Allergies vs. Sinusitis: How to Tell the Difference and Get the Right Treatment

Every sneeze, sniffle, or headache might make you wonder — is it allergies or sinusitis? While these two conditions can cause overlapping symptoms, they are very different and require distinct treatments. During a recent UHealth Talk presented by the University of Miami Health System, ENT specialists Aura Acosta, M.D., and David Lerner, M.D., discussed how to distinguish between the two and explore new treatment options.

What is allergic rhinitis?

Allergic rhinitis is an immune overreaction to environmental allergens like pollen, dust mites, pet dander, or mold. It can cause nasal inflammation, sneezing, congestion and sinus headaches, and runny nose. These symptoms often overlap with chronic sinusitis, making diagnosis tricky.

A key point: Not all nasal inflammation reactions are caused by allergies. For example, if you experience congestion from strong odors or temperature changes, this may be non-allergic rhinitis, not a true allergy.

Allergic rhinitis is also tied to asthma and eczema. “80% of patients with asthma have allergic rhinitis, and 40% of patients with allergic rhinitis have asthma.”

The impact of allergies

Allergic rhinitis is more than a seasonal nuisance. It affects up to 30% of U.S. adults and 40% of children. Left untreated, it can impair concentration, productivity, and sleep quality — making it the fifth most burdensome chronic condition in terms of total cost (including missed work and reduced performance).

Climate change is also driving longer pollen seasons and new allergen exposures. Cities like Jacksonville and Orlando have seen dramatic increases in pollen counts in recent years.

Recognizing sinusitis

Chronic sinusitis disease involves prolonged inflammation of the sinuses lasting more than 12 weeks. Symptoms include facial pressure, headaches, congestion, and loss of (or decreased) smell — very similar to allergic rhinitis, but often more intense and persistent. This condition can be hereditary.

Dr. Lerner noted that many people mistakenly attribute their chronic sinusitis to allergies alone, or recurrent cold or flu infections.  Patients with asthma or eczema are more likely to have sinus disease, and often will have nasal polyps.

Diagnosis: It’s all in the details

Allergic rhinitis is typically diagnosed based on a detailed medical history and physical exam, not imaging. Physical symptoms like inflammation inside the nose and allergic shiners (dark under eyes) can differentiate allergies from sinusitis.

Allergy testing (blood or skin) is used to confirm suspicions or guide treatment, not as a standalone diagnosis. If an allergy test comes back positive for a specific food or environmental allergen, but the patient doesn’t experience an allergic reaction to it, then they are not truly allergic to the allergen and simply have a sensitivity to it.

Chronic sinusitis, by contrast, requires clinical evidence of inflammation via endoscopy or CT scans. ENTs look for nasal polyps, tissue changes, and other signs that distinguish sinusitis from allergy-related symptoms.

Modern treatment options

For allergic rhinitis:

• Avoidance of known triggers is critical.
• Medications like steroidal nasal sprays or rinses (administered with a neti pot), and over-the-counter antihistamines are standard.
• Immunotherapy (allergy shots or sublingual tablets and drops) can retrain the immune system to reduce symptoms long-term.
• Biologics, such as monoclonal antibodies, are an emerging option that target specific immune responses and are under study for allergy treatment.

For chronic sinusitis:

• Topical steroid rinses are mainstays.
• Sinus surgery can open nasal passages, making them more receptive to topical steroid medications.
• Biologics can help patients with both chronic sinusitis and nasal polyps and/or asthma.
• Macrolides, a type of low-dose antibiotic, are showing promise for certain inflammation types, especially in patients without allergies or nasal polyps as well as older patients and smokers who don’t respond well to steroids.

Don’t suffer in silence

If you’ve been cycling through allergy sprays and still have symptoms, don’t assume it’s just seasonal. The ENT team at UHealth emphasized the importance of a professional evaluation to pinpoint the root cause and tailor the right treatment.

“The future is here,” says Dr. Acosta, pointing to biologics and personalized care strategies. Whether you’re dealing with allergies, sinusitis, or a related sensitivity to your environment, expert help is available and effective.

Story was compiled from the transcript of the video. Medically reviewed and approved by Aura Acosta, M.D., and David Lerner, M.D. prior to publication.

Tags: Allergy management strategies, Dr. Aura Marina Acosta Calderon, Dr. David Lerner, Immune system response to allergens, otolaryngology in South Florida, Sinusitis diagnosis criteria