Allergies or COVID-19: A Symptom Checker for Kids

In years past, parents wouldn't hesitate to dismiss itchy eyes or a sore throat as signs of seasonal allergies. More than a few would have sent their children to school with these seemingly minor symptoms. But the coronavirus pandemic changed everything we thought we knew about sick kids—and left people wondering if their little ones had a harmless runny nose or a contagious and potentially deadly respiratory disease. New variants of the coronavirus keep emerging, so how you know whether your child has allergies or COVID-19? We asked the experts to explain the difference.

How To Know When It's Allergies

Allergies happen when the body perceives certain substances as threats, and the immune system responds by producing antibodies and histamine. This prompts an inflammatory response that causes telltale allergy symptoms. Common outdoor allergy triggers include pollen from grasses, trees, and weeds. Indoor allergies might be caused by pet dander, dust mites, and mold, explains Sanjeev Jain, M.D., an allergist and immunologist who founded Columbia Allergy.

Allergy symptoms include:

• Runny nose with clear, thin mucus
• Itchy, red, watery eyes
• Mild sore throat
• Nasal congestion
• Sneezing
• Sinus pressure
• Itchy nose
• Coughing (especially if they have asthma or severe postnasal drip)
• Dark circles under the eyes ("allergic shiners")

How To Know When It's COVID-19

The coronavirus is a respiratory illness caused by a virus (SARS-CoV-2). It commonly spreads through close contact with an infected individual, and symptoms appear within 2 to 14 days of exposure. COVID-19 cases in kids range from mild to severe—and "studies have shown that up to one-third of positive children have no symptoms at all,"says Natasha Burgert, M.D., a pediatrician with Pediatric Associates in Overland Park, Kansas. Other reports suggest that percentage is even higher.

According to the Centers for Disease Control and Prevention (CDC), COVID-19 symptoms include:

• Fever
• Chills
• Headache
• Cough
• Loss of taste or smell
• Fever
• Gastrointestinal issues (nausea, vomiting, diarrhea)
• Nasal congestion or runny nose
• Sore throat
• Difficulty breathing
• Fatigue
• Body aches

Signs that there might be a COVID-19 emergency include:

• Persistent chest pain
• Excessive sleepiness
• Confusion
• Lips, skin, and nail beds that are blue, gray, or pale (depending on skin tone)

Allergy Symptoms vs. COVID-19 Symptoms: Key Differences

The coronavirus can make parents second-guess every ache and pain their kids experience. Is sneezing a symptom of COVID-19? What about a sore throat? How about a runny nose?

As the pandemic has progressed, experts have learned more about how COVID-19 manifests in children. In many ways, the symptoms of the coronavirus are distinct from typical allergy symptoms, says Dr. Burgert. Generally speaking, a physical response that involves multiple areas of distress across the body seems to distinguish the virus from allergies, which primarily irritate the eyes, nose, and throat.

And yet, new variants of the coronavirus have been producing symptoms that health care professionals previously associated with seasonal allergies, such as sneezing, itchiness, and a stuffed-up nose. Many experts say that if you're concerned about those symptoms, test for COVID-19—it's the only way to know for sure. You might also want to test if your child is asymptomatic but had significant exposure to someone with COVID-19.

It's frustrating, we know. To make the basic differences clear, the CDC has compiled a chart comparing symptoms experienced by people with the coronavirus to those that afflict people with seasonal allergies. Its interactive symptom checker is a particularly helpful tool for parents with kids over age 2, who can use it to figure out whether they need to take them to the pediatrician or have them tested.

Here are some key differences between allergies and COVID-19.

Allergies don't usually come with a fever or body aches.

Fever is a common symptom of COVID-19, but allergies rarely make your body temperature shoot up over 100 degrees. What's more, allergy sufferers don't usually experience the body aches, chills, or extreme fatigue that plagues those with COVID, especially not when their allergic symptoms appear.

Allergies don't make you sick to your stomach.

Nausea, vomiting, diarrhea, and other GI symptoms are strongly associated with the coronavirus in pediatric patients, according to a 2021 Italian study published in Pediatrics. Kids may lose their sense of taste or smell, too, or decide that a beloved food suddenly tastes disagreeable to them.

Allergies don't typically cause shortness of breath.

While the coronavirus is marked by respiratory issues, seasonal allergies don't usually make it hard for kids to breathe unless they also have asthma that's triggered by pollen from plants, trees, or grasses.

Allergies are really helped by antihistamines.

Zyrtec, Allegra, and Claritin decrease the symptoms of seasonal allergies; steroids, nasal sprays, and eye drops also work. You won't see such immediate results with COVID-19, although new research does suggest antihistamines might help long COVID, which a small percentage of children develop.

Allergy symptoms are usually very predictable.

According to Dr. Jain, many children with allergies have experienced symptoms before, and their parents can spot the pattern. Kids with ragweed allergies, for example, feel sick during the fall, while pollen allergies strike in the springtime. Indoor allergies tend to hang around throughout the year.

Allergy symptoms are triggered by specific substances.

Allergy symptoms appear when a person comes into contact with an allergen. "These symptoms typically get worse when a person has more frequent exposure to the allergen, and tend to improve when exposure to the allergen is reduced," says Dr. Jain. If your child has a dust mite allergy, for example, they may sneeze and be congested at home, but feel better after spending hours in the backyard. Allergy symptoms can be intermittent and change depending on environmental conditions; COVID-19 symptoms are less likely to do that.

Still Confused? Here's What to Do

Coronavirus symptoms can mimic allergy symptoms—think runny nose, sore throat, and coughing—though there are key differences. If you think your kid might have COVID-19, or if they've had a known exposure, get them tested. "If you are worried that your child has any symptoms of illness, the only way to know if they have COVID-19 is to get an accurate test," reiterates Dr. Burgert.

Now that home tests are everywhere, you can do it quickly and privately. If you're really concerned, you can order a PCR test (the gold standard).

Keep in mind that respiratory symptoms don't always point to COVID-19. The flu, common colds, strep throat, and other viruses still circulate as well. Talk to your child's pediatrician about any concerns.