Sniffing out the truth about allergies, asthma and common colds

• Have you long suspected that every spring you experience mild allergy symptoms, and yet lately you wonder if it’s something worse — although you’ve never seen a doctor about it?
• Or, did you see a doctor years ago and were told you have asthma, but you’re feeling worse this year and wonder if you also have an allergy?
• Or, is it just a heavy flu season, and — together with all the rain — you’re just dealing with repeated common colds?

These, and many more questions like them, are swirling through the minds of countless victims of sneezing, itchy eyes, problems breathing.

HealthySteps to Wellness hopes to clarify some of the realities vs. myths surrounding these separate (but sometimes combined) ailments that share so many symptoms. In compiling these medical facts, observations and tips, HealthySteps to Wellness has drawn primarily from recent material presented by the American College of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and Markheim Heid’s 3/16/17 article in Prevention  (“Is your breathing trouble asthma — or something worse?”). We also received clinical information and expertise from Chitra Dinakar, MD, clinical professor at Stanford University School of Medicine and the Medical Director of Stanford HealthCare Allergy/Immunology Clinics.

The big take-away

The bottom line for anyone having a hard time with the symptoms discussed in this article: you should consider making an appointment to see your provider/allergy specialist, especially if (a) you were diagnosed with asthma but have not been evaluated recently (and therefore could benefit from an updated  asthma action plan and evaluation for possible co-morbidities, including allergies); (b) you have allergy symptoms that seem distinct from the common cold, and (but not only) you’ve tried OTC allergy medications that have not provided significant relief; or (c) you are an athlete having significant breathing problems even though you did not have asthma as a child.

Is it just a cold, or an allergy?

Especially if it is springtime, a season you know can bring on mild seasonal allergies for many people, you may be confused when you come down with a runny nose, stuffy nose and sinus congestion. Is this just the common cold, or a seasonal allergy? Here are a few ways to distinguish the two:

• If your cold symptoms occur even when you are inside, there’s a greater chance that you have the common cold, which is caused by viruses, whereas a seasonal allergy is typically caused by something growing outside. Thus, if you have a seasonal allergy, your sneezing fits and redness of the eyes will typically worsen when you go out versus improve when you come in (especially if you have central air-conditioning).
• If your nasal drainage is whitish-mucus-y and then yellowish-colored as it thickens, and then finally clears up, it’s likely a cold. With an allergy, on the other hand, you typically have clear, watery drainage from the eyes and nose. Allergy sufferers also experience more symptoms of “itchy” eyes and nose.
• If you have the common cold, the symptoms typically last for a short time — a few days to a week or so. In addition to a runny nose, stuffy nose and sinus congestion, you may have slight fever and feel tired and achy. However, resting, drinking warm fluids, and taking symptom-relief OTC medications makes you better and about back to normal in about a week to 10 days. With a seasonal allergy, on the other hand, symptoms keep occurring through the spring and may continue into the early summer — when you may notice that few people around you are sick. Resting, drinking warm fluids and OTC medications makes you a little better, but not well enough. You do not seem to get better after a week or two. You may experience wheezing, on occasion.
• Still unsure? Seeing a medical provider, particularly if you undergo allergy testing that can reveal the presence of underlying significant allergy triggers, is an important option to consider if you just can’t distinguish between a longer cold and a possible allergy.

I am still itchy and sneezing well past 10 days, and it’s not even springtime still … so if this is likely an allergy, what can I do?

See your doctor. Why is that the best advice? Because here’s what’s not  working for you:

• You may be treating symptoms without knowing their specific cause. More than two-thirds of spring allergy sufferers actually have year-round allergies. An allergist, a doctor who is an expert in treating allergies and asthma, can perform tests to pinpoint exactly what you are allergic to and then find the right treatment to stop it.
• You may be racking up drugstore receipts with no relief. If over-the-counter medications aren’t working, talking with an allergist about treatment alternatives might include trying a nasal spray, allergy immunotherapy shot or tablet — which can cure allergies in some cases, and keep you out of the drugstore aisles.
• You may be waiting too long to start treatment. Many people can benefit from an OTC allergy medicine, but they wait until after the sneezing starts. Don’t wait until you’re feeling bad to take allergy medication that has worked for you in the past; rather, try taking it just before the season starts. Local forecasts can be a helpful cue: when the temperature warms up, pollens and molds are released into the air.
• You may be exposing yourself to your “triggers” more than is necessary. Finding the right treatment is important, but it’s also essential to minimize your exposure to things you are allergic to. If you have a pollen allergy, keeping windows closed, showering when you come inside and staying indoors during mid-day when pollen counts are highest can make a big difference in how you feel.
• You may be eating produce that can trigger spring allergies. One in three seasonal allergy sufferers experience an itchy mouth, lips or throat, and may sniffle and sneeze after eating certain raw foods or fresh fruits. The condition is called oral allergy syndrome. The immune system of people who are allergic to pollen can sense a similarity between the proteins of pollen and those in foods. If you are allergic to tree pollen, for example, apples, cherries, pears, apricots, kiwis, oranges, plums, almonds, hazelnut and walnuts may cause an allergic reaction. Cooking or peeling the food may help, but be sure to talk to an allergist.

I’ve seen my doctor, and I have been diagnosed with a seasonal allergy… but why do my symptoms seem worse this year? Is it because it’s been so rainy out this winter?

Yes, there is some indication that a heavier rainy season can lead to a more severe seasonal allergy season. However, the weather factor that most experts believe is actually the greater culprit is the pattern of more extreme temperature swings characteristic of the global warming trend occurring worldwide, which is creating a longer seasonal allergy season. While this and other environmental factors, including pollutants, play a role in your worsening allergies, probably the most significant factor is repeated exposure to allergens over time, which suggests that seeing your doctor regularly is a key to diagnosing and treating your ailments appropriately.

As to the environmental factors, here are some you can partially control:

• Keep your windows closed at night and, if possible, use air conditioning, which cleans, cools and dries the air.
• Try to stay indoors when the pollen or mold counts are high. If your symptoms are severe, wear a pollen mask if long periods of exposure are unavoidable. When you return indoors, take a shower, shampoo your hair and change clothes.
• Avoid being responsible for mowing lawns or raking leaves. This stirs up pollen and molds. Also, avoid hanging sheets or clothes outside to dry.
• When traveling by car, keep your windows closed.
• Take any medications as prescribed.

Asthma vs. colds or allergies

While most asthma sufferers were diagnosed during childhood, adults can develop the disorder as well — and asthma rates are on the rise. Asthma is a chronic inflammation of the bronchial airways that can make breathing a struggle. Wheezing and chest tightness often occur, as well. “We call asthma a syndrome, not a disease, because it’s very complex,” Dinakar explains. “The ways it presents or the course it takes are variable, and not easily defined.”

How can you tell if your breathing problems could be asthma, rather than just a cold or allergy, or even something worse?

• You had asthma as a kid. It is very common for adult asthma sufferers to have had asthma during childhood. But, in some cases, these people learned to avoid certain triggers or behaviors, and so they stopped experiencing symptoms for a time. However, starting a heavy exercise regimen or being around a smoker can bring on their asthma symptoms once again. Therefore, as Dinakar explains, “if you had asthma as a child and you’re experiencing its hallmark symptoms, it’s a good bet your current breathing problems are related to asthma.”
• You tend to cough most when you laugh, at night, or when you exercise. “These sorts of coughing fits are all associated with asthma,” Dinakar says. That doesn’t rule out other respiratory conditions. But if you’re also experiencing shortness of breath or the other symptoms mentioned above, asthma is a likely culprit.
• Your breathing problems seem linked to your allergies. “Many classic allergens are also asthma triggers,” Dinakar says. If you have breathing problems after spending time around cats or other animals, or around pollen — especially if you’re experiencing other allergy symptoms like sneezing or itchy eyes — that’s a good sign you’re dealing with asthma.
• Other triggers seem to set off your symptoms. Along with the allergens mentioned above, “tobacco smoke and cold or dry air are also common asthma triggers,” Dinakar says. Also, if your breathing problems seem to fire up whenever you go to work, or to a specific location, that’s a red flag that you’re dealing with asthma related to an environmental irritant.
• You wheeze when you exhale, not when you inhale. Dinakar says it’s easy to confuse asthma-related wheezing to a similar condition called rhonchi, which is a kind of rattling or chest congestion that can signal other breathing-related health conditions such as COPD or bronchitis. “Rhonchi is usually caused by nasal obstruction and mucous in the chest,” she says. One way to tell it and wheezing apart: Asthma-related wheezing tends to be more of a high-pitched sound that is noticeable when you’re breathing out — as opposed to a congested sound that you notice when you breathe in.

I have some difficulty breathing, but only when I exercise — but I didn’t have asthma as a child. What’s wrong with me?

Exercise-induced bronchoconstriction, or EIB, is a serious but treatable condition that affects as many as 9 in 10 people with asthma, as well as 10 percent of people without it. See your provider for a proper diagnosis and, if advised, take up an asthma action plan that may include a rescue inhaler and controller medications, guidance on how to prevent and treat asthma attacks, and tips to minimize exercise-related breathing worsening.

Some tips to prevent, minimize or treat EIB symptoms (from the American College of Allergy, Asthma and Immunology website):

• Warm up at least 10 minutes before exercise.
• Breathe through your nose — it warms and humidifies the air.
• Use a face mask or scarf when in cold weather.
• Limit exercise if you have a viral infection, such as a cold, or when the air temperature is cold.
• Cool down after exercise.
• If you have EIB with asthma and allergies, avoid exercising outside when pollen counts are high or around pets if these are allergy triggers.
• If you are an elite athlete with EIB alone, cross training and some restriction of activities (e.g., limiting training to 20 hours per week) may be recommended.
• Consider walking, hiking, golf, baseball, football, gymnastics, swimming and shorter track and field events, which are less likely to trigger the condition than endurance sports such as running, biking, soccer and basketball.
• Even if your symptoms are mild, seek treatment to prevent damage to your lungs.
• See an allergist to discuss controlling EIB with prescribed medications. Quick-relief medications are used to open the lungs’ airways shortly before exercise. A short-acting inhaler — or bronchodilator — is carried at all times when exercising to stop symptoms when they start. Long-acting medications and inhaled corticosteroids are taken twice daily and can provide 12-hour control.

By Lane McKenna