What is the role of Kenalog (Triamcinolone) injection in treating allergic rhinitis (hay fever)?

From the Guidelines

Kenalog injections should not be considered first-line treatment for hay fever due to potential side effects, and patients should try standard treatments like antihistamines, nasal corticosteroid sprays, and allergen avoidance first. According to the most recent and highest quality study available 1, intranasal corticosteroids are the most effective medication class in controlling symptoms of allergic rhinitis, and should be considered before initiating treatment with systemic corticosteroids like Kenalog.

Key Points to Consider

• Kenalog injections can be effective for managing severe hay fever symptoms that don't respond to standard treatments, with a typical dose ranging from 40-80 mg given as a single intramuscular injection, and effects lasting approximately 3-4 weeks during allergy season 1.
• However, Kenalog injections have potential side effects including mood changes, elevated blood sugar, increased infection risk, adrenal suppression, and weight gain, and should be limited to once or twice per allergy season with at least 3-4 weeks between doses 1.
• Patients with diabetes, hypertension, glaucoma, osteoporosis, or immunosuppression should use Kenalog with caution, and the injection must be administered by a healthcare professional who can monitor for adverse reactions and determine if this treatment is appropriate for the specific situation.
• Intranasal corticosteroids, such as fluticasone propionate, are more effective than oral and intranasal antihistamines in relieving symptoms of sneezing, nasal congestion, discharge, and itching, and are not significantly different for the relief of eye symptoms 1.

Treatment Approach

• Try standard treatments like antihistamines, nasal corticosteroid sprays, and allergen avoidance first.
• Consider Kenalog injections only for severe hay fever symptoms that don't respond to standard treatments.
• Use Kenalog injections with caution, and limit to once or twice per allergy season with at least 3-4 weeks between doses.
• Monitor for adverse reactions, and determine if this treatment is appropriate for the specific situation.

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. Kenalog injection is indicated for the control of severe or incapacitating allergic conditions, including perennial or seasonal allergic rhinitis, which is also known as hay fever.

• The use of Kenalog injection for hay fever is supported by the drug label.
• Key points:
  • Kenalog injection is used for intramuscular administration.
  • It is used to control severe or incapacitating allergic conditions.
  • Hay fever is listed as one of the conditions for which Kenalog injection is indicated. 2

From the Research

Kenalog Injection for Hay Fever

• Kenalog injection, a type of corticosteroid, is sometimes used to treat severe hay fever 3.
• The efficacy of a single intramuscular injection of systemic corticosteroid (i.m. SCS) was statistically significant in all five placebo-controlled trials and demonstrated considerable clinical benefit, lasting approximately from within the first day to four weeks 3.
• The side-effects of Kenalog injection were few, both clinically and physiologically, with retained ability to respond to stress with hypothalamic-pituitary-adrenal activation 3.

Alternative Treatments for Hay Fever

• Therapy for hay fever should begin with environmental control, because sometimes avoidance of allergens is all that is needed to adequately control symptoms 4.
• Useful medications include antihistamines, decongestants, combinations of the two, prescription nasal sprays, and allergy immunotherapy 4.
• Non-pharmacological measures, such as allergen reduction with air filters or cleaning of the mucous membranes with nasal irrigation, can also be used to prevent and/or relieve allergic symptoms 5.

Management of Hay Fever

• The choice of treatment will be influenced by the spectrum, intensity and frequency of symptoms, and should take into account safety, efficacy, cost and patient preferences 6.
• Several drugs can be bought over the counter, and people with allergic rhinitis may commonly present to the pharmacy or to general practice 6.
• H1-antihistamines and topical corticosteroids are most commonly used pharmacological agents for the treatment of allergic rhinitis 7.