Allergies? Sinusitis?
How to Tell the Difference

You've got a scratchy throat and a runny nose, and a truly horrible headache.

Are you in the throes of seasonal allergies, which are already bedeviling people in many parts of the country? Or are you struggling with a bout of sinusitis, a condition in which the sinuses become inflamed or infected?

The answer may lie in a handful of telltale clues, doctors say.

On the surface, allergies and sinusitis are very similar, even though they are very different, says Dr. Alpen Patel, an assistant professor of otolaryngology at George Washington University Medical Center in Washington, D.C.

"In fact, it's very difficult for patients and health-care providers to differentiate the two, even with diagnostic studies and imagery," Patel says.

Both diseases affect millions of people.

Doctors estimate that about millions are affected by sinusitis every year, according to the National Institutes of Health. And about 32 million people suffer from seasonal allergies.

Allergies are caused by the immune system's overreaction to a misidentified threat, such as pollen. The body's cells defend themselves by releasing histamine, a chemical that causes an "allergic cascade" of familiar symptoms such as coughing, sneezing and a runny nose, says Mike Tringale, a spokesman for the Asthma and Allergy Foundation of America.

Sinusitis, on the other hand, can be triggered by a number of factors, including a cold, allergies or a virus, leading to irritation and inflammation of the sinuses. If left untreated, problems can last from weeks to months, even years, requiring antibiotics and bed rest, Patel says.

Both conditions share a number of symptoms, Patel says. They include:

• nasal congestion or blockage.
• nasal drainage either out of the nose or down the throat.
• cough.
• headaches and "sinus pain."

Making it even more difficult to distinguish between the two, allergy patients are more likely to have sinus infections than people who don't suffer from allergies, Patel says. "They often can't tell whether they have just allergies or an accompanying sinus condition," Patel says.

But there are critical differences than can help you figure out just what you've got.

The color and consistency of the mucus from your nose is one hint, Patel says. Allergy sufferers have thin mucus that's either clear or white in color. People with sinusitis have thick, discolored and foul-smelling mucus.

Because the histamines released during an allergic reaction can affect other parts of the body, people with allergies also will suffer symptoms outside of the sinuses. These could include watery, itchy eyes, and itchy skin.

Sinusitis, on the other hand, can sometimes be accompanied by a toothache or pain between the eyes, suggesting an infection is taking place, rather than an allergic reaction, Patel says.

When it comes to treatments, people with allergies can often control their symptoms with antihistamines, Tringale says. They also can get an allergy test that will give them a better idea what is causing the reaction, so they can avoid it.

With sinusitis, once a diagnosis has been made, some people can get by with rest, plenty of fluids and over-the-counter medications to treat their symptoms, Patel says. He recommends using a saltwater nasal spray to clean out the nose, to help wash away any viruses, and moisturize the inflamed sinus tissues. Pain relievers and decongestants also are helpful.

But if symptoms persist, more aggressive treatments are needed. A person diagnosed with acute sinusitis, for instance, might require a prescription for an antibiotic to eliminate the infection, and a decongestant to reduce congestion. Chronic sinusitis can be more difficult to treat and may require stronger oral antibiotics or intranasal nebulized treatments. If none of these approaches works, or patients have underlying physiological problems such as a narrow sinus passage, surgery may be necessary.

People with recurring and chronic sinusitis might also need a CT scan to determine the extent of their problem, Patel says.

And while these tips may help you tell the difference between seasonal allergies and sinusitis, experts recommend that you seek medical help for a correct diagnosis and the right course of action.

"Because they are so close company, it really requires the intervention of a doctor or allergist," Tringale says.

More information

To learn more about sinusitis, visit the National Institute of Allergy and Infectious Diseases.

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