Cold vs hay fever: how to tell them apart

If your symptoms started gradually over a couple of days, you feel a bit run down, and you have a sore throat, cough or aching muscles, a cold is more likely. If you are sneezing repeatedly, your eyes and nose are itchy, the symptoms follow you around for weeks, and they are worse on warm, windy days in spring or summer, hay fever is more likely.

Neither is dangerous for most people, and both can be managed at home with advice from a pharmacist. The NHS says a pharmacist can suggest treatments for hay fever, and that you can usually treat a cold at home without seeing a GP.

The table below uses only features the NHS describes on its common cold and hay fever pages. Where a feature is not listed for a condition, the table says so rather than implying it can never occur.

The NHS says cold symptoms come on gradually over 2 to 3 days. The main ones are a blocked or runny nose, sneezing, a sore throat, a hoarse voice, a cough and feeling tired and unwell. You may also have a high temperature, aching muscles, a loss of taste and smell and a feeling of pressure in the ears and face.

A cold usually runs its course within 1 to 2 weeks. The NHS advises seeing a GP if you have a high temperature for more than 3 days, symptoms that get worse, feel short of breath or have chest pain, have symptoms that do not improve after 10 days or a cough for more than 3 weeks. People with a long-term condition or a weakened immune system are also advised to get advice.

The NHS describes hay fever as a common allergy that causes sneezing, coughing and itchy eyes. Its symptom list adds a runny or blocked nose, itchy, red or watery eyes, an itchy throat, mouth, nose and ears, loss of smell, pain around the sides of the head and forehead, a headache and feeling tired.

The pattern is the useful part. Symptoms tend to be worse in warm, humid and windy weather when the pollen count is high. They persist for as long as exposure does, which is why they can run for weeks or months rather than days. A GP may be worth seeing if symptoms are getting worse or do not improve after medicines from the pharmacy, the NHS says.

Both conditions inflame the lining of the nose, so the early picture is similar: sneezing, congestion, a runny nose, tiredness and sometimes a headache. Loss of smell appears on both lists, and both can bring pain or pressure around the face and head. A first hay fever season can feel like a cold that will not shift, while a cold during pollen season can be assumed to be hay fever.

Useful questions are: how long has this gone on, do the eyes itch, do I feel feverish or achy, is anyone around me ill, and does it settle when I am indoors or when the weather turns wet? If you have had very similar symptoms at the same time in previous years, that points towards an allergy.

For a cold, the NHS suggests rest, plenty of fluids, a salt water gargle (not suitable for children) or a hot lemon and honey drink for a sore throat, and steam for a blocked nose. Medicines such as paracetamol or ibuprofen can ease aches, and nasal decongestants should not be used for more than a week. Antibiotics do not help because colds are caused by viruses.

For hay fever, the NHS suggests practical steps such as petroleum jelly around the nostrils, wraparound sunglasses, showering and changing clothes after being outdoors, keeping windows shut and avoiding cutting grass. A pharmacist can suggest antihistamine drops, tablets or nasal sprays, or steroid nasal sprays, and a GP may prescribe a steroid or refer for immunotherapy if other treatments are not working. Some antihistamines can make you very sleepy, so non-drowsy options may be preferable.