各位上仙，十裡桃花已綻放，四海八荒去追尋詩與遠方，小心感冒的“偽裝者”（上）
三月春盛，煙煙霞霞，滿山桃花灼灼，一灣秀水青山。不知不覺春暖花開，小明和幾個師兄弟相約週末去踏青賞春。天氣不錯，正是那千里鶯啼綠映紅，水村山郭酒旗風的江南春景，大家乘興而去，興盡而歸。美中不足的是，小明回來就開始有點鼻塞，流涕，噴嚏，嗓子毛毛的和輕微咳嗽。是不是玩的時候貪戀鄉村點點星空的夜景，
春天到了，這是一個天氣變暖，萬物復蘇，綠意盎然的季節。 不過氣溫逐漸回升的同時, 各種病毒細菌也隨之復蘇，而且天氣忽冷忽熱， 加上花粉和各種微生物出現，春季是感冒，流感和過敏的高發季節。
Spring is coming, the arrival of spring brings warmer weather and greenery. The fluctuation of temperatures and the exposure to the pollen and environmental allergies means the overlap of colds, flu and allergies. It is sometimes hard to tell them apart because the symptoms can be so much alike, such as sneezing, runny nose and congestion. How do you tell the differences? Let's look closely to find clues about what's going on which will help us to choose the best treatment choices.
1.發生的時間：是不是在每年相同的時節比較容易出現這些症狀？
Consider the time of year. Is it tend to come at the same time every year?
如果是的話，需要考慮過敏的可能，而不是感冒。季節性的過敏所引起的噴嚏，流涕和鼻塞常發生於每年相同的時節和特定的類似條件下，比如有花粉的春天或落葉的秋天。免疫系統在人體吸入或接觸了諸如花粉，黴菌或動物的毛屑等過敏原後出現過度的反應，釋放組胺引起鼻腔和呼吸道粘膜上皮細胞水腫充血，導致噴嚏，流涕, 鼻癢和鼻塞等症狀。
而感冒大多由病毒引起，
If yes, it may well be seasonal allergies rather than a cold. Seasonal allergies tend to bloom at the same time every year and around the same set of conditions, such as the time of plant flowering in spring or leaves falling in autumn. When exposure to allergens, such as pollen, mold or pet dander, the immune system may overreact to these substances that is harmless to most people but triggers a reaction in anyone allergic to. It releases chemicals called histamines that cause respiratory tissues swelling and congestion and nose may become itchy, stuffed up or runny.
On the other hand, colds are caused by virus mostly. Although colds tend to be more often in winter, it could occurred at any time of year and in any environment. It usually takes several day to show up the symptoms after exposure to a virus.
2. 症狀持續的時間：是不是會持續較長時間？
Consider the duration of the symptoms. Did symptoms last a long time?
如果是的話，需要考慮過敏可能。區分感冒，流感和季節性過敏的最快最好的辦法就是根據症狀持續的時間長短。普通感冒病程一般會持續3~10天，流感持續時間稍長，但通常也會在1~2周後症狀緩解，感冒和流感症狀持續很少會超過2周。
而季節性過敏的症狀則會持續較長時間，數周甚至數月，如果一直持續接觸過敏原的話。所以在春天或秋天等花粉季節，過敏的症狀超過6周到9周也並不少見，不進行治療和規避過敏原的話症狀不會消失。
If yes, it could be allergies. The quick and best way to differentiate cold, flu and seasonal allergies is the duration of the symptoms. Common cold symptoms usually go away within 3 to 10 days and seasonal flu may last 1-2wks. Colds and flu rarely last beyond 2 weeks.
On the other hand, seasonal allergies last longer, usually for several weeks or months, as long as you are exposed to the allergen. It is not uncommon that people might suffer from the symptom about 6 to 9 weeks during pollen seasons in the spring or fall. They won't subsided without treatment or removal from the allergens.
3. 症狀的時間規律性：是不是隨時間段，氣候和環境地點而改變，具有一定週期性或規律性？
Consider the daily patterns of the symptoms. Does the symptoms vary with time of day, weather or location?
如果是的話，需要考慮過敏可能。普通感冒或流感的鼻塞，噴嚏和流涕是連續性的，一般持續數天，隨感冒的好轉而逐漸減輕至消退。而因為季節性過敏導致的症狀則可能會隨根據一天內不同時間段，不同的天氣或環境而表現地輕重不一。
比如，天氣乾燥多風的清晨和晚上，對草花粉過敏的人在戶外可能會症狀明顯嚴重些，而白天呆在室內則會好些。這是因為在氣候溫暖有利於植物生長，花粉量增多；天氣晴朗乾燥多風時，植物花粉囊更容易被吹散破裂隨風飄散，導致空氣中花粉濃度增加。而且一天之內的花粉濃度也有動態變化，在晴朗微風的夜晚是相對濃度最高的。
下雨天花粉過敏者的症狀相對好轉甚至消失，尤其是大雨或暴雨過後，這是是因為花粉受到雨水的沖刷，空氣中花粉量迅速減少。
另外，在長江中下游的江南或華南地區，花粉季後接踵而至的是梅雨季節，正是適於各種黴菌孢子生長的氣候，黴菌過敏者就會在這個時節比較容易出現症狀。
If yes, it is more likely to be allergies. Stuffy nose, sneezing and runny nose may continue for several days and then gradually subsided in people who catch cold or flu. On the other hand, seasonal allergies may varies with time of day, weather or location.
People with grass pollen allergies could have symptoms worse in the morning or evening of warm, dry windy weather when outdoors. This is because more pollen is shed from the grass in dry windy weather and it also varies at all times of the day, being usually worst in a sunny breezy evening.
Symptoms would be improved or even subsided during rainy days because rain dramatically lowers airborne pollen any time of day.
People with mould allergy would more likely to develop symptoms during the plum rain season in the southeastern China where the pollen season is succeeded by the mould spore.
4. 是不是伴有發熱，頭痛和肌肉酸痛？
Is there a fever, headache, or muscle aches?
如果是的話，需要考慮感冒或流感。季節性過敏一般不會引起發熱，頭痛或全身肌肉酸痛，但是感冒或流感通常會有這些症狀。
If yes, it could be a cold or flu. Seasonal allergies won't cause fever, headache or body aches, whereas colds or flu sometimes have these symptoms.
5. 是不是有黃色或綠色的鼻涕？
Is there yellow/greenish nasal discharge?
如果是的話，需要考慮感冒或有細菌感染。季節性過敏通常會有稀薄的清水鼻涕為主，而感冒或細菌感染有時會有黃色或綠色的鼻涕。但是，容易混淆的是，過敏患者有時比較容易發生感冒和鼻竇炎，這個時候鼻涕也會出現黃色或綠色的。
If yes, it could be a cold or infection. Seasonal allergies usually tend to have a thin, clear nasal discharge rather than yellow or greenish discharge that come with cold or infection. However, people with allergies are sometimes more prone to catching colds or developed sinus infection resulting in yellow or greenish discharge.
6. 是不是具有傳染性？
Is it infectious?
如果是的話，需要考慮感冒或流感。感冒和流感是由病毒引起，具有傳染性，特別是流感。季節性過敏是由過敏導致的，不會傳染，雖然有時可以遺傳。父母一方有過敏性疾病的， 子女過敏的發生風險要相對高些。如果父母雙方都有過敏性鼻炎，子女過敏的風險會更高。
If yes, it could be a cold or flu. Common cold and flu are caused by virus and thus are infectious. Seasonal allergies are caused by allergies and appears to have a genetic component. People with a parent who has allergic rhinitis have an increased risk of developing allergic rhinitis themselves. The risk increases significantly if both parents have allergic rhinitis.
7. 是不是伴有眼睛發癢，流淚或水樣分泌物?
Are there itchy or watery eyes?
如果是的話，需要考慮過敏。過敏也可表現為過敏性結膜炎，出現眼睛癢，流淚，紅，或眼瞼腫脹等。這些症狀可以單獨出現也可以伴隨鼻部症狀一起，而通常感冒或流感是不會出現這些困擾的。 AR-SA'>是不是具有傳染性？
If yes, it is could be allergies. Allergies can also cause itchy, watery, red or swollen eyes, which won't normally seen in a cold or flu. This can occurred by itself or with a nasal allergy when allergens cause an inflammation of the conjunctiva.
8. 是不是有黑眼圈，經常揉搓鼻子以及鼻樑上橫向的皺痕？
如果是的話，要考慮過敏。有季節性過敏的人由於鼻粘膜充血腫脹，引起眼睛周圍局部靜脈血液迴圈不佳而出現黑眼圈及浮腫，稱為“變應性黑眼圈”。有過敏性鼻炎的孩子常因為鼻子癢和鼻腔不通暢而經常用手掌向上揉鼻子出現“過敏性敬禮症”。另外還會因手掌反復向上揉搓而在鼻樑上留下橫折，稱為“過敏性鼻皺痕”。當然，感冒有時也會有黑眼圈和揉搓鼻子的動作，但在季節性過敏者常常這些不經意的動作較多且維持時間較長。
If yes, it is more likely to be allergies. People with seasonal allergies are often seen dark, puffy circles under the eyes which are called “allergic shiners”. These are related to poor blood circulation caused by nasal congestion. "Allergic salute " is also be noted in children with seasonal allergies. They often frequently push their noses up with the palms of their hands to wipe or relieve itchiness and stuffiness. A horizontal crease usually develops on the nasal bridge due to upward rubbing called " allergic crease". Anyone with a cold may do the allergic salute, but children with allergies tend to do this a lot.
附錄：感冒，流感和過敏對照
Cold,Flu, or Allergy?
Basedon NIH News in Health, 2014. https://newsinhealth.nih.gov/issue/Oct2014/Feature2
作者：澳大利亞墨爾本大學醫學院兒科博士
百匯醫療（中國）兒科醫師
蔣本然
普通感冒病程一般會持續3~10天，流感持續時間稍長，但通常也會在1~2周後症狀緩解，感冒和流感症狀持續很少會超過2周。而季節性過敏的症狀則會持續較長時間，數周甚至數月，如果一直持續接觸過敏原的話。所以在春天或秋天等花粉季節，過敏的症狀超過6周到9周也並不少見，不進行治療和規避過敏原的話症狀不會消失。
If yes, it could be allergies. The quick and best way to differentiate cold, flu and seasonal allergies is the duration of the symptoms. Common cold symptoms usually go away within 3 to 10 days and seasonal flu may last 1-2wks. Colds and flu rarely last beyond 2 weeks.
On the other hand, seasonal allergies last longer, usually for several weeks or months, as long as you are exposed to the allergen. It is not uncommon that people might suffer from the symptom about 6 to 9 weeks during pollen seasons in the spring or fall. They won't subsided without treatment or removal from the allergens.
3. 症狀的時間規律性：是不是隨時間段，氣候和環境地點而改變，具有一定週期性或規律性？
Consider the daily patterns of the symptoms. Does the symptoms vary with time of day, weather or location?
如果是的話，需要考慮過敏可能。普通感冒或流感的鼻塞，噴嚏和流涕是連續性的，一般持續數天，隨感冒的好轉而逐漸減輕至消退。而因為季節性過敏導致的症狀則可能會隨根據一天內不同時間段，不同的天氣或環境而表現地輕重不一。
比如，天氣乾燥多風的清晨和晚上，對草花粉過敏的人在戶外可能會症狀明顯嚴重些，而白天呆在室內則會好些。這是因為在氣候溫暖有利於植物生長，花粉量增多；天氣晴朗乾燥多風時，植物花粉囊更容易被吹散破裂隨風飄散，導致空氣中花粉濃度增加。而且一天之內的花粉濃度也有動態變化，在晴朗微風的夜晚是相對濃度最高的。
下雨天花粉過敏者的症狀相對好轉甚至消失，尤其是大雨或暴雨過後，這是是因為花粉受到雨水的沖刷，空氣中花粉量迅速減少。
另外，在長江中下游的江南或華南地區，花粉季後接踵而至的是梅雨季節，正是適於各種黴菌孢子生長的氣候，黴菌過敏者就會在這個時節比較容易出現症狀。
If yes, it is more likely to be allergies. Stuffy nose, sneezing and runny nose may continue for several days and then gradually subsided in people who catch cold or flu. On the other hand, seasonal allergies may varies with time of day, weather or location.
People with grass pollen allergies could have symptoms worse in the morning or evening of warm, dry windy weather when outdoors. This is because more pollen is shed from the grass in dry windy weather and it also varies at all times of the day, being usually worst in a sunny breezy evening.
Symptoms would be improved or even subsided during rainy days because rain dramatically lowers airborne pollen any time of day.
People with mould allergy would more likely to develop symptoms during the plum rain season in the southeastern China where the pollen season is succeeded by the mould spore.
4. 是不是伴有發熱，頭痛和肌肉酸痛？
Is there a fever, headache, or muscle aches?
如果是的話，需要考慮感冒或流感。季節性過敏一般不會引起發熱，頭痛或全身肌肉酸痛，但是感冒或流感通常會有這些症狀。
If yes, it could be a cold or flu. Seasonal allergies won't cause fever, headache or body aches, whereas colds or flu sometimes have these symptoms.
5. 是不是有黃色或綠色的鼻涕？
Is there yellow/greenish nasal discharge?
如果是的話，需要考慮感冒或有細菌感染。季節性過敏通常會有稀薄的清水鼻涕為主，而感冒或細菌感染有時會有黃色或綠色的鼻涕。但是，容易混淆的是，過敏患者有時比較容易發生感冒和鼻竇炎，這個時候鼻涕也會出現黃色或綠色的。
If yes, it could be a cold or infection. Seasonal allergies usually tend to have a thin, clear nasal discharge rather than yellow or greenish discharge that come with cold or infection. However, people with allergies are sometimes more prone to catching colds or developed sinus infection resulting in yellow or greenish discharge.
6. 是不是具有傳染性？
Is it infectious?
如果是的話，需要考慮感冒或流感。感冒和流感是由病毒引起，具有傳染性，特別是流感。季節性過敏是由過敏導致的，不會傳染，雖然有時可以遺傳。父母一方有過敏性疾病的， 子女過敏的發生風險要相對高些。如果父母雙方都有過敏性鼻炎，子女過敏的風險會更高。
If yes, it could be a cold or flu. Common cold and flu are caused by virus and thus are infectious. Seasonal allergies are caused by allergies and appears to have a genetic component. People with a parent who has allergic rhinitis have an increased risk of developing allergic rhinitis themselves. The risk increases significantly if both parents have allergic rhinitis.
7. 是不是伴有眼睛發癢，流淚或水樣分泌物?
Are there itchy or watery eyes?
如果是的話，需要考慮過敏。過敏也可表現為過敏性結膜炎，出現眼睛癢，流淚，紅，或眼瞼腫脹等。這些症狀可以單獨出現也可以伴隨鼻部症狀一起，而通常感冒或流感是不會出現這些困擾的。 AR-SA'>是不是具有傳染性？
If yes, it is could be allergies. Allergies can also cause itchy, watery, red or swollen eyes, which won't normally seen in a cold or flu. This can occurred by itself or with a nasal allergy when allergens cause an inflammation of the conjunctiva.
8. 是不是有黑眼圈，經常揉搓鼻子以及鼻樑上橫向的皺痕？
如果是的話，要考慮過敏。有季節性過敏的人由於鼻粘膜充血腫脹，引起眼睛周圍局部靜脈血液迴圈不佳而出現黑眼圈及浮腫，稱為“變應性黑眼圈”。有過敏性鼻炎的孩子常因為鼻子癢和鼻腔不通暢而經常用手掌向上揉鼻子出現“過敏性敬禮症”。另外還會因手掌反復向上揉搓而在鼻樑上留下橫折，稱為“過敏性鼻皺痕”。當然，感冒有時也會有黑眼圈和揉搓鼻子的動作，但在季節性過敏者常常這些不經意的動作較多且維持時間較長。
If yes, it is more likely to be allergies. People with seasonal allergies are often seen dark, puffy circles under the eyes which are called “allergic shiners”. These are related to poor blood circulation caused by nasal congestion. "Allergic salute " is also be noted in children with seasonal allergies. They often frequently push their noses up with the palms of their hands to wipe or relieve itchiness and stuffiness. A horizontal crease usually develops on the nasal bridge due to upward rubbing called " allergic crease". Anyone with a cold may do the allergic salute, but children with allergies tend to do this a lot.
附錄：感冒，流感和過敏對照
Cold,Flu, or Allergy?
Basedon NIH News in Health, 2014. https://newsinhealth.nih.gov/issue/Oct2014/Feature2
作者：澳大利亞墨爾本大學醫學院兒科博士
百匯醫療（中國）兒科醫師
蔣本然