What is the role of Kennalog IM (triamcinolone acetonide) in treating allergic rhinitis?

From the Guidelines

Kenalog IM (triamcinolone acetonide) is not typically recommended as a first-line treatment for allergic rhinitis due to its potential for significant systemic side effects and the availability of safer, more effective alternatives. This injectable corticosteroid is occasionally used for severe, uncontrolled seasonal allergic rhinitis when other treatments have failed, as indicated in the practice parameter for the diagnosis and management of rhinitis 1. The typical dose is 40-80 mg administered as a single intramuscular injection, with effects lasting approximately 3-4 weeks. However, intranasal corticosteroid sprays (like fluticasone or mometasone), oral antihistamines, and leukotriene modifiers are preferred initial treatments due to their better safety profiles and efficacy in controlling symptoms of allergic rhinitis, as supported by studies 1.

Some key points to consider when evaluating the use of Kenalog IM for allergic rhinitis include:

• Intranasal corticosteroids are the most effective medication class in controlling symptoms of allergic rhinitis, with a rapid onset of action and minimal systemic side effects 1.
• Oral antihistamines and leukotriene modifiers are also effective treatments for allergic rhinitis, with a better safety profile compared to injectable corticosteroids like Kenalog IM 1.
• Kenalog IM carries significant risks, including adrenal suppression, elevated blood glucose, immune suppression, and bone density loss, especially with repeated use, making it unsuitable for routine or repeated use in managing allergic rhinitis 1.
• Patients should be informed that while a single injection of Kenalog IM might provide temporary relief from severe symptoms, the potential long-term risks generally outweigh the benefits for a condition that can typically be managed with safer alternatives.

In summary, the use of Kenalog IM for allergic rhinitis should be approached with caution, considering the potential risks and benefits, and alternative treatments should be preferred due to their better safety profiles and efficacy.

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 role of Kennalog IM (triamcinolone acetonide) in treating allergic rhinitis is for the control of severe or incapacitating allergic conditions, including perennial or seasonal allergic rhinitis, when conventional treatment is not feasible. Key points include:

• Intramuscular use for severe or incapacitating allergic conditions
• Allergic rhinitis is a specified indication for use
• Use when conventional treatment is not effective 2

From the Research

Role of Kennalog IM in Treating Allergic Rhinitis

• Kennalog IM, also known as triamcinolone acetonide, is a synthetic glucocorticoid used in the treatment of allergic rhinitis 3.
• It is available as an aerosol and an aqueous metered-dose pump spray for nasal inhalation, and is not significantly absorbed into the systemic circulation, thereby minimizing the risk of systemic adverse effects 3.
• Clinical trials have shown that triamcinolone acetonide is effective in reducing symptoms of allergic rhinitis, including nasal congestion, itching, rhinorrhea, and sneezing, and is considered a first-line therapy option for adults with moderately severe seasonal allergic rhinitis and children with perennial allergic rhinitis 3, 4.

Mechanism of Action

• Triamcinolone acetonide works by decreasing membrane permeability and inhibiting both early and late phase reactions to allergens, minimizing the nasal secretory response, and reducing the sensitivity of local nasal irritant receptors 4.
• It also has a flushing action on the nasal mucosa, which may help reduce allergens and secretions 4.

Efficacy and Safety

• Studies have shown that triamcinolone acetonide is effective in relieving symptoms of allergic rhinitis, with a rapid onset of action, and is well-tolerated, with common adverse effects including sneezing, dry mucosa, nasal irritation, and headache 3, 4.
• It does not appear to suppress adrenal gland function, and has been shown to be safe for use in children, with no effect on height and body weight 4.
• The recommended maximum dose of aqueous triamcinolone acetonide is 220 micrograms once a day, and the aerosol form may be recommended in children between 7 and 12 years old, up to 440 micrograms once a day or in divided doses 4.

Comparison with Other Treatments

• Triamcinolone acetonide has been compared with other intranasal corticosteroids, such as beclomethasone and fluticasone, and has been shown to be equally effective or more effective in reducing symptoms of allergic rhinitis 3, 4.
• It has also been compared with oral antihistamines, such as loratadine, and has been shown to be more effective in reducing nasal symptoms of allergic rhinitis 3.