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Sinusitis vs. Allergies: What's Up with Your Nose?

Nasal congestion and sinus pressure can make you miserable for weeks. You have to find the source of your symptoms to unstuff your nose.

Woman with sinus painYou’re feeling the pressure — in your nose, in your head. Yet nothing can release it. And all you want is for your face to feel normal again.

It must just be a really bad cold. But you’ve gone through all your go-to cold treatments with no luck.

A stuffy nose and headache are signs of many illnesses, including the common cold. It can even be difficult for your doctor to make a diagnosis. But when you’re past the point for a cold to have run its course, your symptoms are likely due to two similar conditions — sinusitis and allergic rhinitis — with very different causes.

Sinusitis — is that like a sinus infection?

One and the same. Sinus infections typically stem from a cold you just can’t shake. When the cold virus lingers long enough, the infection spreads into your sinus cavities. But sinusitis can also come from a bacterial infection. Either way, the symptoms are the same:

  • Sinus headache, pressure and pain
  • Stuffy and runny nose
  • Postnasal discharge, usually yellow or green
  • Bad breath
  • Sore throat
  • Cough
  • Tiredness
  • Light fever

“Some of the biggest things that distinguish a sinus infection that’s caused by bacteria, are the facial pressure and pain,” says Ashley Taliaferro, DO, Family Medicine physician at The Iowa Clinic in Altoona. “You often have a sinus headache with it, and feel pain in your forehead, cheeks — even your teeth.”

Woman spraying nose with nasal spray

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Isn’t allergic rhinitis a seasonal allergy?

Allergic rhinitis is more commonly known as hay fever. That’s a very confusing name. Allergic rhinitis isn’t brought on by hay, it doesn’t cause a fever and it isn’t confined to certain seasons.

In one form, allergic rhinitis is a seasonal allergy that affects those sensitive to certain weeds, tree pollen or grass. The season you suffer depends on the allergen.

The other form is perennial allergic rhinitis, where you can suffer from allergies year-round. Instead of outside allergens, this form is typically caused by dust mites, pet hair and dander, cockroaches or mold. Sometimes, a food allergy may be the root cause of your symptoms.

Allergic rhinitis leads to some of the same problems as a sinus infection. Your nasal passages are all blocked up, your nose runs, you develop a cough, you’re more tired than usual and the sinus pressure makes your head hurt. But hay fever displays the distinct signs of allergies as well:

  • Sneezing
  • Itchy, puffy, watery eyes
  • Itchy nose, mouth, throat or skin

How can you tell the difference between a sinus infection and hay fever?

Sinusitis vs. Allergy Symptoms

The symptoms aren’t completely the same but there’s plenty of overlap. A major differentiator however is in your mucus. An infection often leads to discoloration. Your snot will be thick and yellow or green. Allergies just make your nose run — your body’s way of flushing the allergen out of your nasal passages. Your mucus will be thin, runny and clear.

The other thing you can look at is the timing of your symptoms. If your symptoms came on quickly and all at once, it’s most likely an allergy. If your stuffy nose, cough and sinus pressure have been ongoing, chances are it’s a sinus infection.

“It’s not always obvious. It can be hard to tell the difference, even for providers,” says Dr. Taliaferro. “The timing often tells us which one.”

When your condition is chronic, it’s more difficult to distinguish between the two. Allergic rhinitis should resolve as soon as you’re no longer exposed to your allergen. But if you're sensitive to something in your environment and you don’t know it, you could have symptoms continuously.

The same is true of sinusitis. Your facial pain, sinus pressure and other symptoms can last a few weeks or a few months. Sometimes, sinus infections return regularly. Both can lead you to believe it’s seasonal allergies.

How do I get relief for my sinus and nasal issues?

Unfortunately, because of the nature of sinusitis and allergic rhinitis, you have to manage your symptoms with the treatments that work for you:

  • Antihistamines – While these medicines specifically target allergies, they help relieve the congestion and other symptoms that are associated with both sinusitis and allergic rhinitis.
  • Decongestants – Over-the-counter oral and nasal decongestants take care of that issue without the side effects of antihistamines. It can help with both sinus infections and hay fever.
  • Sinus rinses and nasal sprays – These treatments relieve congestion from any source by helping clear away the drainage. They especially help to flush out allergens. After a rinse or spray, you can breathe more easily through your nose.
  • Ibuprofen or naproxen – Sinus infections cause inflammation. Ibuprofen and naproxen are designed to relieve it.

“When it comes to treating allergic rhinitis, we focus on antihistamines and nasal sprays. Over-the-counter steroid nasal sprays like Flonase are the most effective thing. I tell patients to do two sprays in each nostril every morning,” says Dr. Taliaferro. “In addition, a daily antihistamine like Zyrtec, Claritin or Allegra can be helpful.”

Many patients get fed up with their stuffed up nose and sinuses and want medication that provides immediate and permanent relief. There usually isn’t one. Allergic rhinitis stems from allergen exposure and sinusitis typically comes from a virus. In some cases, the infection is bacterial and antibiotics are a solution.

“Other things can still be helpful, like rinses, steroid nasal sprays or decongestants,” Dr. Taliaferro says. “But if you’ve been taking over-the-counter medications for going on two weeks and are still having symptoms, that’s when we think about antibiotics.”

Symptoms that last for two weeks or that get a little better, only to get worse, are signs of a bacterial sinus infection. If at any point, you have overwhelming facial pain and pressure, fevers, chills, it’s time to see your primary care provider.

Chronic infections can cause complications and may be due to a problem with the anatomy of your sinuses. Severe year-round allergies may warrant a prescription or further testing from an allergist to keep you comfortable. Your provider will find the cause of your discomfort and the best method to resolve it.

“A virus should start to feel better. Sometimes allergies last an entire season,” Dr. Taliaferro says. “At that two-week time frame is when we can hopefully sort through whether you have ongoing allergies or a bacterial sinus infection.”

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