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FILE - In this March 26, 2020, file photo, people exercise on the trail along Kelly Drive in Philadelphia. For millions of seasonal allergy sufferers, the annual onset of watery eyes and scratchy throats is bumping up against the global spread of a new virus that produces its own constellation of respiratory symptoms. That's causing angst for people who suffer from hay fever and are now asking themselves whether their symptoms are related to their allergies or the new coronavirus. (AP Photo/Matt Rourke, File)

CLARIFICATION: This story was updated at 11:43 a.m. on Thursday, April 2, 2020, to clarify the fourth paragraph to state that allergies are reactions to "allergens or substances." A previous version stated "irritants."

With the COVID-19 outbreak at the height of spring tree pollen season, which is typically late March through mid-April, people who experience allergy-like symptoms may question whether those symptoms are caused by the coronavirus or allergies.

"It's a really awkward time to have bad allergies," said Dr. Michael Hollie of the Allergy & Asthma Group of Galen.

Fever is one of the three main coronavirus symptoms — which also include coughing and shortness of breath — that is not a symptom of allergies. Muscle aches and gastrointestinal symptoms, such as diarrhea, are other symptoms that are not associated with allergies but could indicate coronavirus infection, he said.

The coronavirus is an infectious organism, while allergies are reactions to allergens or substances such as mold, pollen, dust mites or pets, said Dr. Susan Raschal of Covenant Allergy & Asthma Care.

Allergy symptoms include a wet cough; itching of the ears, eyes, mouth or nose; sneezing several times in a row; and a stuffy nose. If the pollen count is high and the person has no fever or body symptoms, they are most likely experiencing allergies, she said.

Someone with allergies who develops a sinus infection may feel tired, but they won't feel so achy that they want to stay in bed all day like someone with COVID-19 or influenza, she added.

"The hard part right now is that additional [coronavirus] symptoms are popping up" that mimic some allergy symptoms, Hollie said.

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Doctors in Germany, Italy, China and South Korea report that significant numbers of patients infected with COVID-19 experience loss of smell, and doctors are also reporting an increasing number of COVID-19 patients whose sole symptom is loss of smell, according to ENT UK, a professional association for ear, nose and throat practitioners in the United Kingdom.

People with severe allergies occasionally experience some loss of smell, said Hollie, which can be confusing when trying to distinguish between COVID-19 and allergy symptoms.

According to the American Academy of Ophthalmology, several reports also suggest the virus can cause mild conjunctivitis, aka pink eye, which people could mistake for red, itchy eyes associated with allergies.

If someone is unable to rule out COVID-19 or allergies based on their symptoms, Hollie said, the best thing to do is to talk to their allergy doctor.

"During this time it's really important to stay in contact with your physician," said Hollie, who started offering telemedicine last week and is now seeing most of his patients virtually.

When seeing a patient via telemedicine, he is able to evaluate patients by taking down their history, listening to their breathing, and examining their skin and the inside of their mouth, he said.

Raschal, who offers telemedicine as well, also recommends that people with allergies who have not developed asthma consider allergen immunotherapy shots, drops or tablets, as allergy patients who have used those treatments are less likely to develop asthma than those who don't.

Do allergies make a person more susceptible to coronavirus infection?

"We don't know if allergies make you more susceptible [to coronavirus infection]," Hollie said.

Raschal said doctors also don't know if COVID-19 can trigger asthma, which affects about half of people with allergies. But allergies can and often do trigger and cause asthma, she said.

People with asthma who get COVID-19 are more at risk for severe symptoms, Hollie said.

Both doctors stressed the importance of people keeping their allergies and asthma under control with continued use of their regular medication.

Hollie also recommends those who suffer from allergies limit their exposure to pollen, including tree pollen over the next four to six weeks and grass pollen from late April through early July.

Raschal warned that people with asthma who use a nebulizer for treatment use it in an area away from other people in a well-ventilated area. If they have the virus, the nebulizer can cause secretions from the mouth to aerosolize for up to two hours and infect other people, she said.

Contact Emily Crisman at ecrisman@timesfreepress.com or 423-757-6508.

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