Is It a Cold or Is It Hay Fever? How to Tell the Difference This Spring | 3 min read

The cold that will not go away

Every spring, doctors see a wave of patients convinced they have picked up a stubborn cold that has hung around for weeks. In many cases, it is not a cold at all. It is allergic rhinitis, better known as hay fever, and the Allergy Foundation of South Africa estimates that between 20% and 30% of South Africans have it.

The timing is not coincidental. September is one of the highest pollen months of the year in South Africa, with tree, grass and weed pollen all climbing, and levels continuing to rise into October and November. Pollen counts generally peak in spring between August and November, with grass pollen lingering into early summer.

How to tell them apart

The two can look similar at first because both cause a runny or blocked nose and sneezing. The differences become clearer when you know what to look for.

Signs it is more likely a cold:

• Thick or discoloured nasal discharge.
• A low-grade fever and general body aches.
• Symptoms that build over a day or two and then resolve within roughly seven to ten days.

Signs it is more likely an allergy:

• Clear, watery nasal discharge and repeated bouts of sneezing.
• Itching, which is the giveaway: an itchy nose, itchy or watery eyes, sometimes an itchy mouth or inner ear.
• Symptoms that persist for weeks or even months rather than clearing up.
• Symptoms that flare at predictable times, such as after being outdoors or during a particular season each year.
• Dark circles under the eyes from congested nasal passages, or headaches from sinus pressure.

What is actually happening in your body

An allergy is the result of an over-active immune response. Most people are unaffected by pollen, dust mites, mould spores and pet dander. If you have an allergy, your immune system identifies these normally harmless particles as a threat and releases histamine. Histamine inflames the nasal membranes and triggers watery secretions intended to wash the particles away, which is why you end up sneezing with a streaming nose and itching eyes.

Two broader trends are making this worse over time. Warmer temperatures mean pollination seasons are starting earlier, lasting longer and producing more pollen, and air pollutants irritate the airways so that people react more strongly to the pollen that is there. The Allergy Foundation of South Africa notes that scientists expect average pollen counts by 2040 to be more than double what they were in 2000.

Why starting early matters

One of the most useful pieces of advice for anyone with seasonal allergies is not to wait for symptoms to arrive. For more severe hay fever, starting regular antihistamine treatment up to four weeks before pollen season begins has been shown to improve symptom control. Treating pre-emptively is consistently more effective than chasing symptoms once they have taken hold.

Knowing exactly what you react to also changes how well you can manage it. Allergy testing can identify your specific triggers, which tells you which season is likely to be your difficult one and allows you to prepare for it rather than be surprised by it each year.

When to see a doctor

See a healthcare professional if your symptoms last longer than ten days, if they return at the same time every year, if over-the-counter antihistamines are not giving you relief, or if your symptoms are disrupting your sleep, work or concentration.

It is also worth getting checked because other conditions, including sinusitis, can mimic allergy symptoms closely. Accurate diagnosis needs more than self-assessment. A doctor will take a proper history, examine you, and, where appropriate, refer you to an allergologist for testing. Untreated allergic rhinitis can also aggravate asthma, which is another reason not to simply push through it.

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