Differentiating and Treating Seasonal Allergies versus Sinus Infection

Key Distinguishing Features

The American Academy of Otolaryngology-Head and Neck Surgery recommends distinguishing allergic rhinitis from sinusitis by the presence of nasal itching, sneezing, clear rhinorrhea, and bilateral symptoms (allergic rhinitis) versus facial pain/pressure, purulent drainage, fever, and unilateral symptoms (sinusitis) 1
The Journal of Allergy and Clinical Immunology suggests that ocular symptoms, such as itching and tearing of the eyes, are highly suggestive of allergic etiology 2
The American Academy of Otolaryngology-Head and Neck Surgery notes that palatal itching, itching of the nose and palate, strongly indicates allergic cause 1
The Journal of Allergy and Clinical Immunology reports that bilateral symptoms, affecting both nasal passages equally, are characteristic of allergic rhinitis 1
The American Academy of Otolaryngology-Head and Neck Surgery states that facial pain or pressure, particularly over the cheeks and forehead, is uncommon in pure allergic rhinitis and suggests sinusitis 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery indicates that purulent nasal drainage, colored (yellow or green) rhinorrhea, suggests bacterial infection 1

The Annals of Internal Medicine recommends intranasal corticosteroids as the most effective single medication class for controlling all symptoms of allergic rhinitis, including nasal congestion, rhinorrhea, sneezing, and itching 5
The American Academy of Otolaryngology-Head and Neck Surgery suggests that adults and children ≥12 years should start with fluticasone propionate 2 sprays per nostril once daily (200 mcg total) or mometasone furoate 2 sprays per nostril once daily (200 mcg total) 7
The Journal of Allergy and Clinical Immunology notes that combination therapy with an intranasal antihistamine (azelastine) and an intranasal corticosteroid (fluticasone) provides >40% relative improvement compared to either agent alone for patients with moderate-to-severe allergic rhinitis 8

The Journal of Allergy and Clinical Immunology reports that mixed rhinitis (combined allergic and nonallergic rhinitis) occurs in 44% to 87% of patients with allergic rhinitis and is more common than either pure form 4, 9
The Journal of Allergy and Clinical Immunology suggests that these patients require intranasal corticosteroids as the foundation of therapy, as they address both allergic and inflammatory components 4

The American Academy of Otolaryngology-Head and Neck Surgery notes that family history of atopy strengthens the diagnosis of allergic rhinitis 1
The American Academy of Otolaryngology-Head and Neck Surgery states that medication review is essential, as antihypertensive drugs, psychotropic agents, and topical decongestants can cause nasal symptoms 1
The American Academy of Otolaryngology-Head and Neck Surgery recommends that allergy testing (skin or blood specific IgE) should be performed when diagnosis is uncertain or when patients do not respond to empiric treatment 1
The Praxis Medical Insights notes that intranasal corticosteroids are safe for indefinite use at recommended doses, with no effect on growth in children or hypothalamic-pituitary-adrenal axis function 7