Runny nose and congestion have been recently added to the COVID-19 symptom list. What are the recommendations for evaluating employees with this symptom, which could also be allergy-related?

Runny nose and congestion can be symptoms of allergy as well as viral illness such as COVID-19, and influenza among others. Differentiating the cause of runny nose and congestion is a clinical decision. As with most clinical decision making, taking a thorough history should be the first step. Has there been recent travel or contact with someone known to be infected with COVID? Has the employee had seasonal or other environmental allergies before?  What are their usual symptoms? What is the usual timing of those symptoms? What are the current pollen/mold counts in your geographic area? Is there a new pet or other non-seasonal environmental allergen exposure? 

Symptoms that are commonly associated with allergy in addition to runny nose and congestion are itchy eyes, itchy nose and sneezing. Viral infection more often causes systemic symptoms of fever, headache, cough, myalgia, arthralgia, gastrointestinal symptoms and malaise1. The absence of systemic symptoms makes allergy more likely. If an employee with a history of allergy has found antihistamines  and/or nasal sprays helpful in the past, using them and finding them effective can be reassuring.  At the same time, it would be very important to continue to watch for the development of other symptoms. 

Rhinorrhea and congestion are among the symptoms of COVID-19 that may arise later in the infection in some patients, although additional symptoms may be present. In one study, 4 out of 13 residents of a long-term care skilled nursing facility, King County, Washington, who were initially asymptomatic despite positive test results,  were noted to have atypical symptoms including rhinorrhea and congestion one week later. Other symptoms seen in this group included confusion, myalgia, dizziness, headache, nausea, and diarrhea. It is important to consider these less common symptoms as part of COVID-19 assessments5

Should the usual allergy medication not prove useful or other COVID-19 associated symptoms develop, allergy is less likely and employees should be tested for COVID-19 and influenza if it is present in the community at that time. The CDC offers guidance on the similarities and differences between Influenza and COVID-192. This guidance will be increasingly important as the flu season returns. The American Academy of Allergy and Immunology has produced an infographic that describes the relative incidence of symptoms in COVID-19-Allergies-Influenza-Common Cold3. Employees with seasonal allergies should be advised that they can create a personalized email alert through the National Allergy Bureau that will provide geographically specific pollen and mold levels4.


  3. Coronavirus Symptoms:
  5. Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:377–381. DOI: icon

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