How to Differentiate Between a Cold, Flu and Allergies

Todd Richwine, D.O., Family Medicine

As we are currently navigating fall allergy season, and we prepare for cold and flu season, in addition to the ongoing COVID-19 pandemic, chances are seasonal illness may be on your mind more than usual this year.

When you first start noticing a sore throat, congestion and a runny nose, how do you know what you’re dealing with? We reached out to Todd Richwine, D.O., family medicine specialist and physician on the medical staffs at Texas Health Southwest Fort Worth and Texas Health Family Care – Clearfork, a Texas Health Physicians Group practice, for advice on how to recognize the telltale signs of a cold, the flu and allergies.

 

Recognizing Symptoms

“Typically, the flu has a sudden onset and you’ll experience high or at least moderate fever and frequent body or muscle aches. Chills, fatigue and headaches are common,” he explains. “Colds typically come on slowly, meaning there is a gradual progression of symptoms and people go from wondering if they are getting sick to progressing to where they know they are. I often hear patients say they felt normal and then were suddenly sick with the flu, while it is a very gradual progression with the common cold.

“With colds, fever is rare (at least above 100 degrees), aches are mild and chills are uncommon. There typically is more congestion, sneezing and sore throat with a cold, and headaches are rare.”

The five most common winter illnesses are the common cold and the flu, along with pneumonia, RSV and strep. And while these tend to trend upward in the colder months, if you’re an allergy sufferer, you know all too well allergies can be a problem in North Texas year-round.

Richwine says allergies may share some of the same symptoms with colds and the flu, but there are some marked differences.

“Allergies typically cause a lot of the upper respiratory symptoms like a cold, such as sneezing and congestion, but you’ll also have runny or itchy eyes and itchy skin. Those with allergies may feel tired, but typically don’t describe themselves as feeling sick. Colds and flu typically run their course within five to 10 days, where allergy symptoms can last as long as the person is exposed to what they are allergic to, often weeks to months.”

 

Over the Counter Treatments

As more prescription allergy medicines have switched to over-the-counter (OTC), there has been a clear shift toward these oftentimes more convenient and affordable options. In 2020, it was reported that Americans spent $36.5 billion on OTCs — the highest its ever been. In fact, 81 percent of adults use OTC medicines as a first response to minor ailments.

But while consumers have access to everything from pain relievers and antihistamines to nasal sprays and cough drops, there are differing opinions as to how effective OTC medications really are.

“Over-the counter-medicines are very helpful with allergies, both the oral antihistamines like Claritin and Allegra and the nasal steroid sprays like Flonase and Nasonex,” Richwine explains. “They typically are much less helpful for the flu or a cold. Ibuprofen or Tylenol products can address aches and fever, and decongestants and mucolytics can help some of the congestion symptoms for colds. Beyond that, most other OTCs haven’t been found to help much.

“The best ‘medicine’ hasn’t really changed much, which is to cover coughs and wash your hands frequently to not spread your illness to others, get lots of fluids and plenty of rest, and allow yourself the time to get well.”

 

When to See the Doctor

Sometimes it’s difficult to know when to make an appointment to see your physician, especially if you’re not sure what you have. Is it worth the time and money just to be told to rest, drink plenty of fluids and soothe symptoms with OTCs?

Richwine has a few tips for knowing when to head to the doctor.

“Most people have been either sick with the flu or a cold at some point, so if they feel like they or their loved one feel worse than they would expect, I would encourage them to see their provider,” he says. “Shortness of breath could be an indication they have a complication from the flu, like pneumonia, or even COVID-19. Other things to watch for in adults are pain or pressure in the chest or abdomen, confusion, and severe or persistent vomiting. Those that are high risk, such as those with chronic respiratory issues or who have their immune system suppressed from medications or disease, should see their provider. I would also recommend that caregivers of those who are chronically ill see their providers if they have flu-like symptoms.

“In children, you want to watch out for fast or troubled breathing, bluish skin color, not eating or drinking well, not waking up or interacting well, a fever with a rash or, in the case of infants, being so irritable that he or she doesn’t want to be held. If a child or adult gets better for 24 to 48 hours, then starts getting sick again, that is a good indication for them to see their provider as well.”

 

Preparing for the Season

Thankfully, unlike this time last year, we do have a vaccine for COVID, in addition to this season’s flu vaccine. Getting both can help decrease the number of cases and/or the severity if you do end up contracting either the coronavirus or the flu virus — meaning there’s more of a chance you can recover at home versus at a health care location.

“Most physicians in practice believe that even those who get the flu with a flu shot tend to have more mild symptoms, are at much less risk for the severe symptoms, and in general do better than those who do not get the vaccine. A lot of people also don’t understand that you can get Flu A and Flu B during the same year, as they are different viruses, so there may be a reason to get a flu shot even if you have already had the flu.”

Typically, the CDC recommends getting vaccinated by the end of October to give the vaccine time to protect your body before the peak of flu season (December-February), but this year the organization is advocating to get vaccinated as soon as the vaccine is available in your area. You also don’t have to space out your flu shot and your COVID vaccine if you’re planning on getting both around the same time, according to the CDC. However, it is recommended that if you’re receiving both vaccines, you should receive them in different arms if you can to reduce and/or identify localized reactions.

Many of the locations that you can receive your flu vaccine are also locations you can receive your COVID-19 vaccine as well, if you haven’t already received it. If you need help narrowing down a location, you can call 2-1-1 or visit 211Texas.org to find information on vaccine availability from local public health departments and other nearby non-profit organizations.

In need of a primary care physician this cold and flu season? Head to TexasHealth.org/provider to find the closest physician near you this cold and flu season, and every season. 

Want more tips? Read our post “5 Ways to Arm Your Immune System” to get prepared this season.

Texas Health Physicians Group providers are employed by Texas Health Physicians Group and are not employees or agents of Texas Health Resources hospitals.

2 Comments

  • marie valentino says:

    These links are always so informative. thank you

  • Patricia Gay says:

    3/17/18
    Many thanks for the above very helpful info & clues for determining differences between cold, flu, & allergies & remedies for each, as well as when to head to Dr. Thanks for taking the time & effort to help many of us confused about similarities/differences.
    Gratefully,

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