Are Allergies Making Me Tired?

Q: When spring comes around, I never know if my lack of energy is a result of allergies or something else. How can you tell the difference?

For the estimated 26 percent of adults in the United States who deal with seasonal allergies, spring is not just the time to ditch your winter jacket and frolic around outside. It also heralds the beginning of spring allergy season, and the dreaded symptoms that come along with it — runny noses, sneezing, watery eyes — and fatigue, said Dr. Jyothi Tirumalasetty, a clinical assistant professor of medicine at Stanford University who specializes in allergy and immunology.

But figuring out if tiredness is a result of allergies or something else — like a cold, Covid-19 or even just the changing of the clocks — can be challenging because many of the signs may be the same. Here are some simple ways to tell them all apart.

Pay attention to your symptoms

Allergies can cause fatigue indirectly by hampering your ability to sleep, Dr. Tirumalasetty said. A blocked nose or mild wheezing can prevent you from falling asleep, or you might startle awake with coughing fits. Congestion can also create a lot of pressure in the upper airways that can make you tired, said Dr. Joyce Yu, a pediatric allergist and immunologist at Columbia University Irving Medical Center. “It sends a signal to your brain and says, ‘Hey, I’m exhausted,’” she said.

A key sign that your fatigue may be caused by allergies is if you have other allergy symptoms at the same time, Dr. Tirumalasetty said. These include itchiness in the eyes, ears, nose and throat, as well as sneezing, coughing, runny nose, watery eyes, a slight wheezing or whistling when you breathe, postnasal drip and skin rashes or hives.

4 Tips to Help Manage Your Allergy Symptoms

1. Give your sinuses a bath. Nasal irrigation is another option whose effectiveness is backed by research. Try it yourself: Use a neti pot or bulb syringe and pour a saline solution in one nostril, letting it drain out the other. You will feel less congested and may need less medication.

2. Plan time outdoors wisely. Pollen counts tend to be at their highest between early morning and midmorning, as well as on hot, dry, windy days. Stay indoors during those times and go out later in the evening, to reduce the amount of pollen you inhale. You can also try wearing a face mask when you go outside.

3. Reduce pollen at home. Avoid bringing pollen back inside after you’ve been outdoors by taking your shoes off, changing your clothes and showering. In order to sleep better, you can try zipping up your mattress and pillows in hypoallergenic cases and wash your bedding in hot soapy water.

4. Find medication that works for you. It may take some trial and error to find the right allergy medication regimen for you — talk to your doctor to create a plan of action. Nasal steroid sprays are usually recommended as a first line of treatment; antihistamines and decongestants can offer some immediate relief. For a longer-term solution, consider allergy immunotherapy.

But “if you’re not a coughing, wheezing, sniffling, snotty person, then you probably don’t really have allergies, and your fatigue may be due to something else,” Dr. Yu said.

Common health conditions that can cause fatigue include depression, iron deficiency, thyroid problems and sleep apnea, said Dr. Nina Mingioni, a professor of medicine at Thomas Jefferson University in Philadelphia.

Respiratory infections like the common cold or even Covid-19 can cause fatigue too, Dr. Tirumalasetty said, along with other common allergy symptoms like a cough, headache and stuffy or runny nose. But the main symptoms that would distinguish allergies from these other conditions are itchiness in the nose, eyes and ears. If you have an upper respiratory infection, you might also have a fever, sore throat, swollen glands and muscle aches — which are not really associated with allergies, Dr. Yu said.

The duration of your symptoms can be another giveaway for what you have, Dr. Tirumalasetty said. “Your average cold is going to clear within two weeks,” she said, so if you’re feeling off for weeks or months on end, your symptoms are more likely a result of allergies.

Medications can alleviate allergy symptoms, but beware of daytime drowsiness

Because fatigue is a symptom and not a medical condition itself, Dr. Mingioni said, there is no specific treatment for it. So to address fatigue, you “pretty much always have to address the underlying problem.”

If sinus pressure from congestion is making you tired or causing other symptoms like a headache, you can treat it with over-the-counter allergy medications such as oral antihistamines, Dr. Yu said. But they do come with some pros and cons.

Oral allergy medications are effective at alleviating symptoms like congestion, itchiness and sneezing, but a significant downside is that many cause drowsiness, Dr. Tirumalasetty said. First-generation oral antihistamines, like Benadryl (diphenhydramine) or Atarax (hydroxyzine), are more likely than second-generation antihistamines, like Claritin (loratadine) or Zyrtec (cetirizine), to cause drowsiness, Dr. Yu said.

And even the ones that are labeled “nondrowsy” can still cause some sleepiness for some people, Dr. Tirumalasetty said, so it may take some trial and error to find the allergy medication that works for you.

That being said, Dr. Yu added, “it’s definitely much more beneficial to treat your allergies than to try to avoid the medications because of fear of sedation” — at least in her own experience treating patients. And if your symptoms are causing fatigue by keeping you up at night, the drowsiness from the medications might work in your favor.

Still, there are alternatives to oral medications that can help alleviate allergy symptoms, Dr. Yu said, including saline nasal sprays or rinses and antihistamine or saline eye drops.

Track your triggers

Identifying the patterns in your symptoms can help you prepare for allergy season, Dr. Yu said. For example, if you know that fatigue and other allergy symptoms typically occur during the spring, you can start gathering your medications a few weeks or months ahead.

“I think keeping a diary is really helpful,” Dr. Tirumalasetty said, whether that’s tracking your symptoms in the calendar on your phone or jotting them down in a notes app or a physical notebook. An example entry might be something like, “I was at my brother’s house and they’ve got six cats, and now I feel itchy and tired,” she said.

If you know which allergens are problematic for you, you can also see how bad pollen levels across the country are on a given day using online trackers. Those from the American Academy of Allergy, Asthma and Immunology or can be useful, Dr. Tirumalasetty said. When pollen levels are high, you might take a preventive step, such as taking an antihistamine, before going outside, she said.

Another key strategy for minimizing allergy symptoms is to “allergy-proof your house,” Dr. Tirumalasetty said. If you’re allergic to dust mites, you might use hypoallergenic bedding or “allergy-proof” mattress, pillow and duvet covers that stop dust mites from getting into your bedding and help minimize symptoms, she said. To prevent dust and other possible irritants from accumulating, Dr. Tirumalasetty said, make sure to “wash your sheets once a week.” Try to avoid any animals you may be allergic to, and if you have seasonal allergies, showering after you’ve been outside and cleaning those worn clothes will help you avoid tracking too much pollen or other allergens into your home.

When dealing with fatigue from any cause, Dr. Mingioni said, it’s important to prioritize the habits that promote quality rest, such as going to sleep and waking up at the same times each day, “keeping bedrooms free of distractions” and limiting cellphone use before bed. Rest is crucial for managing health concerns, she added, whether they’re from stress, a cold or allergies.

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