Nfld. & Labrador

Is it allergies, or is it COVID-19? An allergy specialist weighs in

For allergy sufferers concerned their symptoms are a sign of COVID-19, St. John's allergist and immunologist Dr. Andrew O'Keefe helps clear the confusion.

Overlap between symptoms rare, says allergist

Dr. Andrew O'Keefe is an allergy and immunology specialist in St. John's. (Paula Gale/CBC)

Allergy sufferers are accustomed to a runny nose and watery eyes during high pollen counts, although they may also be anxious about potential COVID-19 infection in the midst of a pandemic. 

Dr. Andrew O'Keefe said it's important to know the similarities and differences, and cautions that patients should not jump to conclusions. 

O'Keefe said some symptoms typical of perennial and seasonal allergies, which also might include sneezing and itching, can indeed overlap with those associated with COVID-19.

"It's been quite stressful for these patients because the symptoms can be confused with COVID-19," O'Keefe said.

But, he cautions, patients experiencing these types of symptoms shouldn't jump to conclusions.

"Allergies tend to affect the upper respiratory tract, things like the nose and sinuses or sometimes the throat," O'Keefe said in a recent interview with The St. John's Morning Show

He said these more typical allergic reactions are less likely to be signs of COVID-19 than, say, a cough. While the latter can be a reaction to allergens, especially in the case of asthma sufferers, O'Keefe said coughing is less frequently associated with allergies. 

"Anything that's not affecting the respiratory tract would certainly be more in keeping with COVID-19," O'Keefe said, citing muscle aches, fever and nausea as examples.

O'Keefe says allergies are more likely to affect the upper respiratory tract, whereas typical COVID-19 symptoms such as the cough, which affect the lower respiratory tract, are less common among allergy sufferers. (Dale Molnar/CBC)

For those experiencing symptoms, O'Keefe said, a key indicator to consider is whether they've had them before. "It's important to pay attention to what your norm is," he explained. "Allergies are very reproducible. They follow a pattern. When you have an exposure, you have symptoms."

If those symptoms follow patterns of previous years, O'Keefe said, it's safe to follow the same treatment plan.

"But if your symptoms are unusual or different then you should talk to someone or arrange for an appointment to get a swab done," he said.

It's important to pay attention to what your norm is.- Dr. Andrew O'Keefe

O'Keefe said his patients are reporting fewer asthma exacerbations over the past year — a trend he credits to increased mask-wearing, physical distancing and heightened hygiene.

But while some reactions may be on the decline, O'Keefe noted, others are on the rise.

"Allergic reactions to COVID vaccines have been flagged as a more significant issue than with other vaccinations," he said.

According to the Public Health Agency of Canada's Canadian Adverse Events Following Immunization Surveillance System and Health Canada's Canada Vigilance program, more than 6,400 cases of adverse events have been reported across the country following COVID-19 immunizations. Of these, more than 1,200 were considered serious.

The agencies define an "adverse event" as an "unfavourable or unintended sign," such as a skin rash, or an "abnormal laboratory finding, symptom or disease." The events range from extensive swelling of the vaccinated limb (least common) to vaccination site pain (most common).

O'Keefe said a national effort known as the Special Immunization Clinic could help the province's health providers assess reactions to COVID-19 vaccines. Established in 2013, the program has expanded across the country, but has yet to be adopted in Newfoundland and Labrador.

O'Keefe says an application will soon be submitted to a health research ethics board to bring the program to the province.

Expert advice for rare events

Dr. Karina Top, a pediatric infectious disease physician at Izaak Walton Killam Hospital for Children in Halifax, is credited with spearheading the Special Immunization Clinic. She says the program, if adopted, could support health professionals in their efforts to safely vaccinate as many people as possible.

"We can provide individual expert advice for people who have had potential adverse events that are rare, and where health providers need help on how to proceed."

Top said the program has helped nearly 600 patients in Nova Scotia since its inception, and has safely re-vaccinated close to half of them. "We've developed a nice network that's integrated with public health," Top said.

She said she's encouraged by the enthusiasm she's seen in the province for the adoption of the Special Immunization Clinic. For Top, the benefits for the province are clear.

"We provide that extra followup, and can feed that back to public health," she said.

"Ultimately, we're protecting people."

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