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allergies or sinus infection

Is it allergies or a sinus infection? | Ask the Pediatrician

Find the source of your spring misery, then relief

It’s warmer and we’re outside more, hopefully playing in the grass or getting our hands dirty in the garden. We’re also still dealing with the tail of cold and flu (and COVID) season. When your little one has a lingering runny, dripping or stuffy nose, you might wonder: Is it springtime allergies or sinus infection?

It can be hard to tell a sinus infection (sinusitis) and environmental allergies (allergic rhinitis) apart. The treatment is different so it’s important to determine which one is making your child (and you) suffer through spring. I’ll walk you through it.

Let’s talk about sinusitis: What it is. What it isn’t.

What are sinuses?

Sinuses are air-filled spaces behind your cheekbones, forehead and eyes. The tissue lining of the sinus makes mucous, which keeps your nose moist and protects against irritants. This is the way it is supposed to work. Unfortunately, occasionally the sinuses become plugged up and infected. This is called acute sinusitis.

In the perfect world the sinuses protect you by trapping and getting rid of dust, pollen and allergens. Certain conditions cause swelling and blockage of the sinuses which then puts you at risk for developing a secondary bacterial infection or sinus infection, including:

  • The common cold or any respiratory viral infection
  • Allergic rhinitis (nasal allergies)
  • Smoke exposure
  • Deviated septum (asymmetry in the nasal cavity)
  • Nasal polyps (small growths in the nasal cavity)

By far, the first two are the most common and give us the most headaches.

What is an acute sinus infection?

Acute sinusitis typically is preceded by a cold or nasal allergies. With acute sinusitis, instead of getting better, symptoms worsen. Common symptoms include facial pain, fevers, a bad taste in the back of the throat, bad breath and a stuffy nose. Additionally, children with sinusitis also just feel crummy because they are fighting an infection. Occasionally children are diagnosed with “chronic sinusitis,” which also has symptoms of facial pain, pressure, fever and fatigue but lasts longer than 12 weeks.

What are nasal allergies?

Allergies occur when your immune system treats something harmless, like pollen or dust, as if it were a harmful germ or virus. The body has an inflammatory response which leads to red itchy eyes, runny nose, sneezing and nasal congestion. If the symptoms are primarily nasal congestion, facial pain, sneezing, cough and post nasal drip, it is called “allergic rhinitis” or nasal allergies.

Clues that the stuffy nose is from allergies rather than sinusitis are:

  • Seasonal symptoms, i.e., symptoms that show up at the same time every year
  • Itchy, watery eyes or itchy skin
  • Post nasal drip down the back of the throat
  • A dry, hacking cough or wheezing
  • Spasmodic sneezing and clear, watery nasal discharge
  • No fever

It can also be helpful to look for triggers. Clearly if your child starts sneezing as soon as they play in the grass or Fido walks into the room, it’s a hint that it’s allergies!

allergies or sinus infection

Sinus infection: Can you treat it at home?

Sometimes sinusitis resolves on its own as the immune system jumps in to fight the infection. You can try the following things at home:

  • Breathing in humidified air (steam from a shower, a humidifier with water only).
  • Warm, wet towels on the face to reduce facial pressure.
  • Pain medication such as ibuprofen or acetaminophen to help ease the discomfort.
  • Saline nose spray. This is a salt and distilled water nasal spray which can help clear out mucous.
  • Nasal irrigation with saline and distilled water. Use of neti pots or a syringe may help, but it is very important to only use distilled water and to rinse the device and air dry before using again.

Sinus infection: When to see a provider

Sometimes sinus infections need more than home treatment. If there is no improvement in symptoms with home treatment after a few days or if your child is getting worse, it is important to be seen by your provider. Not only is sinusitis miserable, if it is not treated appropriately the infection can spread. Your provider may offer the following:

  • Decongestants, often as nasal sprays, are helpful in decreasing the inflammation and lowering the amount of mucous in sinuses.
  • Nasal steroids to decrease swelling in the nose.

More from Dr. Block and Kaiser Permanente

About the Author

Susanna Block

Dr. Susanna Block, MD, MPH, is a pediatrician with Kaiser Permanente in Seattle and lives with her family in Queen Anne.