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Allergy or Cold?

As many as 40 million Americans suffer from allergies, and many more suffer from the common cold. Allergies and colds share many of the same symptoms, but effective treatment depends on knowing which one you have. As a family doctor at New York Presbyterian-Columbia, Dr. Marion Richman has seen her share of both. Below, she answers some fundamental questions about making the distinction between allergy and the common cold.


Do you find that patients often confuse colds and allergy?

Definitely. There are just so many overlapping symptoms between the two that it's very easy to confuse them. Doctors confuse them as well.

So what is the difference between what causes a cold and an allergy?

An allergy is an inappropriate immune response to a substance in the environment that's normally harmless. A cold is an infection which is contagious. Ninety-nine percent of the time it is caused by a virus, and very rarely by bacteria.

What are the signs and symptoms of each one?

The signs that are common to the two are runny nose and nasal congestion. More particular to allergies are the itchy, watery eyes and/or throat and the clear, runny nose. With colds you are more likely to have a fever, and maybe some sinus pain. Also the mucus discharge may be a different color, like green or yellow.

How can a person tell the difference?

It's difficult. But if you're getting a cold at the same time every year, or after you visit your cousin who has a cat, and get symptoms, you might have an allergy. There are also some other telltale signs of having an allergy, like eczema, itchy skin, asthma or a history of allergies in the family. A cold usually follows a time course of about 7 to 10 days, usually with a predictable series of symptoms. But it is possible that they have identical symptoms.

How does a doctor tell them apart?

Using good detective work, but sometimes it's trial and error. If the person's coming back to the doctor again and again and the cold remedies aren't working, a doctor will begin to suspect it's an allergy.

What are the treatment options for a cold?

Doctors don't have a cure for the cold, so the treatment options are limited to treating the symptoms. For the congestion there are decongestants. For runny nose there are antihistamines. Cough suppressants can help with a cough.

What are the treatment options for allergies?

Before any kind of medical treatment, it's best to try to modify your lifestyle to avoid what is causing your allergies. For example, if you're allergic to cats, try to avoid them.

Treatment options for allergies are a little broader. You can use the over-the-counter cold remedies, but, the non-sedating antihistamines are a mainstay of allergy treatment. Steroids, which help reduce inflammation, are also used. They can be sprayed into the nose, or taken orally for short term relief. There are also allergy shots, or immunotherapy that exposes a person to the allergen in order to increase their tolerance to that substance. Allergy shots are usually reserved for people who have severe allergies.

At what point should a person with congestion, runny nose and sneezing see a doctor?

If it's a cold, it's usually going to follow a time course of about 7 to 10 days. If you've had a cold for a month, you should go see a doctor. If you have a temperature of over 101°F for three days or more, or if you develop pain in your ear, throat, sinuses or teeth, you could be getting an infection, and should see a doctor. If there's any trouble breathing, you should go to the emergency room immediately.

Children also suffer from allergies and colds, and have similar allergy symptoms to adults. Allergies are rare in kids under 3 years old. But in older children, if they're getting recurrent ear infections or hearing problems, then you might want to see the child's doctor, and inquire if the problem might be related to an allergy.

However, a fever is definitely a warning sign of something more serious. Allergies don't usually cause a fever, so if your child does have a fever or if they're complaining of any kind of pain or having any trouble breathing, then they should see a doctor. If they're not eating or drinking as much as they usually do or not going to the bathroom, those are definite reasons to come to the doctor immediately.

What are some of the treatments available for children with cold or allergy?

Richman feels that with young children, over-the-counter medicines for colds, and even the prescription ones, are not that effective, and using these medications are not worth the risk of side effects. Toughing it out is a better approach to a child's cold.

In terms of allergies, there are some non-sedating antihistamines that are approved for children as young as 2 years of age, and they come in syrup form or they come in dissolvable tablets that go under the tongue. For the kids that truly have allergies, those treatments are out there for them, and do help.