What's Causing Your Congestion?

How to deter­mine if you’re suf­fer­ing from a cold, aller­gies or a sinus infection

As tem­per­a­tures drop and sea­sons change, it’s not uncom­mon to devel­op symp­toms such as nasal con­ges­tion, sneez­ing, itchy eyes, cough­ing, facial pres­sure and body aches. You may shrug off these symp­toms as noth­ing more than a head cold, but they may be caused by sea­son­al aller­gies or a sinus infec­tion which may require dif­fer­ent treat­ments to resolve. To help you deter­mine what’s behind your symp­toms, board-cer­ti­fied oto­laryn­gol­o­gist (ENT), Feodor Ung, MD, shares dif­fer­ences between colds, aller­gies and sinus infec­tions and how you can get symp­tom relief.

Spot­ting the Difference

While they share many of the same symp­toms, the dura­tion, sever­i­ty and the under­ly­ing caus­es of colds, aller­gies and sinus infec­tions can be quite different.

Com­mon colds devel­op due to an upper-res­pi­ra­to­ry infec­tion caused by virus­es and bac­te­ria that are trans­mit­ted through the air or by direct con­tact with a con­t­a­m­i­nat­ed sur­face or an infect­ed individual.

Envi­ron­men­tal aller­gies are caused by an aller­gic reac­tion to spe­cif­ic sub­stances or aller­gens like pollen, mold, dust or ani­mal dander.

Sinus infec­tions devel­op when the tis­sue lin­ing your sinus cav­i­ty becomes inflamed after expo­sure to bac­te­ria, virus­es or fun­gi. In some cas­es, dur­ing a cold or aller­gy flare-up, your sinus cav­i­ty is unable to drain prop­er­ly. This caus­es symp­toms to linger longer than nor­mal. It can cause increased inflam­ma­tion and bac­te­r­i­al build-up, which even­tu­al­ly leads to a sinus infection. 

In addi­tion to their dif­fer­ent caus­es, each con­di­tion also has dif­fer­ences in their symp­toms including:


Sea­son­al Allergies

Sinus Infec­tions


Mild head and/​or body aches

Headaches and less com­mon­ly, body aches

A headache that may wors­en over time

Cough and/​or sore throat



Com­mon, and may be accom­pa­nied by bad breath, due to sinus­es drain­ing into the throat

Nasal con­ges­tion and sneezing


Com­mon, often mul­ti­ple sneezes in a row


Eye dis­com­fort



Com­mon, described as pres­sure and/​or pain around the fore­head, eyes and cheeks









Mucus type

Can vary from clear to green, yel­low and thick

Most often thin, clear

Usu­al­ly green or yel­low and thick, often last­ing longer than 10 days

Symp­tom onset

Sud­den onset of symptoms 

Varies by per­son, in some, symp­toms grad­u­al­ly wors­en, while in oth­ers symp­toms appear suddenly

Symp­toms may ini­tial­ly seem to improve and then wors­en significantly

Time of year

More com­mon in winter

More com­mon dur­ing the spring and fall

Can devel­op year-round but can increase dur­ing cold, flu and aller­gy seasons


Typ­i­cal­ly resolves on its own with­in 10 days

Symp­toms gen­er­al­ly improve quick­ly after reduc­ing or elim­i­nat­ing your expo­sure to the aller­gen (stay­ing indoors and keep­ing win­dows closed)

Symp­toms can last sev­er­al weeks and in some cas­es, more than a month and often require antibiotics

Treat­ment for each con­di­tion also varies slight­ly. In most cas­es, colds can be man­aged with over-the-counter med­ica­tions such as Tylenol and Motrin (for head and body aches), anti­his­t­a­mines, decon­ges­tants, saline irri­ga­tions and nasal sprays (for nasal con­ges­tion) and cough sup­pres­sants. In addi­tion to med­ica­tions, drink­ing plen­ty of flu­ids and rest­ing will help you recov­er from a cold.

Aller­gies, depend­ing on the sever­i­ty, may be treat­ed with over-the-counter or pre­scrip­tion-strength anti­his­t­a­mines, nasal sprays or eye drops. Lim­it your expo­sure to aller­gens in your home with HEPA air fil­ters, aller­gen-proof pil­low and mat­tress cov­ers, keep­ing win­dows and doors shut when pollen counts are high and chang­ing your clothes after spend­ing time out­doors. If you expe­ri­ence fre­quent or severe aller­gy symp­toms, your doc­tor may rec­om­mend immunother­a­py (aller­gy shots) to help build up your immune sys­tem and tol­er­ance to cer­tain allergens.

Sinus infec­tion treat­ments aim to reduce inflam­ma­tion by open­ing your air­ways and elim­i­nat­ing the infec­tion. Your physi­cian may rec­om­mend sev­er­al ther­a­pies to help man­age your symp­toms and clear your infec­tion, including:

  • Nasal sprays and/​or oral decon­ges­tants (to open up nasal pas­sages and allow your sinus­es to drain)
  • Nasal saline wash­es (which help clear thick mucus from your nasal passage)
  • Anti­his­t­a­mines (to reduce inflammation)
  • Pain reliev­ers (like Tylenol or Motrin)
  • Nasal cor­ti­cos­teroids (pre­scrip­tion-strength nasal sprays that pre­vent and reduce inflam­ma­tion in your sinuses)
  • Antibi­otics (which tar­get the bac­te­ria caus­ing the infection)
  • Oral steroids

When oth­er treat­ment meth­ods don’t com­plete­ly clear the infec­tion or for those who expe­ri­ence chron­ic sinus infec­tions, sur­gi­cal treat­ment may be rec­om­mend­ed. Sinus infec­tions are con­sid­ered to be chron­ic when they occur four or more times a year or when symp­toms per­sist for more than three months.

As we head into cold and flu sea­son, it’s impor­tant to under­stand the dif­fer­ences between colds, aller­gies and sinus infec­tions so that you can select treat­ment options that will give you the fastest relief.

We know that it can be dif­fi­cult to diag­nose an ill­ness on your own. That’s why our team of pri­ma­ry care and spe­cial­ty physi­cians is here to help you eval­u­ate and treat any ail­ment that may arise, to help you stay healthy through­out the year.

For help man­ag­ing your symp­toms, sched­ule an appoint­ment with one of our physi­cians at duly​healthand​care​.com/​o​n​l​i​n​e​-​s​c​h​e​dule/.

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