Allergies, covid and vaccines: Your questions answered

In ordinary springtimes, many allergy sufferers must cope with bothersome, or even debilitating, symptoms such as itchy, red, watery eyes; sneezing; a runny or stuffy nose; and sometimes, coughing, wheezing or feeling short of breath. But during this pandemic, they are also dealing with concerns about whether their symptoms might be due to covid-19.

As the beginning of this year’s pollen season coincides with yet another troubling increase in new coronavirus infections, we’ve compiled answers to some of the most commonly asked questions about allergies, the coronavirus and vaccines. The information and recommendations below are drawn from previously published Washington Post articles and new interviews with allergy and immunology experts.

Please keep in mind that as research into the virus and vaccines continues, guidance may change.

Q: How do I know if it’s allergies or covid?

A: “It can be confusing, and it’s important to differentiate,” Sally Joo Bailey, an allergist at Allergy Associates of Northern Virginia in Arlington, told The Washington Post in early March last year. “If it’s viral, every time you cough, you’re spreading droplets” that can infect others. Allergies, on the other hand, are not contagious.

There are key differences between the virus and allergies that should help you determine what’s causing you to feel unwell. One of the symptoms doctors often look for is the presence of a fever, typically a temperature above 100.4, says Jody Tversky, an assistant professor of medicine and former clinical director of the Division of Allergy and Clinical Immunology at Johns Hopkins University.

“It would be very unusual for someone with nasal or sinus allergies to develop a fever,” Tversky says. “That just really doesn’t happen on exposure to allergens.”

Other symptoms more commonly associated with viral infections include chills and body aches. It is also unlikely that common allergies would cause you to suddenly lose your sense of smell and taste, another telltale sign of covid, says Ryan Steele, a board-certified allergist-immunologist and internist and assistant professor of clinical medicine at Yale.

To help people figure out the likely cause of their symptoms, the American Academy of Allergy Asthma and Immunology and the Asthma and Allergy Foundation of America (AAFA) have created online charts comparing allergies, covid, the flu and the common cold.

But rather than relying on symptoms alone, experts recommend assessing other factors, such as your history of allergies, the timing of the onset of your symptoms and whether you may have been exposed to the coronavirus.

“If you tell us, ‘I’ve never had allergies before, but I went to a dinner party last week and I found out that three people tested positive for covid, and now I’m getting symptoms that I have not experienced – congestion, stuffy nose, feeling a little bit tired,’ that’s very different than someone that tells you the same sort of symptoms with no new exposure, but in fact, a long history of allergies,” Tversky says.

When in doubt, get tested if possible, advises Mitchell Grayson, chair of AAFA’s Medical Scientific Council.

“That takes the covid risk off the table, because that’s going to be the most worrisome piece of this,” Grayson says, adding that you should “act as if it is covid until you find out otherwise” through your test results.

Dr. Purvi Parikh, NYU Langone health System specialist on infectious disease allergy and immunology, co-investigator in the Pfizer clinical trials. Photo: courtesy Dr. Purvi Parikh.

It also may be helpful to start preventive treatments for seasonal allergies or asthma symptoms early, says Purvi Parikh, an allergist and immunologist with the Allergy and Asthma Network.

“We recommend that every year, even when there’s no pandemic,” Parikh says. It’s especially important this year, she adds, because if at least “your allergy and asthma are under control, it’s easier to navigate what’s going on.”

Q: Does having allergies increase my risk of contracting covid?

A: There is no definitive scientific evidence that people with allergies have a greater chance of becoming infected and falling ill, experts say.

A recent large-scale international study published in the Proceedings of the National Academies of Sciences found that higher airborne pollen levels appeared to be associated with an increase in coronavirus infection rates. But experts emphasize that correlation does not necessarily mean causation and are urging people to not jump to conclusions about their risk levels based on those findings.

“The first thing to do is not panic,” Tversky says. Instead, he recommends continuing to practice risk mitigation strategies such as masking. Wearing masks, he adds, may serve “double duty on a high-pollen-count day. This may prevent not only virus particles from being inhaled, but it may prevent pollen particles from being inhaled.”

Q: Should I be vaccinated against covid if I have allergies?

A: A common misconception among people with allergies is that they can’t safely be vaccinated against the coronavirus, Parikh says.

“Unless you’re allergic to an ingredient in the vaccine itself, there’s no reason to avoid it,” says Parikh, a vaccine researcher who has been involved with trials at NYU Langone Health. She noted that people with seasonal allergies also are not at increased risk for developing side effects or having serious adverse reactions to the shots.

These recommendations are supported by the Centers for Disease Control and Prevention. In its guidance about allergies and the vaccines, the agency cautions against taking certain shots if you have had a previous allergic reaction to ingredients such as polyethylene glycol, also known as PEG, or polysorbate. PEG is an ingredient in the Pfizer-BioNTech and Moderna mRNA vaccines and polysorbate is used in the Johnson & Johnson vaccine.

If you have an allergic reaction within four hours of receiving your shot, the CDC does not recommend getting a second dose of the same vaccine. If you have had allergic reactions to other vaccines or injectable therapies in the past, the CDC recommends talking to your doctor about whether you should get any of the available coronavirus vaccines.

Another potential reaction to the vaccine is a red, itchy, swollen or painful rash at the injection site known as “covid arm.” In this case, the CDC says you should still get a second shot of that vaccine. The agency recommends telling your vaccination provider about the reaction, noting that the provider may then suggest you get the second shot in your other arm.

Grayson and other experts say they are generally not advising people with a history of anaphylaxis or reactions to non-coronavirus vaccines to skip the shots.

“You should be observed, but you should still get the coronavirus vaccine,” Grayson says. The small risk of some populations having additional side effects “is far outweighed by the value of the vaccine itself,” Tversky adds.

Approved vaccination sites have a recommended 30-minute waiting period after the injection for people with a history of reacting to vaccines and are equipped to treat anaphylaxis, Steele says. Although the CDC has reported that such events are uncommon, anyone at risk should come prepared for the possibility of a severe allergic reaction.

“If somebody does have a history of anaphylaxis, they should bring their own EpiPen with them,” Steele says. “Just in case you do fall outside that window or it’s on the way home, you do have protection.”

Q: How should I prepare for my vaccination?

A: People with nasal or sinus allergies often also have asthma, and if you’re among them, experts recommend getting your asthma symptoms under control before taking the vaccine. Acute or uncontrolled asthma could make an adverse allergic reaction more severe.

“Generally speaking, we tell patients if they have asthma, to make sure their asthma is under control before they have any sort of therapy, whether it’s a coronavirus vaccine or allergy shots or any other sort of remedy,” Tversky says.

As noted above, experts advise trying to control any seasonal allergy symptoms this spring. But a runny nose, sneezing or itchy eyes aren’t reasons to delay getting your vaccine, Grayson says.

“If you have the opportunity to get the vaccine, get the vaccine,” he says. “If it wasn’t a pandemic situation, I would say then you have the luxury of time.”

Q: I get regular allergy shots, how should I schedule my vaccine appointment?

A: Avoid getting your allergy shot and the coronavirus vaccine on the same day. The American Academy of Allergy Asthma and Immunology recommends separating the shots by 48 hours.

“The reason why is simply so there’s no confusion about a reaction,” says Grayson, who is a member of the organization’s coronavirus task force. “But there is no mechanistic reason to really space them out at all.”

Q: Will my allergy medicine have an effect on my immune system’s response to the vaccine?

A: Common over-the-counter allergy medicines such as inhalers, nasal sprays and antihistamines should not have a significant impact on your immune system’s ability to respond to the vaccine, experts say. But if you’re taking regular high doses of oral or injectable steroids, you should consult with your doctor before getting vaccinated.

“Steroids suppress your immune system; that’s how they work,” Parikh says. “Often you need to suppress your immune system if you’re having a flare up of allergies or asthma or other conditions” such as autoimmune diseases.

“But because of that effect of the steroid, it can also suppress things you don’t want to suppress, like the formation of antibodies or T-cells that help you fight covid-19,” she adds. “So ideally, it’s best if you don’t need the steroid during that time to be off of it, but sometimes it’s unavoidable.”

Inhalers and nasal sprays also contain steroids, but they usually only have a small amount and not much is absorbed into the body, Grayson says.

Experts emphasize that you should not make the decision on your own to abruptly stop taking prescribed steroids. Even if your doctor can’t pause or adjust the dosage of your medication, “the likelihood is most people will still mount a response to the vaccine,” Grayson says.

Steele agrees. Though “you may not make as robust an immune response,” he says, “it’s still going to be better than the protection you would have if you’re not vaccinated.”

Q: Where can I go for trusted information?

A: Always talk to your primary care provider or allergist if you have concerns or questions. Experts also recommend using online resources provided by the CDC and trustworthy professional medical organizations.

You should not try to self-medicate, especially if you’re not sure whether you have covid, Parikh says. Any serious or abnormal breathing issues should be seen by a medical professional.

If you have an allergy to ingredients in the coronavirus vaccines, it’s important that you don’t “write off getting the vaccine all together,” Steele says. “Now that we have multiple vaccines, even if someone has an allergy to the component of one, we can now have an alternative to give them, so it’s really important that they get evaluated by an allergist and we can usually find a safe vaccination strategy.”

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The Washington Post’s Sindya Bhanoo contributed to this report.

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