What are the considerations for administering a Kenalog (triamcinolone) allergy injection?

From the Guidelines

Kenalog (triamcinolone acetonide) injections for allergies should only be administered in a medical facility with trained staff and medical equipment capable of recognizing and treating anaphylaxis, as stated in the most recent guideline 1.

Important Considerations

Before administration, several key factors must be considered to ensure safe and effective treatment:

• A thorough medical history should be obtained, including current medications, as corticosteroids can interact with drugs like anticoagulants and certain antibiotics.
• Patients should be screened for contraindications including systemic fungal infections, active tuberculosis, immunosuppression, diabetes, glaucoma, and pregnancy.
• The injection site should be properly cleaned with alcohol, and proper technique used to avoid injecting into blood vessels.
• Patients should be monitored for 15-30 minutes after injection for immediate adverse reactions.

Administration and Monitoring

Some key points to consider when administering Kenalog injections include:

• The typical dose ranges from 40-80 mg for adults, administered intramuscularly in the gluteal muscle, with effects lasting approximately 2-6 weeks.
• Patients with asthma should have their airway function assessed before receiving the injection, and their asthma must be stable before administration, as indicated in 1.
• Common side effects include temporary pain at the injection site, insomnia, increased appetite, and mood changes.
• More serious potential complications include adrenal suppression, elevated blood glucose, increased susceptibility to infections, and rarely, anaphylaxis.

Patient Education

Patients should be informed that:

• Symptom relief may take 24-48 hours to begin.
• They should be limited to 3-4 injections per year to minimize systemic side effects.
• Triamcinolone is a potent intermediate-acting corticosteroid that works by suppressing inflammatory and allergic responses through inhibition of inflammatory mediators. As emphasized in 1, allergen immunotherapy vaccines should only be administered by healthcare professionals trained in the recognition and treatment of anaphylaxis, in healthcare facilities with proper equipment for anaphylaxis treatment.

From the FDA Drug Label

Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. The considerations for administering a Kenalog (triamcinolone) allergy injection include:

• Control of severe or incapacitating allergic conditions that are intractable to conventional treatment
• Administration for conditions such as asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, and transfusion reactions
• Intramuscular use is indicated for these conditions 2
• Serious neurologic adverse reactions have been reported with epidural administration of corticosteroids, but this is not relevant to intramuscular administration for allergic conditions 2
• Rare instances of anaphylaxis have occurred in patients receiving corticosteroid therapy, including triamcinolone acetonide injection 2

From the Research

Considerations for Administering a Kenalog (Triamcinolone) Allergy Injection

• The possibility of an allergic reaction to the carboxymethylcellulose component of Kenalog, as reported in studies 3, 4, should be considered.
• Patients who experience allergic-type reactions to Kenalog should undergo component testing to determine the cause of the reaction 3.
• Allergic reactions to triamcinolone itself are rare, but have been reported, and can manifest as immediate hypersensitivity reactions 5.
• Intra-articular injections of Kenalog can cause postinjection flares, which can be severe and mimic septic arthritis 6.
• Delayed allergic reactions to local injections of triamcinolone acetonide can also occur, and may require treatment with anti-inflammatory and anti-allergic medications 7.
• It is essential to inform patients of the potential side effects of Kenalog injections, including allergic reactions and postinjection flares, and to monitor them closely after administration.
• In cases of suspected allergic reactions, skin testing and serologic testing for allergen-specific IgE antibodies may be necessary to determine the cause of the reaction 3, 5.