Useful information, support and guides

• When is hay fever season in the UK?
• About pollen
• Pollen forecast
• Pollen allergies
• 10 things you should know about pollen 
• Surviving hay fever: A guide for sufferers
• How hay fever affects your pets

What is Hay Fever?

Hay fever, or seasonal allergic rhinitis, affects approximately 10-15% of the population. It is an allergic reaction to pollen from trees, grasses, and weeds, leading to symptoms such as:

• Sneezing
• Coughing
• Itchy, red, watery eyes
• Runny or blocked nose
• Itchy throat
• Loss of smell
• Wheezing or shortness of breath
• Fatigue
• Headaches

These symptoms typically occur between March and September, especially on warm, humid, and windy days when pollen counts are high.

Treatments for Hay Fever

It is always more effective to begin treating hay fever approximately three weeks before the pollen season begins. Early and consistent treatment can significantly reduce symptoms. Options include:

• Limiting Pollen Exposure:
  • Stay indoors when pollen counts are high
  • Avoid cutting grass, playing in grassy areas, and camping
  • Keep windows and doors closed
  • Use recirculating air conditioning in your car
  • Avoid drying clothes outside

• Self-Care Measures:
  • Apply petroleum jelly around your nostrils to trap pollen
  • Wear wraparound sunglasses to protect your eyes
  • Shower and change your clothes after being outside
  • Vacuum regularly and dust with a damp cloth
  • Use a pollen filter in your car’s air vents
  • Use a HEPA filter in your vacuum cleaner
  • Rinse your eyes with water after being outside
  • Wipe your pet’s coat with a damp cloth after being outside

• Over-the-Counter Medications:
  • Antihistamines: Loratadine, Cetirizine, and Acravastine.
  • Eye Drops: Sodium Cromoglycate to relieve eye irritation.
  • Nasal Sprays: Beclometasone and Fluticasone to reduce nasal inflammation.

• Prescription Medications:
  • Oral Steroids: Prednisolone for short-term use in severe cases.
  • Antihistamine Nasal Sprays: Such as Rhinolast or combination sprays like Dymista.
  • Stronger Antihistamines: Fexofenadine.
  • Leukotriene Receptor Antagonists: Montelukast.
  • Intramuscular injection: Kenalog™

• Immunotherapy (Desensitisation Therapy):
  • Gradual exposure to allergens through injections or tablets over two years.
  • Highly recommended for children with severe allergies.
  • Kenalog™ cannot be given concurrently with desensitisation treatments, as it counteracts the therapy’s effectiveness.

What is Kenalog™?

More information – Electronic Medicines Compendium

More information – British National Formulary (BNF)

• The active ingredient in kenalog is Triamcinolone acetonide.
• Triamcinolone acetonide belongs to a group of medicines called corticosteroids (steroids).
• Kenalog is licensed for the treatment of joint pain, swelling and stiffness in inflammatory disorders such as rheumatoid arthritis.
• It is also for the treatment of various allergic disorders including asthma, blood disorders, hormone problems, rheumatic fever, and problems associated with digestive system, kidneys, lungs or skin.
• Kenalog is NOT licensed for the treatment of hay fever, but can be prescribed “off-label” (the practice of prescribing a medication for a condition, dosage, or patient group that is not included in its official licensing by regulatory authorities) for the management of severe hay fever in patients who have exhausted all other treatment options.
• An injection of Kenalog is approximately equivalent to the effects you would get from taking a 5mg tablet of prednisolone every day for about 3 weeks.
• The unique issue with a Kenalog injection that differentiates it from oral steroids, is that once the injection is administered, the effects can last for 3 weeks or more, whereas with tablets the effects are gone within 24 hours or less.
• A Kenalog injection does not cure hay fever, but temporarily suppresses the immune system enough to take away the symptoms in most people who need it.

Kenalog™ Treatment Dose and Frequency?

Kenalog™ injections for hay fever should be administered with strict limitations due to potential risks associated with corticosteroid use in order to help reduce the risk of long-term side effects. The following is based on clinical guidance:

• Dosage: The dose is weight-dependent, at 1mg per kg of body weight, with a maximum single dose of 100mg.
• Frequency: The injection can be repeated (at full cost) after 4 weeks if the symptoms return.
• Annual Maximum: Due to the longer-term risks of Kenalog™ it is not recommended to have more than 3 treatments in a year.

Off-Label Use for Hay Fever

Kenalog™ is not licensed for the treatment of hay fever. However, some healthcare providers may prescribe it “off-label” for severe hay fever cases where standard treatments are not controlling symptoms effectively.

What Does “Off-Label” Mean?

“Off-label” use refers to prescribing a medication for a condition or in a manner not specified in its official licensing. While the medication has been approved for other uses, its efficacy and safety for the unapproved condition may not have been thoroughly evaluated. Prescribing off-label is a common and legal practice when a clinician believes it will benefit the patient. However, it’s essential to understand that such use hasn’t undergone the same regulatory scrutiny as approved indications.

Why Has the NHS Stopped Offering Kenalog™ for Hay Fever?

Kenalog hay fever injections, also known as corticosteroid injections, were previously offered by the NHS as an “off-label” treatment option for severe hay fever symptoms. However, in recent years, concerns have emerged regarding potential side effects and long-term risks associated with corticosteroid injections. These concerns prompted the NHS to reassess the safety and effectiveness of Kenalog injections for hay fever treatment. In 2018, the NHS made the decision to discontinue Kenalog injections due to a lack of robust evidence supporting their long-term effectiveness.

Kenalog™ as a Last Resort

Kenalog™ will only be prescribed when all other conventional hay fever treatments have failed. This includes antihistamines, nasal corticosteroids, immunotherapy, and other prescribed medications. The decision to proceed with Kenalog™ is made after a thorough medical assessment to ensure that no safer and more effective alternatives are available for the patient.

Treatment for Young People

• Kenalog™ treatment may be given to individuals from the age of 13.
• A parent or guardian must provide consent for those under 16 and be present during the treatment.
• Young people age 16 – 17 can give their own consent to treatment, but a parent or guardian MUST be present during the procedure.

Potential Benefits

Some patients report significant reduction or complete relief from hay fever symptoms following a Kenalog™ injection, which can improve quality of life during the pollen season.

Risks and Side Effects

NB: This list is not exhaustive, please visit here for more details

As with any medication, Kenalog™ can cause side effects. Potential risks include:

• Suppression of the Immune System: Increased susceptibility to infections.
• Hormonal Imbalances: Potential weight gain, fluid retention, or menstrual irregularities.
• Bone Density Reduction: Long-term use may lead to osteoporosis.
• Mood Changes: Including mood swings, anxiety, or depression.
• Injection Site Reactions: Such as pain, redness, or swelling.

It’s crucial to discuss your medical history with your healthcare provider to determine if Kenalog™ is suitable for you.

Other Possible Side Effects

• Increased risk of infections.
• If infected with viruses like measles or chickenpox within three weeks of receiving the injection, the illness may be more severe.
• Skin changes at the injection site, including dimpling or discolouration due to fat loss beneath the skin.
• Potential for sterile abscess formation at the injection site.
• Gastrointestinal issues, such as stomach pain, bloating, or ulcers.
• Increased risk of osteoporosis (bone thinning) with repeated steroid use.
• Eye problems, including glaucoma and cataracts.

Possible Psychological Effects of Steroids

While rare, steroids, including Kenalog™, can occasionally cause mental health issues, particularly at higher doses. If you experience any of the following symptoms, contact a healthcare provider immediately:

• Feeling depressed, including thoughts of self-harm.
• Experiencing mood swings, mania, or anxiety.
• Difficulty sleeping, memory problems, or confusion.
• Hallucinations or experiencing things that are not real.

Pre-Treatment Instructions

• Ensure you have exhausted all other conventional treatments, including antihistamines, nasal sprays, and immunotherapy, before considering Kenalog™.
• Inform your healthcare provider of any existing medical conditions when completing your health questionnaire.
• Disclose all medications you are currently taking, including over-the-counter and herbal supplements.
• Avoid alcohol consumption for at least 24 hours before the injection.
• Stay hydrated and eat a light meal before your appointment.
• Wear comfortable clothing to allow easy access to the injection site.

The Procedure

The treatment involves a single intramuscular injection of Kenalog™, usually administered into the gluteal muscle (buttock). The injection is given by a trained healthcare professional and typically takes only a few minutes. Before the injection, the clinician will review your medical history and assess whether you are a suitable candidate for the treatment. Patients are advised to remain at the clinic for a short period after administration to monitor for any immediate adverse reactions. The effects of the injection can last for several weeks, offering relief throughout the pollen season.

You will be given the option to have a chaperone present during your treatment. If you would like a chaperone, please inform the clinician before the injection is administered. This ensures clarity while maintaining a professional and patient-centred approach.

Consent to Share

To ensure your medical records remain up to date, we recommend informing your GP about your treatment with us. This is important for maintaining continuity of care, particularly if you require hospital admission or are prescribed medication for other conditions. You will be asked for consent to share your treatment details with your GP, as this helps ensure safe and coordinated medical management.

Post-Treatment Instructions

• Avoid cardio-vascular exercise and try to rest the injection site for 24hours.
• Do not rub the area in order to avoid irritation.
• Do not wash the injection site for 6 hours – tap water harbours bacteria, which may enter the injection site.
• Monitor for any adverse effects, such as swelling, redness, or pain at the injection site.
• Always contact the clinic if you have any queries, side-effects or feel unwell after injection.
• Seek medical attention if you experience unusual symptoms such as persistent headaches, dizziness, or mood changes.
• Maintain a healthy lifestyle and use additional hay fever management strategies as advised by your healthcare provider.