Coronavirus vs. Seasonal Allergies: How to Tell the Difference with Dr. David Lang

Podcast Transcript

Cassandra Holloway:  Hi, thanks for joining us. I'm your host, Cassandra Holloway and you're listening to the Health Essentials Podcast brought to you by Cleveland Clinic. Today, we're broadcasting virtually as we are following the social distancing initiative that our hospital, as well as our community, has set for us. We're joined virtually by allergist, David Lang. Thank you so much for being here today, Dr. Lang.

Dr. David Lang:  Pleasure to be with you, Cassandra.

Cassandra Holloway:  Today we're going to be talking about how to tell the difference between springtime allergies and coronavirus. But before we dive into all of that, we want to remind our listeners that this is for informational purposes only and should not replace your own doctor's advice.

Cassandra Holloway:  It's estimated that one in six people suffer from allergic rhinitis or hay fever, and since spring is in the air and unfortunately, coronavirus is all around us, it's likely that a lot of people are going to soon be questioning whether their symptoms are traditional allergies or if it's something more serious like coronavirus, because the symptoms do tend to overlap a bit. Dr. Lang, I first want to start off by asking about the name. We refer to it as allergic rhinitis, hay fever, seasonal or springtime allergies. Do all of these names mean the same thing?

Dr. David Lang:  Yeah. Again, thank you for inviting me and basically, yes, they all refer to nasal/eye symptoms that occur in association with pollen seasons. The springtime, generally, it's tree pollens that are in the air and the summertime. So the spring season for Northeast Ohio would be March, April, early May. The grass season would be May and June, and then the weed season or ragweed season would be mid-August to the frost. So seasonal allergy could refer to the ragweed season, which is in the fall, but it's trees right now. And the peak of the, we have the rather holiday-focused specialty in that the peak of the grass season is Memorial Day weekend and the peak of the ragweed season, is Labor Day weekend. But in Northeast Ohio, it's the tree pollen season, in my experience, that tends to cause the most prominent symptoms and tends to bring more people into the office to see us.

Cassandra Holloway:  Gotcha. So yeah, definitely a lot of triggers, like you said; weeds, trees, pollen, that sort of thing. Let's talk a little bit about the symptoms of allergies. What do people experience when they are suffering from springtime allergies?

Dr. David Lang:  The spring season, again, entails exposure to airborne pollens. When individuals are outdoors, particularly on warm summer breezy days, they will experience nasal congestion, drainage, fits of sneezing and prominent itching of the nose, eyes and possibly also, the ears, the throat and the roof of the mouth. And a key clue as to whether these symptoms reflect allergy or something else, is that the symptoms are worse outdoors and they improve or go away when someone enters the indoor environment with the windows closed and the air conditioning on.

Cassandra Holloway:  Gotcha. So paying attention to when you feel these symptoms is important.

Dr. David Lang:  That's correct.

Cassandra Holloway:  I noticed you didn't mention fever as one of the symptoms. So we never see fever as a symptom of allergies?

Dr. David Lang:  Right. So Cassandra, you zeroed in on a very important issue, which is that springtime is here. And the good news is that means that warmer weather is on the way. But this year, the spring tree season coincides with the coronavirus pandemic. So for individuals who are familiar with these symptoms from past seasons in which they've had them, as I said, the onset of these symptoms will entail congestion, drainage, sneezing and itching. But there is some overlap with symptoms that may reflect the onset of a viral upper respiratory infection, including a viral illness such as coronavirus.

Dr. David Lang:  However, on the studies from China, more than nine to 10 people had a fever in association with the onset of coronavirus infection. Three out of four developed prominent fatigue, and about 40% of individuals developed gastrointestinal symptoms such as diarrhea with the onset of coronavirus infection. So fever, in particular, doesn't occur with tree pollen induced allergy symptoms. So if you have a fever that can't be explained by allergy-

Cassandra Holloway:  That might your first cue that's something different or more serious might be happening?

Dr. David Lang:  That's correct. Also, there can be a cough in association with allergy symptoms, either related to post-nasal drainage in people who have prominent nasal symptoms or related to asthma in people who tend to have asthma provoked by the allergy season. So cough is a symptom that may be shared, in terms of infection versus allergy. However, again, if there's a fever, it's not explained by allergy and individuals should seek medical attention as appropriate.

Cassandra Holloway:  And so, you mentioned this a little bit, but can you talk about just the general symptoms laid out of coronavirus just so we have them for our listeners?

Dr. David Lang:  Right. Coronavirus generally would present with fever. More than nine in 10 patients develop a prominent fever. Three out of four patients have cough and three out of four patients have prominent fatigue. Interestingly, about four out of 10 individuals will develop gastrointestinal symptoms, particularly diarrhea. And fever and diarrhea are not characteristic of symptoms provoked by pollen season.

Cassandra Holloway:  By allergies, yeah, in general.

Dr. David Lang:  That's correct.

Cassandra Holloway:  Gotcha. Okay. That's good to know. Can someone have allergies and coronavirus at the same time?

Dr. David Lang:  Yeah, if you have allergy symptoms related to the tree season, you can develop coronavirus infection independent of that. But again, the things to watch out for are a fever, prominent fever and cough.

Cassandra Holloway:  Are the big red flags again.

Dr. David Lang:  That's correct.

Cassandra Holloway:  So if someone knows that they suffer from springtime allergies, I know I do. I know a lot of people close to me do. What advice or tips would you give to people like me and other people who suffer from these springtime allergies? What advice would you give about paying attention in determining if it's truly allergies or if it's something more serious?

Dr. David Lang:  With the onset of the springtime season, warmer weather, more exposure outdoors, individuals who have the potential to develop these symptoms will notice that they're developing congestion, drainage, sneezing, itching. So even now, prior to the season getting into full swing, it's appropriate for individuals to begin taking regular medication. Air conditioning is an effective avoidance strategy. With the air conditioning on and the windows closed, you can cut down on the indoor pollen count by 90% or more.

Dr. David Lang:  But people generally are going to still be exposed to tree pollens and they're going to have symptoms, so it's important to begin taking regular medications. Studies show that you're actually better off beginning to take medication early in the season before your symptoms reach a peak. So even if you're not having symptoms or you're only having mild symptoms now, it's better for you to begin taking regular medication, and the number one medication to take is an intranasal steroid. There are three intranasal steroids that are available over the counter. These are widely used. They're safe medications.

Dr. David Lang:  The steroid content of the medicine is effective in the lining of the nose and is not absorbed into the bloodstream or into the body to a sufficient degree to cause any remarkable side effects. The only side effect you need to be aware of, is it can irritate the lining of the nose so that if you develop irritation or you get a nosebleed, you should stop using it. You can minimize that by directing the spray to the side. So I usually tell people to look down, look at your toes, and direct the spray laterally, aiming for the top of your ear each side and two sprays in each nostril daily. And that's the number one medication to use.

Dr. David Lang:  And it may be that that alone is sufficient to control your symptoms. Some patients also may benefit from the use of an oral anti-histamine. There are oral anti-histamines available over the counter that are not going to make you sleepy. Those are also well tolerated and effective. If symptoms are not controlled with a regimen of intranasal steroids and oral anti-histamine taken regularly plus avoidance strategies as relevant or as feasible, and I think the lack of control would be reflected in having frequent daytime symptoms, sleep disruption, drowsiness during the day. If your symptoms aren't well controlled, then you should seek medical attention.

Cassandra Holloway:  Absolutely. That's great advice. I want to go back quickly to the medications and about your advice to take it earlier than you anticipate even needing it. Is that because it takes a while for the medicine to kind of buildup in our systems to start protecting us?

Dr. David Lang:  Well, to some extent, I think it's related to the effect of the medicine in preventing symptoms from becoming more serious versus trying to reverse symptoms that have already progressed to a more serious level and it's tougher for the medicine, perhaps, to turn that around once symptoms have progressed.

Cassandra Holloway:  Absolutely. And I'm sure you have advice for people who have suffered from seasonal allergies in the past to really just be mindful of how you feel this season compared to last season, I imagine.

Dr. David Lang:  Yeah. And I should say in tying this into a discussion you and I had a few minutes, Cassandra, regarding the coronavirus pandemic, for people who have had the symptoms year after year after year after year, they recognize these symptoms and they're aware of what the symptoms associated with the allergy season feel like.

Dr. David Lang:  But for people who may be developing these symptoms for the first time, that may create more apprehension in terms of whether they may be developing the coronavirus infection. So again, a major feature distinguishing coronavirus infection from seasonal allergic rhinitis or a tree pollen related allergy symptoms is the onset of fever. So if you have a fever, it can't be explained by the allergy season.

Cassandra Holloway:  Gotcha. Yeah.

Dr. David Lang:  And it kind of feels, for the people who are developing these symptoms for first time, it kind of feels like you've got a cold, but there's a lot more itching and sneezing and it goes on, as opposed to a cold. These symptoms go on for longer than a week, 10 days.

Cassandra Holloway:  Absolutely. Yeah. So with people who are experiencing or they think they might be experiencing allergies for the first time this season, what advice do you have for them? And they don't have a fever, do they need to seek care with their primary care specialist or an allergist? What would be that first step if they don't have a fever and they think it might be allergies?

Dr. David Lang:  In the current situation, I would say that if you're developing these symptoms for the first time, and another major clue is that you have the symptoms in association with being outdoors on a warm summer, breezy day, and when you go in the air conditioning indoors with the windows closed, the symptoms get better remarkably or they even go away. So if that's the case, then it's in your best health care interest to purchase medications over the counter, intra nasal steroid with or without an oral antihistamine. Take that regularly. And when the coronavirus pandemic is in the rear view mirror, it would be appropriate for you to seek medical attention.

Cassandra Holloway:  That's great advice. I want to ask you about tips for allergy sufferers right now. We've talked a little bit about it, but I know that cough etiquette and sneeze etiquette is really important right now, washing your hands. And is there any other advice that you can give to allergy sufferers for just managing their symptoms, especially if they do have to go out in public? Any just advice for them?

Dr. David Lang:  That's potentially a major issue, more so in the context of the coronavirus pandemic, which is that there may be a social stigma, if you will, associated with people exhibiting allergy symptoms like sneezing, coughing, wiping their nose in public. People might shun them because they may think that they're contagious, and they may have the coronavirus infection. So to avoid that, I would encourage everyone during the tree pollen season who's having symptoms, to exhibit a social consciousness, I guess, if you will, or a sensitivity.

Dr. David Lang:  And I think this year in particular, it's really important for you to take medication regularly to minimize the likelihood that you're going to exhibit these symptoms, say at the supermarket. And again, if you tend to have symptoms during the spring season, it's important that you begin taking your medications now, even if you're having no or minimal symptoms at this time.

Cassandra Holloway:  Absolutely. That's great advice. And so, the last thing I want to ask you about, you mentioned asthma a little bit ago. Can you talk about how asthma plays into allergies? Is that a component of it?

Dr. David Lang:  About 8% of the population in the United States has asthma and the overwhelming majority of individuals with asthma exhibit reactions on skin testing to common inhalants. So we believe that allergy is important for, not all, but for the majority of individuals with asthma. There are individuals who will have a worsening of their asthma symptoms during a pollen season such as what we're answering now. So as I said, for individuals who have nasal/eye symptoms or allergy symptoms, if you will, during the springtime, if you have asthma, it's really important for you to continue taking your medications on a regular basis and for you to implement avoidance measures. And the major avoidance measure this time of year is the use of air conditioning in buildings and in cars.

Cassandra Holloway:  Absolutely. And so, to wrap everything up, I just want to make sure we set this out for our listeners. The main differences between seasonal allergies and coronavirus is fever, cough and GI issues?

Dr. David Lang:  Fever in more than nine out of 10 people, and we find that at least in the literature and initial experience in Northeast Ohio with patients who develop COVID-19 infection, that about two out of five people will have gastrointestinal symptoms such as diarrhea that heralds the onset of this infection.

Cassandra Holloway:  Absolutely. I think that's really important to just drive that home to our listeners.

Dr. David Lang:  Yeah. The other thing I'd like to mention, Cassandra, if I may, is that in the management of patients with these symptoms, particularly when a combination of avoidance measures as feasible combined with regular medication use is not effective, not feasible, not desirable, that if symptoms are ongoing with impairment of quality of life, that allergen immunotherapy is what we call it, or allergy shots, if you will, can be effective for reducing the level of symptoms and medication reliance on a long-term basis. And in properly selected patients that continues to be an option that we prescribe.

Cassandra Holloway:  Absolutely. That's great advice. Great. Well, that's all the time that we have today. Thank you, Dr. Lang, for joining us. I know you shared a lot of really great information that I know our listeners will really find value in.

Dr. David Lang:  Thank you, Cassandra. It's been a pleasure to talk with you.

Cassandra Holloway:  To learn more about springtime allergies, visit clevelandclinic.org/respiratory. If you want to listen to more Health Essentials Podcast featuring Cleveland Clinic experts, subscribe wherever you get your podcasts from or visit clevelandclinic.org/ag podcast. And don't forget to follow us on Facebook, Twitter, and Instagram at ClevelandClinic, all one word, to stay up to date on the latest news and information about coronavirus, as well as, your own health and wellness.

Cassandra Holloway:  Thanks again for listening. Take care of yourself and stay safe.