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Kenalog steroid injections for hay fever

Many people still seek Kenalog steroid injections as a treatment for hay fever. Worryingly too many doctors and clinics still advocate such therapy. Trained allergists refuse to give such injections because there is significant risk and Kenalog only has a transient impact on relieving hay fever symptoms.

Kenalog steroid injections

PubChem CID
CID 31307 (Triamcinolone)

 

What is Kenalog?

Each Kenalog injection contains the very strong steroid called triamcinolone acetonide as the active ingredient. It is a long acting formulation of steroid, one that once it is in your system it will continually dampen down your immune system thus relieving hay fever allergic symptoms.

 

Risks vs benefits of Kenalog therapy

As a potent steroid it effects the metabolism of the body and weakens the immune system. Even with short use, given the duration of action after even just one injection, there is higher risk of an adverse response compared to other treatments for hay fever. With oral steroids the effects last 24 hours only, so should any adverse events occur the drug is out of the body’s system by the next day. This is not so with Kenalog. Any adverse events such as that as an infection promoted by a Kenalog weakened immune system or poor mental health such as depression, anxiety or even suicidal ideation can be much worse by strong steroids.

In 2013, retrospective analysis of the Danish National Registry database confirmed that regular use of depot corticosteroid injections to treat hay fever and other forms of allergic rhinitis increased the risk of being diagnosed with diabetes and osteoporosis (thin bones with increased risk of fracture).

 

Advice

As stated in the British Society for Allergy and Clinical Immunology (BSACI) guidelines for the treatment of Allergic and Non-Allergic Rhinitis, allergists do not recommend long acting (depot) systemic steroids. The guideline states the following:

"Injected preparations are not recommended as compared to other available treatments the risk-benefit profile for intramuscular corticosteroids is poor."

https://www.bsaci.org/guidelines/bsaci-guidelines/rhinitis-2017-update/

Interesting reading

  1. Aasbjerg K, Torp-Pedersen C, Vaag A, Backer V. Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes. Respir Med. 2013;107:1852-1858.
  2. Nasser SM, Ewan PW. Lesson of the week: depot corticosteroid treatment for hay fever causing avascular necrosis of both hips. BMJ. 2001; 322:1589-1591.
  3. Drug Ther Bull. 2020 Apr;58(4):57-59. doi: 10.1136/dtb.2019.000060. Epub 2020 Feb 12.
    Still no place for depot triamcinolone in hay fever?

 

Key message

If the hay fever is severe then a short course of once daily oral steroids is the last resort. Often such therapy should prompt the physician treating the hay fever to urgently refer the patient to an allergist to consider pollen desensitisation (otherwise termed immunotherapy) before the next pollen season arrives. Such therapy, if done correctly, is safe and very effective.

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