Achoo 2

In prior blogs from 4/2010 and 9/2010, I bloviated as to the signs and symptoms of colds and respiratory allergies. Recently I have seen patients and coworkers who were not sure if they had a cold or "hay fever".

Colds are upper respiratory tract infections caused by rhinoviruses, coronaviruses and adenoviruses. An adult may average 2-4 colds per year; school aged children up to 12 colds per year. The cold virus enters one's body as an aerosol of viral particle (think sneezes), or by touching a surface that has been contaminated with a cold virus and then touching your eyes or nose. The symptoms of a cold (runny nose, sore throat, cough and low grade fever) lasts 7-10 days but may persist for as long as 3 weeks.

Allergies to plant pollens trigger the misery of seasonal allergic rhinitis. Red, itchy eyes, runny and/or congested nose are the most common symptoms. Post-nasal drip may trigger a cough, especially at night. Sinus pressure and pain may develop as the turbinates (fleshy masses in the nose) swell and block the outflow tracts of the sinuses.

The presence of a fever would indicate that one has a cold. Nasal mucous that is thick and yellow is more common with a cold. Allergic rhinitis usually produces watery, clear drainage. Allergy symptoms come on abruptly after exposure. Brushing the dog may release pollen that has settled on Fido's fur and achoo.

Seasonal allergies occur when the source of pollen or other offending allergen are in the atmosphere. My personal pollen poison is ragweed from August until the first frost. Colds may strike at any time of the year but are more common in the Northern Hemisphere from September to April.

Over the counter cold and allergy preparations are equally effective (ineffective) for colds and allergy symptoms. Allergic rhinitis and conjunctivitis have prescription remedies that are not appropriate and may worsen or prolong a cold. Steroid nasal sprays are very effective in treating allergic rhinitis. They diminish the IgE release of histamine by MAST cells and certain white blood cells.

The use of Neti pots, echinacea, zinc sprays and lozenges, large doses of vitamin C and a steaming bowl of chicken soup have all been recommended as treatments for colds. All are probably harmless and useless. At least the chicken soup tastes good.

The ER sees lots of patients suffering from the annoying symptoms of colds and allergies. The 24/7 availability and the lack of primary care providers contribute to this use of the ER for non urgent problems. The caring ER staff stand ready with boxes of tissues and lots of compassion to help differentiate the cause of your nasal symptoms and prescribe the correct treatment.