Cold vs. Allergic Rhinitis: Symptoms, Duration, and Diagnosis

Symptoms of a cold

Sneezing, Runny nose, Nasal congestion, Thick, dark mucus, Sore throat, Mild body aches. Symptoms take about 3 days to appear and last 7-14 days.

Symptoms of allergic rhinitis

Prominent sneezing, Runny nose, Nasal congestion, Thin, clear mucus, Red, watery eyes, Itchy nose, eyes, or throat. Symptoms can last for days or months.

Duration of cold symptoms

7-14 days.

Duration of allergic rhinitis symptoms

Days or months.

Difficulty distinguishing cold from allergies

Symptoms of the common cold and allergies are very similar.

Type of infection for the common cold

Benign self-limited viral infection of the upper respiratory tract (URI).

Common viruses causing the common cold

Rhinoviruses (30-50%), Coronaviruses (10-15%), Parainfluenza viruses (5-15%), Others (20-30%).

Colds experienced by adults each year

2 to 4 colds.

Colds experienced by children each year

6 to 10 colds.

Complications from colds

Bacterial superinfections, Acute otitis media, Acute bacterial rhinosinusitis, Bronchitis, Pneumonia, Asthma exacerbation.

Infection rate increase for colds

During fall through spring, highest in winter months.

How viruses enter the upper respiratory tract

Inhalation of aerosols, Infected droplets, Direct contact with contaminated secretions.

What occurs after viral entry into cells

Viral replication, Shedding for several days to weeks.

Causes of clinical symptoms in colds

Epithelial cell damage, Inflammation, Vasodilation, Edema, Increased mucus production, Impaired mucociliary clearance.

What leads to congestion during a cold

Mucosal inflammation, Venous engorgement, Increased nasal secretions (rhinorrhea), Tissue edema.

Definition of rhinorrhea in colds

Excessive mucus production within the nasal cavities, contributing to congestion.

Complications from excessive mucus that does not drain

Facial pain, Post-nasal drip, Sore throat, Sinusitis, Otitis media.

Inducement of cough during a cold

Tracheobronchial inflammation and irritation via afferent nerve impulse transmission to the medulla.

When do symptoms typically begin after infectious contact

Symptoms begin 24 to 72 hours after infectious contact.

When do symptoms peak after onset

Symptoms peak on days 3 to 4.

Typical duration of colds

Colds typically last 10 to 14 days.

Initial symptoms of the condition

Malaise, Fatigue, Headache, Pharyngitis, Low grade fever.

Symptoms that can occur in infants and children

Higher fever can occur in infants and children.

Secondary symptoms that may develop

Nasal drainage (clear to thick), Nasal congestion, Cough, Sneezing, Conjunctivitis.

Basis for diagnosis

Diagnosis is based on: - Patient interview - Symptoms - Physical examination.

Onset characteristic of the 'flu'

Acute onset, quicker than cold, relatively sudden.

Onset characteristic of Allergic Rhinitis

May be off and on, often linked to allergens.

Onset characteristic of a cold

Slow onset (12 to 48 hours), symptoms progressively worsen.

Nasal discharge quality in the 'flu'

Copious, clear and watery.

Nasal discharge quality in Allergic Rhinitis

Copious, clear and watery.

Nasal discharge quality in a cold

Initially clear and thin, progresses to mucoid, then green tinged after 3 to 5 days.

Seasonal setting for the 'flu'

September to March, often with others having it.

Seasonal setting for Allergic Rhinitis

March to September, may be year-round; linked to allergen exposure.

Seasonal setting for a cold

September to March, often with others having it.

Associated symptoms of the 'flu'

Fever, myalgia, arthralgia, looks sick, productive cough.

Associated symptoms of Allergic Rhinitis

Sneezing, itchiness, itchy watery red eyes.

Associated symptoms of a cold

Minimal sneezing, feverish, worse cough at night, dry mild sore throat in the morning.

Fever symptom in 'flu'

High fever

Fever symptom in 'allergic rhinitis'

No fever

Fever symptom in 'cold'

Usually mild to no fever

Nasal examination finding in 'flu'

None

Nasal examination finding in 'allergic rhinitis'

Allergic shiners, Nasal crease, Dennie's lines, Elevated levels of serum IgE

Nasal examination finding in 'cold'

Inflamed, red swollen nasal mucosa, Mucoid discharge, May be green tinged after 3 to 5 days

Nasal mucosa appearance in 'allergic rhinitis'

Swollen, pale, boggy nasal mucosa with clear watery discharge

Nasal mucosa appearance in 'cold'

Inflamed, red swollen nasal mucosa with mucoid discharge

Goal of cold treatment

To reduce duration and frequency of symptoms, allowing patients to function normally.

Preventative measures for colds

Limit the spread of infection to others.

Role of antibiotics in treating the common cold

No, antibiotics have no role in cold treatment.

Focus of treatment measures for colds

Symptom relief based on a patient's presenting symptoms.

Common symptoms of a cold

Nasal congestion, Runny nose, Sneezing, Sore throat, Cough, Fever, pain

Fever threshold that excludes self-care for the common cold

Fever >100.4 F (38 C; oral)

Symptom indicating need for medical attention instead of self-care

Chest pain

Respiratory symptom that excludes self-care for the common cold

Shortness of breath

Action if symptoms worsen during self-care

Seek medical attention

Chronic diseases that exclude self-care for the common cold

Asthma, COPD, CHF

Condition related to immune function that excludes self-care for the common cold

AIDS or chronic immunosuppression

Frail patients that should avoid self-care for the common cold

Patients of advanced age

Age limit for infants that excludes self-care for the common cold

Infants < 3 months old

First step in the self-care decision tree for a common cold

Determine if symptoms are present.

Next assessment if symptoms are present

Assess the severity of symptoms.

Assessment if symptoms are mild

Consider self-care measures.

Action if symptoms are severe

Seek medical attention.

Common self-care measures for mild symptoms

Rest, Hydration, Over-the-counter medications

Monitoring for a common cold

Monitor for worsening symptoms.

Recommended actions if you have a common cold

Rest, Stay hydrated, Use over-the-counter medications

When to see a doctor for a cold

If symptoms worsen, If you have a high fever, If symptoms last more than 10 days

Common symptoms of a cold (repeated)

Runny nose, Sore throat, Cough, Fatigue

Relief for a sore throat

Gargling salt water, Drinking warm liquids, Using throat lozenges

Good way to prevent colds

Wash hands frequently, Avoid close contact with sick individuals, Maintain a healthy lifestyle

Type of preparations frequently used for cold symptoms

Nonprescription cough and cold preparations

Factors influencing choice of therapy for cold symptoms

Patient age, Co-morbid conditions, Effectiveness and safety balance

Preferred agents for cold symptom treatment

Single-ingredient agents

Reason for preferring single-ingredient agents over multi-ingredient products

To minimize toxicity and overdose risk

What should be avoided when treating cold symptoms

Antihistamines

Effect of first generation antihistamines on secretions

They may help dry watery secretions.

Impact of first generation antihistamines on mucociliary clearance

They impair mucociliary clearance of thick mucus.

What can worsen congestion when using antihistamines

Impairment of mucociliary clearance.

Use of oral decongestants

To relieve nasal congestion in colds, allergic and nonallergic rhinitis.

Nasal congestion relief

To relieve nasal congestion in colds, allergic and nonallergic rhinitis.

OTC oral decongestants

Pseudoephedrine (tablet, liquid, syrup) and Phenylephrine (tablet, liquid, solution).

Mechanism of action for oral decongestants

Alpha-adrenergic agonists causing vasoconstriction and decreasing mucosal edema.

Onset of action for oral decongestants

15-60 minutes.

Effectiveness comparison

Pseudoephedrine is more effective than phenylephrine.

Bioavailability of phenylephrine

Less than 38%.

Dosage of Phenylephrine HCL for ages 4-5 years

5mg po q4h (Max 30mg).

Dosage of Pseudoephedrine for ages 4-5 years

30mg po q4-6h (Max 120mg).

Maximum dosage of Phenylephrine HCL for ages 6-11 years

60mg po q4h (Max 60mg).

Maximum dosage of Pseudoephedrine for ages 12 years and older

240mg q24h.

Dosage of Pseudoephedrine for ages 6-11 years

IR: 60mg po q4-6h; ER: 120mg q12h.

Dosage of Phenylephrine HCL for ages <4 years

Do not use.

Dosage of Pseudoephedrine for ages <4 years

Do not use.

Cardiovascular effects of decongestants

Increased blood pressure, Tachycardia, Palpitations.

CNS effects of decongestants

Anxiety, Tremors, Insomnia, Nervousness, Restlessness, Fear, Hallucinations.

Common adverse effects of OTC oral decongestants

Decreased appetite, Dizziness, Headache.

Caution for decongestant use

Elderly patients should use extra caution.

Tolerance of adverse effects

Patients may tolerate adverse effects better if taken in the morning/daytime instead of bedtime.

Age group to avoid OTC oral decongestants

Children < 2 years (FDA) and < 4 years (package labeling).

Contraindications for decongestants

CV disease, Uncontrolled hypertension, Hyperthyroidism, Diabetes, Bowel obstruction, Glaucoma, Benign prostatic hyperplasia, Seizure disorder.

MAOIs and decongestants

Should not be used within 14 days of these decongestants.

Recommended duration for intranasal decongestants

3-5 days.