Allergies or COVID-19: What Are the Differences?

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Spring Allergy Season Affecting Some People For The First Time

Seasonal allergies aren't just for lifelong sufferers anymore.

Doctors say it's increasingly common for adults who've never had allergies to suddenly experience symptoms like sneezing, runny nose, and itchy eyes, especially in the spring.

"Allergies can develop later in life," said Dr. Jonathan Matz, an allergist and immunologist with Life Bridge Health. "Over successive exposures, the immune system starts to recognize these allergens and produces antibodies that bind to pollen proteins. It just turns it on."

Right now, tree pollen is the biggest trigger. While local trees may not be fully in bloom, pollen from southern New England and the Mid-Atlantic is making its way north, carried by the wind.

Experts say allergies often run in families, and people with asthma may be more vulnerable.

The combination of pollen and asthma can lead to more severe respiratory symptoms.

To manage symptoms, allergists recommend checking pollen forecasts through weather apps or the National Allergy Bureau.

Dr. Matz encourages sufferers to start allergy medications before symptoms begin because it can make a big difference, especially for those experiencing allergies for the first time.

He said the best over-the-counter medicines are the non-sedating antihistamines.

Grasses are expected to peak later this spring, followed by ragweed in the late summer and into the fall.

According to the Cleveland Clinic, some of the common allergies include bee stings, dust mites, foods, medications, mold, pets and animals, poison ivy, and pollen.

Allergies can cause symptoms, including a skin rash, hives, itchy skin, sneezing, stuffy or runny nose, cough, wheezing, watery eyes, swelling, difficulty breathing, low blood pressure, or vomiting, according to the Cleveland Clinic.

The Cleveland Clinic suggests using antihistamines, steroid nasal sprays, leukotriene modifiers, allergy medications or omalizumab injections for treatments.

Urticaria Diagnosis Challenged By Overlapping Pruritic Skin Conditions

Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.

Diagnosing urticaria can be a frustrating puzzle for both patients and clinicians, as this mast cell–driven allergic skin condition often mimics other pruritic diseases, hindering clear epidemiological understanding, according to a recent review in Frontiers in Allergy.1

Urticaria affects both children and adults, with acute forms more frequent in children. Chronic cases affect women more often than men at a 2:1 ratio, and global studies from 1990 to 2019 showed stable disability rates with higher incidence in women.2

Although allergy consultations typically evaluate urticaria, many patients initially seek help in emergency, dermatology, or toxicology settings, where the condition manifests as itchy hives or wheals with surrounding redness and can indicate other underlying pathologies like infections, drug reactions, or anaphylaxis.1

Notably, the literature on urticaria includes many pathologies that do not meet its diagnostic criteria, such as vasculitic urticaria, erythema multiforme, urticaria pigmentosa, papular urticaria, erythema marginatum, autoinflammatory syndrome, urticarial dermatitis, and bullous pemphigus.

Vasculitic urticaria, a rare condition often associated with autoimmune phenomena, presents with recurrent skin lesions resembling chronic urticaria but persisting beyond 24 hours. The US reported an incidence of 0.5 cases per 100,000 persons/year, with 12% of leukocytoclastic vasculitis cases attributed to it. Although its etiology remains unidentified, factors like medications, infections, autoimmune diseases, malignancy, complement deficiency, and IgG4 deficiency are implicated, while antihistamines, oral corticosteroids, and omalizumab are the most common treatments.

Erythema multiforme, an often benign, short-term, self-limiting acute inflammatory disease of the skin and mucous membranes that tends to recur, presents with erythematous raised lesions featuring central flattening and blister formation. Papules can enlarge to adopt the characteristic target shape of erythema multiforme, and epidermal necrosis may develop centrally, with infectious conditions like herpes simplex, streptococcus, coxsackie, or certain medications causing it. While no specific treatment exists, antivirals are suggested for severe cases.

Urticaria pigmentosa, a form of mastocytosis, features a clonal and pathological accumulation of mast cells in various tissues, presenting as small brown itchy spots that can become edematous and form a wheal when scratched. Papular urticaria, a chronic Th2 cell-mediated hypersensitivity reaction most common in the tropics and often linked to atopy in children, occurs as an isolated pathology or with comorbid atopic disease. Lesional reactions from scabies can increase mite sensitization by causing skin inflammation and barrier alteration, thus enhancing the immune response.

Erythema marginatum, a reactive inflammatory erythema specific to acute rheumatic fever, presents with circular, evanescent, nonpruritic erythematous rashes with serpiginous edges that spontaneously resolve and reappear. Clinicians can diagnose it based on clinical findings, hereditary angioedema, and psittacosis, and they primarily manage the condition with β-lactam antibiotics such as penicillin, amoxicillin, cephalosporins, or macrolides.

Autoinflammatory syndromes are a group of diseases featuring spontaneous, recurrent, or persistent episodes of multisystem inflammation, fever, or urticaria, often resulting from alterations in innate immunity that dysregulate the immune system and cause abnormal inflammatory activity. Treatment for these syndromes may involve biologic agents like IL-1 inhibitors or TNF-α inhibitors.

Urticarial dermatitis, a rarely used term, labels a subset of dermal hypersensitivity reactions. It does not limit itself to a specific entity, but eczema and drug reactions most frequently appear as clinical associations. Clinicians describe urticarial dermatitis as a combination of urticaria and dermatitis features. Similarly, protein contact dermatitis comprises cutaneous hypersensitivity reactions that follow chronic and recurrent exposure or chronic irritation to animal or plant proteins, including occupational contact dermatitis, a common and almost always irritating disease.

Bullous pemphigus, a spectrum of rare mucocutaneous blistering diseases, originates from autoimmune processes. The disease typically presents severely in infants, with blisters occurring on the hands and feet in all cases. Overall, the prognosis of the disease is favorable.

The accurate diagnosis and effective management of urticaria require careful clinical evaluation to distinguish it from a spectrum of other conditions that share similar skin manifestations. Recognizing the nuances of these mimicker dermatoses is crucial for guiding appropriate treatment strategies and improving patient outcomes in this complex field of allergic and immunological skin disorders.

References

1. Rojo-Gutierrez MI, Moncayo-Coello CV, Macias Weinmann A, et al. Urticaria and other mimickers of urticaria. Front Allergy. 2025;5:1522749. Doi:10.3389/falgy.2024.1522749

2. Liu X, Cao Y, Wang W. Burden of and trends in urticaria globally, regionally, and nationally from 1990 to 2019: systematic analysis. JMIR Public Health Surveill. 2023;9:e50114-e50114. Doi:10.2196/50114

FDA Approves Dupixent For Chronic Skin Condition

April 21, 2025 – The FDA just approved the popular drug Dupixent for adults and kids 12 and up with chronic spontaneous urticaria (CSU), a long-lasting itchy skin condition, when regular allergy meds don't do the trick.

This is the seventh approved use for Dupixent and the first new targeted treatment in over a decade for the 300,000 people in the U.S. Whose CSU isn't well controlled.

CSU is an inflammatory condition marked by raised, red, itchy bumps (hives) or welts on the skin that often come and go unexpectedly. The hives can affect any part of the body and typically last from 30 minutes to 24 hours. The exact cause is unknown, but it is linked to allergic reactions and an immune response known as type 2 inflammation – a process also seen in conditions like asthma and eczema. Antihistamines are often the first line of treatment, though they don't work well for many people – highlighting the need for more targeted options.

"People with chronic spontaneous urticaria experience sudden, unpredictable hives and severe itch that cause a significant, and often overwhelming, burden on their everyday lives. The approval of this treatment offers patients more options and the chance to control their disease," Kenneth Mendez, president and chief executive officer at the Asthma and Allergy Foundation of America, said in a news release from Sanofi, the drug's maker.

The FDA's decision came from two studies of 284 people, 12 and up, who still had symptoms after antihistamines and hadn't tried other stronger options. After 24 weeks, patients taking Dupixent as an add-on to antihistamines had significant relief from itchiness and hives, compared with those who took antihistamines alone. And compared with a placebo, Dupixent helped more people get their condition under control or even clear up completely after 24 weeks.

Developed by Sanofi and Regeneron and first approved in 2017, Dupixent (generic name, dupilumab) is a biologic that works by blocking certain pathways that add to type 2 inflammation, which plays a key role in CSU symptoms. Dupixent is available as a prefilled pen for shots under the skin and is used with standard antihistamines. After the first dose, it's given every two weeks under a doctor's guidance, either in a clinic or at home after training. For children ages 12 to 17, an adult should supervise the shots.

Dupixent's list of uses already includes asthma, eczema, chronic sinus inflammation with nasal polyps, eosinophilic food pipe inflammation, prurigo nodularis (hard, itchy bumps on the skin), and chronic obstructive pulmonary disease.

The safety of Dupixent was consistent with that found in previous trials, with reactions where the needle went in being the most common side effect.

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