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That Sneeze: Is it Allergy, Cold, Flu…or Covid?

That Sneeze: Is it Allergy, Cold, Flu…or Covid?

As spring sets in, trees and grasses burst out with pollens. Mothers tell me, “My child gets a runny nose every spring.” With COVID on everyone’s mind, however, we worry there might be a more serious cause this time. Hay fever, colds, the flu, and COVID all may present with cough and nasal drainage; determining the true cause is important.

Hay fever — our easy-to-remember name for allergic rhinitis — causes sneezing, a runny nose, and perhaps puffy eyes. The child won’t develop fever or chills, and nasal drainage is usually thin and clear. Shortness of breath or wheezing can occur if the sufferer has asthma, but usually not in those who don’t. Unless the sinuses become involved, antibiotics usually aren’t helpful. Instead, over-the-counter treatments of antihistamines, cough syrup, and a humidifier near the bedside is usually enough.

Prescription medicines can help, such as Montelukast (Singulair), a strong anti-allergy medicine, and occasionally steroids, particularly nasal sprays like Flonase. Allergy shots may help in prevention for those with severe symptoms. Masks have been proven to be helpful in reducing allergy symptoms, perhaps because the pollens causing allergies are 100 times larger than the viruses that cause infections, so masks are more effective in catching them.

Upper respiratory infections — known as the common cold — may be difficult to distinguish from allergic rhinitis. Rather than just bothered, the child tends to appear sicker, with less sneezing and more cough. Fever almost always indicates an infection, and the child’s snot may get thicker and colored. Colds are caused by viruses and don’t need antibiotics. However, if the child has underlying medical issues or if high fever or trouble breathing develops, a bacterial infection may have set in and antibiotics will be needed. 

The flu is caused by a specific set of viruses from the influenza family. Although symptoms are similar to those caused by cold viruses, instead of sticking in the upper respiratory system, flu viruses invade the body. Muscle aches, vomiting, and diarrhea are common flu symptoms, as well as headaches and sore throat. Fever and chills can be severe. Rest, fluids, and anti-fever medicines like acetaminophen and ibuprofen help. The prescription medicine Tamiflu can shorten the duration of symptoms. Influenza is much less common during the warmer months of summer.

Which brings us to COVID. Like colds and flus, COVID-19 is caused by a virus. In this case, it’s a coronavirus called SARS-CoV-2. Similar to the influenza virus, it spreads throughout the body, causing multiple symptoms including muscle aches, vomiting, diarrhea, “pink eye,” sore throat, blood clots, headaches and cough. One of the most unique symptoms is loss of sense of smell and taste. If your child experiences these symptoms, please consult your physician immediately.

Many issues can cause cough, runny nose and sneezing in children. If your child has a fever or appears ill, it’s best to schedule an appointment with your pediatrician.

Philip L. Levin, MD is a Coast-based physician and writer. He is the author of numerous award-winning stories and poems, many nonfiction articles, and eight published books, including two children’s books.

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