When managing an illness like COVID-19, people often seek relief for symptoms that overlap with conditions like seasonal allergies. The question of whether to continue or begin taking over-the-counter (OTC) allergy medication while infected is a valid concern. While many common allergy treatments are generally safe for symptom management, specific considerations regarding symptom differentiation and potential drug interactions are necessary.
General Safety of OTC Allergy Relief
Non-sedating, second-generation oral antihistamines (e.g., cetirizine, loratadine, fexofenadine) are generally considered safe for continued use during a COVID-19 infection. These medications work by blocking histamine, treating the body’s response to inhaled allergens rather than targeting the SARS-CoV-2 virus itself. Their primary role is addressing allergy-related symptoms like sneezing, itchy eyes, and a runny nose, which can be confused with viral symptoms.
Since these medications have a well-established safety profile, continuing a regular regimen is typically acceptable. This class is preferred because it avoids the sedative effects common with first-generation antihistamines like diphenhydramine, minimizing the risk of drowsiness or confusion. If an individual is already taking a non-sedating antihistamine for chronic allergies, they should generally maintain their routine. Consulting with a healthcare provider remains the best course of action.
Differentiating Allergy Symptoms from COVID-19
Distinguishing between allergy symptoms and those caused by a COVID-19 infection can be challenging due to the significant overlap in respiratory complaints. Both conditions can cause a runny nose, congestion, sore throat, and a cough.
The most telling difference is the presence of a fever, which is common in COVID-19 but not caused by seasonal allergies. Allergy symptoms frequently involve itching (e.g., watery or itchy eyes, nose, or throat), which is rare in COVID-19 infections. Symptoms like muscle aches, body pains, nausea, vomiting, or significant loss of taste and smell are far more characteristic of a viral infection.
Allergy symptoms also tend to follow a predictable seasonal pattern and may worsen after exposure to outdoor allergens like pollen. Ultimately, a definitive diagnosis relies on viral testing. Any new or concerning symptoms should prompt an individual to take a COVID-19 test, as relying on a known history of seasonal allergies is not a substitute for testing when a viral infection is suspected.
Specific Medication Considerations and Drug Interactions
Decongestants
Using decongestants (e.g., pseudoephedrine and phenylephrine) with a COVID-19 infection requires more caution than non-sedating antihistamines. Decongestants work by causing vasoconstriction, which narrows blood vessels in the nasal passages to reduce swelling and congestion. This mechanism can lead to an increase in heart rate and blood pressure.
Since a viral illness like COVID-19 can already place stress on the cardiovascular system, adding a decongestant can potentially exacerbate conditions like hypertension, heart disease, or an elevated heart rate associated with fever. Individuals with pre-existing conditions like glaucoma or diabetes should also be cautious. Furthermore, prolonged use of topical decongestant nasal sprays can lead to rebound congestion.
Steroid Nasal Sprays
Intranasal corticosteroids, commonly used to treat allergy-related inflammation, are generally considered safe to continue during a COVID-19 infection. These sprays (e.g., fluticasone) deliver a low dose of anti-inflammatory medication directly to the nasal lining. Because systemic absorption is minimal, they pose a low risk of the body-wide side effects associated with oral steroids.
Some observational studies have suggested that individuals who regularly use intranasal corticosteroids might have a lower risk of severe COVID-19 outcomes. Patients who use these sprays chronically should typically continue them as prescribed, but starting a new steroid treatment for COVID-19 is not recommended without specific medical guidance.
Interactions with COVID Antivirals
The most serious medication concern involves potential drug interactions with prescription COVID-19 antiviral treatments, such as Paxlovid. The ritonavir component in Paxlovid is a strong inhibitor of the CYP3A enzyme, which is responsible for metabolizing many other medications. Inhibiting this enzyme can cause blood levels of co-administered drugs to increase significantly, raising the risk of serious side effects.
While non-sedating antihistamines like loratadine are generally considered to have a manageable interaction risk, the combination must still be reviewed by a pharmacist or physician. If a person is prescribed a COVID-19 antiviral, they must provide a complete and accurate list of all OTC allergy medications, supplements, and prescription drugs to their healthcare provider or pharmacist for a thorough interaction screening.