Get answers! Do you have a cold vs allergies vs sinus infection?

Are your wondering whether or not your symptoms are being caused by a cold vs allergies vs sinus infection?

Sick with cold vs allergy vs sinus infection
Get the right diagnosis and treatment below!

I already know your answer:  “I don’t care, just fix it!

Personally, when I feel sick (regardless of whether or not it’s a cold, allergy, or sinus infection) I am pretty much willing to take ANY medication, vitamin/supplement, enchantment or voodoo magic to feel better as soon as possible:

  • Take these 4 pills and risk liver failure?  I’ll roll that die!
  • You got some “newly discovered trick found on a 2000 year old tablet under a statue in China?” Great, I’ll take it.
  • What about an ancient anti-sickness interpretive dance from a cave painting? I’ll do it too!  (and submit it to YouTube and get some followers)!

I understand that, more than anything else, you want to feel better and feel better RIGHT NOW!

 

So I’ve created this guide to help you find out what is actually causing your symptoms (the distinction between distinction between a cold vs allergies vs sinus infection) as well as how to properly treat each one.  If this is what you want, read on!  I’ll try to make it as exciting as I can (OK, not a 10/10 exciting… maybe a solid 6 though)!

 

Why is it so hard to tell the difference?
Cold vs allergy vs sinus Infection?

I’m guessing you’ve probably had AT LEAST ONE experience where you started to get treated for one of these problems, then didn’t get better, then went back to your provider and they changed the diagnosis to something else!

I know, as a patient, I have had this happen (but as a doctor, I’m sure my record is 100% correct!)

The problem is that all these diagnoses are in your nose/sinus area, which has a lot of tiny, interconnected tubes and shared spaces blurring the underlying problem.

It is also possible the medical community has found a very sneaky way to charge you 3 times for the same problem (which is not true… or if it is, I haven’t been welcomed to the secret society of stonecutters where we learn this conspiracy).

If we assume that there is no conspiracy, then think of the cause of cold vs allergies vs sinus infection symptoms this way:

Cause of cold symptoms

Cold symptoms are usually caused by a virus triggers an immune response in the nose causing a runny, stuffy, sneezy nose with some drainage down the back of your throat.  The infection is in the nose itself.   But since your sinuses drain into the nose, if the nose is swollen it is possible for sinuses to get inflamed as well as cause sinus pain, pressure and headaches.

Cause of sinus infection symptoms

A sinus infection’s symptoms usually starts with a viral infection, but after 10-14 days bacteria decide that the virus had the right idea and set up a nice home in your sinuses, buy a bacteria Prius and raise their 2.5 bacteria kids.  The sinus infection causes your sinus pain, pressure and headaches.  It also causes drainage into the nose, which can cause inflammation as well as a runny, stuffy, sneezy nose and some drainage down your throat.

Cause of allergy symptoms

Allergy symptoms are caused by an allergen (pollen, pet dander, dust) hits the nose and triggers a different immune response than a virus but with similar outcomes:  a runny, stuffy, sneezy and itchy nose as well as drainage down the back of the throat.  If your inflammation is large enough, it can also plug the sinus tubes and cause sinus pain, pressure and headaches.

 

As you can see, colds, allergies and sinus infections all happen in the same area and cause very similar symptoms!  No wonder it’s confusing!

 

Why does an accurate diagnosis matter?

I’ve said this before but will say it again:  the biggest reason it is important to correctly diagnose cold vs allergies vs sinus infection is because the treatment is very different.  Getting the wrong answer (and wrong treatment) means you will feel sick longer!

Getting the correct diagnosis and treatment will get you feeling better… faster!

I’ll spend the next section discussing the subtle differences within each diagnosis (I’ll compare two at a time to make it easier to compare) and then after that discuss the best treatment options for each problem.

Celebrity Deathmatch:  where should you focus your hate?

Before I begin, please remember that this is as clear and distinct as I can make it but there WILL sometimes be overlap.  If you are unsure, please just send me a PM and I will help you as much as possible.

sinus infection vs cold vs allergy
Sinus headaches can happen in both colds and sinus infections.  But the subtle differences can help make the diagnosis!

Cold vs sinus infection

Cold Symptoms

  • Usually starts out of nowhere (and usually you are around people who are/were also sick)
  • Usually starts with runny or stuffy nose and often has drainage down your throat all day long (which can cause a sore throat)
  • It is possible to have a fever, but not always
  • Sinus pain tends to change (sometimes get better, sometimes worse) through the day, and seems to get better when your nose is less stuffy.
  • If you bend over to tie your shoe, you might get a runny or drippy nose
  • Sleeping is miserable because, often, you can’t breathe.
  • You can push on your frontal sinuses (behind forehead) or your maxillary sinuses (behind your cheek bones) without any problems
  • It causes grown men to become whiney boys and grown women to become whiney girls. (I’m very gender fair). Oh and kids to also be whiney if it will get them out of school but somehow not whiney as soon as they get to stay home.

Sinus infection symptoms

  • Often starts AFTER you had a cold or allergies first, but not always
  • You might have a stuffy nose, but not always. You can have a runny nose that drains down your throat, but this is often worse at night or first thing in the morning (But a nice warm shower in the morning give you a solid 2-3 minutes of relief).
  • It is possible to have a fever, but not always
  • Sinus pain and pressure are there all day long, often getting worse as the day goes on.
  • Bending down to tie your shoe is a miserable experience and causes every bit of anger and hatred in you to rise to the surface
  • Sleeping is miserable because the drainage down your throat.
  • There is often pain or pressure in your frontal sinuses (behind forehead), in your maxillary sinuses (behind your cheek bones) or in the center of your nose
  • You can sometimes predict the weather… in that your head feels like it is going to explode if a storm is moving in!

Cold vs. Allergies

Cold Symptoms

  • Often happens in the fall or winter, and a little in the spring. And usually there are people around you who are sick.
  • Usually has a runny and/or stuffy nose, with drainage down the back of your throat that can cause a sore throat
  • There are rarely eye symptoms
  • It is possible to have a fever, but not always
  • If you have sinus pain, it tends to change (sometimes get better, sometimes worse) through the day.
  • If you bend over to tie your shoe, you might get a runny or drippy nose
  • Sleeping is miserable because, often, you can’t breathe.
  • You can take an antihistamine all day long and it doesn’t help. Nothing helps.  You are miserable and always will be!  This is the worst!

Allergy Symptoms

  • Usually has a seasonal or predictable pattern (happens every spring, summer or fall, happens every time around pets, etc).
  • Often has a stuffy or runny nose, but also an itchy nose! There can be drainage down your throat, but it doesn’t usually cause a sore throat.
  • There can be itchy, red, watery or scratchy eyes
  • You should not have a fever! Fever often means infection, not allergies.
  • If you have sinus pain, it tends to be more constant through the day when you have symptoms and go away when you don’t.
  • You can tie you shoes all day long. You might get a little runny nose but not usually.
  • Sleeping is miserable because, often, you can’t breathe.
  • Antihistamines help. Not all the way, but enough to take you from a DEFCON 2 (“I’m about to throw things at you”) to a DEFCON 4 (“I’ll tolerate this, but I am NOT going to like it!”

sick-cold-vs-allergy-vs-sinus-infection
Are your symptoms due to cold vs allergy vs sinus infection? Pick the right diagnosis then pick the best treatment below

Allergies vs. Sinus infection

Allergy Symptoms

  • Usually has a seasonal or predictable pattern (happens every spring, summer or fall, happens every time around pets, etc).
  • Often has a stuffy or runny nose, but also an itchy nose. You often also have red, watery, itchy or irritated eyes
  • No fever! This is actually a trick question from the allergy boards too.  The correct answer is no fever!  And if you have a great aunt or someone who says otherwise… they’re wrong!  NO FEVER!
  • If you have sinus pain, it tends to be more constant through the day and worse when pollen counts are higher.
  • You can tie you shoes all day long. As long as you’re not standing in a field of grass or ragweed or in an adoption agency full of cats… which would cause symptoms to worsen.
  • Sleeping is miserable because, often, you can’t breathe.
  • You can’t cause pain by pressing on your sinuses.
  • People tell you that they have allergies and they’re “not that bad.” And you want to punch them for lying.

 

Sinus infection symptoms

  • Can happen at the same times as allergies… but often allergies start to bother you a little bit first and THEN sinus infection symptoms get you!
  • You might have a stuffy nose or a runny nose, but it shouldn’t be itchy. You might have some eye watering or pressure behind your eyes, but it shouldn’t be eye symptoms.
  • It is possible to have a fever, but not always
  • Sinus pain and pressure are there all day long, often getting worse as the day goes on. It is often better, briefly, in the morning.  Very briefly.
  • Tying your shoes is the equivalent of torture. Guantanamo Bay should have been shut down because tying your shoes with a sinus infection is the correct way to make people reveal secrets!
  • Sleeping is miserable because the drainage down your throat.
  • There is often pain or pressure in your frontal sinuses (behind forehead) or in your maxillary sinuses (behind your cheek bones) or in the center of your nose
  • People tell you that sinus infection headaches are no big deal. And you want to punch THEM for lying.

 

I think this is a fairly decent comparison.  Of course, there is always subtle differences.  Which is why WebMD hasn’t taken over my job yet (also, I tend to diagnose fewer people with cancer than WebMD so that’s nice).

If you don’t fit into one of these categories (or if you fit into many of them) and want further clarification, just shoot me an email and I will do my best to help.

Best treatment for cold vs allergy vs sinus infections
Pills. pills the musical fruit. The more you eat… wait, I think I got this song wrong.

Treating your CORRECTLY DIAGNOSED problem!

The whole point of this exercise is not just to say “gee whiz I now know what I have” and then keep feeling miserable.  The point is to feel better right away!

Let me jump right in to treatment, because the treatment plans for cold vs allergies vs sinus infection are very different.

 

Treating a cold

Let me tell you now that there is no good way to treat the common cold (again, unless there is a secret society with knowledge that I haven’t been invited to yet).  A cold needs to run its course naturally, which usually takes 7-14 days.   But you CAN treat the symptoms and make your days less miserable!

Your cold treatment plan:

  1. First, frequent hand washing. This prevents the spread to other people (who could then spread it back to you in a horrible pyramid scheme of germs)
  2. Second, fluids! I don’t care if it is water, Gatorade, Mio, or other liquids but you need to hydrate.  The fluids being lost from runny nose, drainage down your throat and tears of sickness-frustration need to be replaced.  Not replacing them can cause headaches, fatigue, dryness and keep you feeling sick.
  3. If your nose is stuffy:
    • Sudafed (pseudoephedrine) is usually the best and is found behind the pharmacy counter in the US.
    • Note: it can raise blood pressure.  If you have a blood pressure problem then change to a medication with chlorpheniramine (which is usually the cold/sinus medication NOT behind the pharmacy counter) .
  4. If your nose is runny:
    • Consider getting a prescription for nasal atrovent, which is GREAT at stopping a runny nose.
    • Sudafed and Benadryl can also work, but in this case they work by their drying side-effect, which can worsen #2 above.
  5. One of the biggest frustrations is not being able to sleep! So I usually recommend a topical decongestant like Afrin (oxymetazoline).
    • Note: this medication can cause a problem called rhinitis medicamentosa if you use it too much or for too long (which is where your nose becomes “addicted” to the medication).
    • I recommend using 1-2 sprays each nostril at night only x 6 days (the bottle says twice a day x 3 days, but once a day x 6 days lets you sleep and also prevents rhinitis medicamentosa.
  6. Finally, consider wearing a nose-strip at night to “open your nasal passages” a little bit more and help you feel better.

 

Treating a sinus infection

There are two parts to a sinus infection:  a viral stage, which usually happens first and lasts 14 (possibly up to 21) days and a bacterial stage which happens second.

How can you tell which type of sinus infection is yours?

Your viral sinus infection treatment plan:

Obviously the easiest way is time.  It is very uncommon to have a bacterial sinus infection in the first 2 weeks.  During this time, it is best to treat the sinus infection like a virus:

  1. Start with fluids. Sinus infections often have thick mucus which can really dry out your nose and throat.  Fluids no only help replenish the fluids lost but also help thin out the mucous a little.  And every little bit helps.
  2. Sinus rinses are a temporary friend. More correctly, I’d say “the enemy of my enemy” is the best way to describe sinus rinses.  They are often not fun by themselves, but they do a good job at getting some of the sinus gunk away.
  3. Mucinex (guaifenesin) is also a great addition because it helps to thin the mucous, which can then help it drain out of the sinuses and can relieve a lot of symptoms.
  4. If your nose is stuffy:
    • Sudafed (pseudoephedrine) is usually the best and is found behind the pharmacy counter in the US.
    • Note: it can raise blood pressure.  If you have a blood pressure problem then change to a medication with chlorpheniramine (which is usually the cold/sinus medication NOT behind the pharmacy counter) .
  5. If you have bad headaches, you can treat those with Tylenol or ibuprofen type products. But if you have a headache, I would also strongly consider implementing everything above to help eliminate the cause of the headaches.

 

Your bacterial sinus infection treatment plan:

If your symptoms last longer than 2 weeks, they have often undergone bacterial transformation.  Typically, the history is that you get a sinus infection that is not fun but then starts to get better.  Yay, right?  WRONG!  Because it then starts to get worse again.  That second wave is the bacteria taking over where the virus left off.

Treatment is symptomatic with everything above, but also add an antibiotic.

There are a lot of antibiotics out there to choose from, and I would defer to your medical provider for treatment.  But as a general rule, here are my antibiotic thoughts:

  1. The first line of treatment is usually a penicillin. Amoxicillin is a good choice to start with, but if you have recurrent or frequent infections you might bump it up to Augmentin (which is amoxicillin + a bacteria resistance fighting component)
  2. If you are penicillin allergic, I usually recommend a fluoroquinolone such as Levaquin (levofloxacin).
  3. I RARELY recommend azithromycin or a zpack. There have been some decent reports that show some areas have up to 50% resistance for azithromycin for sinus infections.  If you are in an area with low resistance, then it is an ok option.

 

Treating allergies

If your symptoms are most likely due to allergies and you need the best treatment… um, you’ve come to the right place.  I mean, an entire blog dedicated to sharing the treatment strategies of an allergist… for free?!  Plus, you can email me for personalized advice!  Yeah, I have good treatment for treating allergies.

Your allergy treatment plan:

I’ll reference the more detailed articles as I write them, but a great allergy plan includes:

  1. First, it is important to identify the cause of your allergies! This can be done pretty well with this quiz, but seeing an allergist or asking your primary care for an allergy blood test will be best.
  2. Second, once you identify your triggers you should implement some exposure reduction techniques.
  3. If you want some non-medication treatment options, I first recommend you consider starting a sinus rinse.
    • In my clinic I describe sinus rinses as “Roughly 75% of people love sinus rinses and 25% hate them and hate me forever suggesting them. If you’re in the first group, awesome.  If you’re in the second, don’t force yourself to use them because I have a lot of options.”
    • If you do want to try a sinus rinse, I recommend preparing it ahead of time and then using it when you first get into the shower. This way, the steam helps open up your nasal passages and when the gross and disgusting water comes back out your nose it just disappears down the drain!  Like magic!
  4. If this is not enough then you’ll need to add medications. There are a lot of medications to choose from, but often I recommend:
    • Start with a good nasal steroid spray.
    • If that’s not enough, you can ADD a nasal antihistamine spray
    • I also recommend a good antihistamine too.
    • I rarely recommend montelukast and if I do it’s usually for younger kids.
  5. If all this is not enough, or if you want to treat “naturally” by training your immune system to tolerate allergies, you have 3 options:
    • First, you can consider dissolvable allergy immunotherapy tablets (Grastek, Ragwitek, Oralair)
    • Or you can consider allergy immunotherapy drops
    • Or if you want the best results, you can consider allergy immunotherapy shots.
    • NOTE: if you want more information on these, please email me and I will try to help.

cold symptoms vs allergy symptoms vs sinus infection symptoms
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Now you’re on the way to feeling better!

Hopefully this has helped you get on a good path toward feeling better.  In my dreams, you read partway through this article and then rushed to the store to get the right medication to feel better (don’t ruin it for me… I would like to think that’s how the internet works).

If you found this article useful, consider liking it on Facebook (while you’re there, like my page too so you can keep getting these awesome tips).

And as always, if you have any questions please just let me know

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