stuffy nose and sinus pressure are bothersome symptoms, using a steroid nasal spray may be beneficial. In fact, pharmacists commonly recommend combining an antihistamine and an intranasal steroid to combat allergy symptoms and inflammation. The recommended children's ages for steroid nasal sprays vary, so be sure to check the product label or ask your pharmacist.

Examples of OTC steroid nasal sprays include:

• Fluticasone propionate nasal (Flonase Allergy Relief)

• Fluticasone furoate nasal (Flonase Sensimist)

• Mometasone nasal (Nasonex 24HR Allergy)

   

Treatment for OTC Cold Relief

Unlike allergies, no specific treatments are proven to prevent the common cold. Focus on maintaining good hand hygiene and avoiding contact with symptomatic people to reduce the risk of catching a cold.

It's important to note that antibiotics are ineffective against the common cold as it's caused by a viral infection, and antibiotics only treat bacterial infections.

Taking OTC medications may not be necessary if your cold symptoms are minor. Getting plenty of rest and increasing your fluid intake may be all you need. For symptom management, use OTC medications for relief.

OTC analgesics, such as ibuprofen (Motrin) or acetaminophen (Tylenol), help to relieve pain and reduce fever. Decongestants can provide short-term relief for nasal/sinus congestion and pressure. Antihistamines, on the other hand, help with sneezing, runny nose, itchy/watery eyes and itchy throat. Nasal decongestants are often combined with antihistamines in OTC products.

That said, some people should avoid decongestants, particularly if they have high blood pressure or heart problems. Examples of OTC nasal decongestants are pseudoephedrine (Sudafed) and oxymetazoline nasal spray (Afrin).

Seeking the Right Care

Allergies and the common cold often present with similar symptoms, making it easy to confuse the two. However, understanding the differences is helpful for proper symptom management and setting realistic expectations.

Allergies require a long-term plan to identify and avoid allergens whenever possible, while colds typically resolve on their own within a couple of weeks. Correctly identifying the underlying condition will guide appropriate treatment with OTC treatments. If uncertainty persists, seeking advice from a healthcare provider is a good idea, especially if you have other medical conditions.

Written by: Patricia Weiser, PharmD

Resources:

Asthma and Allergy Foundation of America. Allergy Facts and Figures. https://aafa.org/allergies/allergy-facts/

U.S. Centers for Disease Control and Prevention. Common cold. https://www.cdc.gov/antibiotic-use/colds.html

U.S. Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases. Rhinoviruses. https://www.cdc.gov/ncird/rhinoviruses-common-cold.html

Degeorge KC, Ring DJ, Dalrymple, SN. Treatment of the Common Cold. American Family Physician. 2019;100(5):281-289. Retrieved from https://www.aafp.org/pubs/afp/issues/2019/0901/p281.html

Hauk L. Treatment of Seasonal Allergic Rhinitis: A Guideline from the AAAAI/ACAAI Joint Task Force on Practice Parameters. American Family Physician. 2018;97(11):756-757. Retrieved from https://www.aafp.org/pubs/afp/issues/2018/0601/p756.html

MedlinePlus. Allergen. https://medlineplus.gov/ency/article/002229.htm

MedlinePlus. Allergic rhinitis. https://medlineplus.gov/ency/article/000813.htm

Min YG. The pathophysiology, diagnosis and treatment of allergic rhinitis. Allergy, asthma & immunology research. 2010;2(2):65-76. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846743/

Pappas DE. The Common Cold. Principles and Practice of Pediatric Infectious Diseases. 2018;199-202.e1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152197/

These articles are intended for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment and are not intended to treat or cure any disease. Never disregard professional medical advice or delay in seeking it because of something you have read in these articles. Advances in medicine may cause this information to become outdated, invalid, or subject to debate. Professional opinions and interpretations of scientific literature may vary. Consult your healthcare professional before making changes to your diet, exercise or medication regimen.