Q&A: How to distinguish between COVID-19 and allergies, sinusitis

Treating patients with allergy-like symptoms can be difficult during the pandemic, especially when patients show signs that resemble COVID-19.

Chronic rhinosinusitis can share similar symptoms to a viral infection in patients, but there are key differences that can be helpful when making a diagnosis and determining treatment.

Jessica Grayson, MD, assistant professor in the department of otolaryngology at University of Alabama at Birmingham, spoke with Healio about what physicians should look for when treating patients with these symptoms.

Healio: What are the overlapping symptoms that make it difficult to distinguish between COVID-19 and chronic rhinosinusitis?

Jessica Grayson

Grayson: One of the big issues is that you can have nasal congestion with both. It can be an early-onset symptom with COVID-19, and it can be a long-standing symptom with chronic rhinosinusitis. Rhinorrhea — drainage from the nose down the back of the throat, out the front of the nose — also may be present for both. Some people have said with COVID-19 they feel like they have a cold, so they can get a little bit of facial pain and pressure, which we can also see in sinusitis. Smell loss also is an overlapping symptom.

Healio: What key differences in symptoms should doctors look for?

Grayson: COVID-19 comes on suddenly. The nasal congestion and smell loss in COVID-19 will come on suddenly, whereas these are more insidious symptoms in chronic rhinosinusitis. Symptoms of chronic rhinosinusitis had to have been there for a long period of time, at least 12 weeks, to even be considered chronic sinusitis. So, it's not something that came and went. If it comes on quickly, it is typically viral.

Healio: How should a doctor diagnose and treat chronic rhinosinusitis?

Grayson: The truth in the world right now is it is all COVID-19 until proven otherwise. Patients should get a COVID-19 test upfront, and then if that is negative and the patient has symptoms that lasts beyond 7 to 10 days — because that is typical for viral sinusitis — then they should be evaluated to determine whether they should undergo courses of antibiotics and steroids, and they should start rinsing the nose out with saline, such as with saline washes or with a neti pot. Taking these steps is really helpful to help distinguish who is actually going to have long-term sinus inflammation, and who is just dealing with a post-viral sinusitis. If patients do not respond to that treatment, then that is a good time to send them on to ENT.

Healio: How common is chronic rhinosinusitis?

Grayson: Chronic rhinosinusitis is one of the most common illnesses that afflicts Americans and it is responsible for millions of dollars in lost wages every year.

Healio: Are there steps that patients can take to avoid chronic rhinosinusitis?

Grayson: There is not really much you can do to prevent the inflammatory processes, because we do not really know what causes them and there is a lot of flavors of chronic sinus disease. There are ones that follow asthma, there are some that follow allergy and there are some that are almost autoimmune-esque, some of which are driven by autoimmune diseases. In general, there is not a good way to prevent it, except that if a patient has terrible allergies, managing them earlier can prevent worse sinus symptoms, for example, with allergy testing and immunotherapy allergy shots, to help make them not allergic anymore.

You cannot really prevent exposure to viruses, but you can do some things such as wearing a mask, washing your hands and eating healthy but, in general, we all are still going to come into contact with them. Patients with symptoms that do not get better after about 2 weeks should see their physicians so that they can stop whatever inflammatory process is continuing to rumble on. Outside of that, there is not much you can do to prevent it from happening, but you can act early to prevent or at least get on top of symptoms before they get out of hand.

Healio: Can a previous COVID-19 infection impact symptoms of chronic rhinosinusitis?

Grayson: We do not have any evidence of anything like that in our patients. However, those patients who have had COVID-19-induced smell loss have struggled to regain smell. Although viral-induced smell loss is not new, 200 other viruses can also cause this, but COVID-19 has certainly caused smell loss at higher rates and with incomplete recovery of smell. We haven't seen any evidence that having had COVID-19 makes future sinus infections worse.

For more information:

Jessica Grayson, MD, can be reached through the UAB media contact Adam Pope at arpope@uab.edu.