Hay fever can be treated by using methods to limit pollen exposure, over the counter treatments or by using prescription medication. Although there are many treatments available, there is currently no cure for hay fever and the symptoms may last for several weeks or months.

Limiting pollen exposure

• Place Vaseline around your nostrils to trap the pollen.
• Wear wrap-around sunglasses to limit pollen getting into the eyes.
• Shower and change clothes after being outdoors to wash the pollen off.
• Stay indoors whenever possible.
• Keep windows and doors shut as much as possible.
• Damp dust and vacuum regularly.
• Use a pollen/HEPA filter.

Over the counter treatments

Antihistamines: These medications block the action of histamine, which is released by the body when it detects something harmful, or pollen in the case of hay fever. There are many different types and are classed as either drowsy, such as Piriton® (chlorphenamine), or non-drowsy, such as loratadine, cetirizine or fexofenadine. They come in various forms such as tablets, liquids, nasal sprays, or eye-drops. Side-effects can include drowsiness, headache, dry mouth, and nausea.

Steroid nasal sprays: Steroid nasal sprays contain man-made hormones which act in the body to reduce inflammation and swelling. They work on the lining of the nose and reduce symptoms such as sneezing and blocked nose. They can cause some side-effects including dryness, stinging, nosebleeds, or taste disturbance. Some are available over the counter, and some are prescription only.

Eye-drops: If eye symptoms are the main feature, using topical antihistamine eye drops may control the problem. These are also available over the counter or on prescription.

Approximately 10% of hay fever sufferers will not obtain relief by simply using over the counter treatments.

Prescription medications

A pharmacist or your GP can advise on treatments, including prescription only antihistamines, nasal sprays, and eye drops. If these fail to control symptoms, you may be referred to a specialist to consider immunotherapy where small amounts of pollen are either injected or taken by tablet to slowly build up your resistance.

If these measures are ineffective, an injection of Kenalog™ may provide relief from hay fever symptoms.

We do not recommend that treatments are performed in a non-clinical environment.

Kenalog™, also known as triamcinolone, is a synthetic corticosteroid which is a hormone that works within the body to reduce inflammatory responses. It is widely used in medicine for the treatment of certain breathing conditions, arthritis, endocrine diseases, kidney problems, allergies, skin diseases, and some blood disorders. Steroids are one of the most powerful anti-inflammatory medicines that work by suppressing your body’s immune response and ultimately reducing symptoms.

Kenalog™ is administered as an intra-muscular injection into the top of the buttock. Unlike other intra-muscular injections, it is not advisable to inject this into the top of the arm. After injection, the drug is slowly released into the body over several weeks and generally provides relief of symptoms for 3 to 8 weeks. A single vial of Kenalog™ (40 milligrams) is used to treat hay fever in adults, although in rare circumstances, the dosage can be increased if symptoms are not controlled. Due to the longer-term risks of Kenalog™ affecting the body’s own steroid production, it is not recommended to have more than 3 treatments in a year.

Kenalog™ is not a first line treatment for hay fever and must only be considered when symptoms are severe and not controlled by other methods, including limiting pollen exposure and medications, or if other methods produce intolerable side-effects. Over the counter or prescription medication may still be required for symptom control even after receiving a Kenalog™ injection.

When booking an appointment, ensure your initial consultation will be with a prescribing practitioner.

Kenalog™ is injected using a fine needle, into the muscle at the top outer part of the buttock. As with any injection, it can sting and cause a slight burning sensation when it is administered. It can also cause some discomfort and throbbing in the area for a few hours or days afterwards.

If the injection is very painful, you should inform your treating practitioner.

As with any injection, there may be some redness, tenderness, and a small lump at the injection site. This will usually resolve within 24 hours. As steroid injections suppress your body’s natural immune response, you should make your healthcare provider aware if you are having any vaccinations. As a rule, it is not advisable to have a Kenalog™ injection either 2 weeks before or until 3 weeks after a vaccine. It is also important that you avoid people who have chickenpox or shingles if you have not had chickenpox previously.

All medicines can cause side-effects and Kenalog™ is no exception, although most people will have mild or no effects.

If you develop any unexpected side-effects after treatment, it is important to contact your practitioner as soon as possible, who may be able to offer advice or corrective treatment.

Possible side-effects include:

• Headache
• Injection site reaction
• Joint pains
• Infections due to lowered immunity
• Anxiety
• Fatigue
• Stomach pains
• Fluid retention
• Changes in blood sugar levels
• Changes in blood pressure
• Impaired wound healing
• Increase in hair growth
• Increased sweating
• Irregular menstrual periods
• Nausea
• Thinning of the bones (osteoporosis)
• Heartburn, indigestion, stomach ulcer
• Skin reactions
• Sleep disturbance
• Increased appetite and weight gain
• Dizziness
• Eye problems

Rarely, adverse effects can be serious and include:

• Anaphylaxis (serious and life-threatening allergy)
• Severe psychiatric reactions (including psychotic behaviour, mood, and personality changes)
• Vascular reactions (including blood clots)
• Heart disorders (including heart failure and irregular heart rhythms)

Signs and symptoms of a serious allergy may include a rash, wheezing, difficulty in breathing, tight chest or throat, trouble speaking and swelling of the mouth, face, lips, tongue and/or throat. If you experience any of these, you must ring 999 immediately.

Prior to treatment, you should complete a medical history with your practitioner, you should also receive all the relevant information you need to make an informed decision about whether to go ahead with treatment or not, as well as possible side-effects specific to your treatment and costs involved. It is usual to have an initial consultation and then rebook treatment for a later date, giving you the opportunity to have a cooling off period to consider all the information provided. Before treatment, you should be given the opportunity to have any further questions answered and sign a consent form, either printed or electronically produced.

Do not feel pressurised or coerced into having treatment at the same time as your consultation.

The area for injection will most likely be the upper outer aspect of one of your buttocks and is a deep injection into the muscle. The area will be inspected to find the best place for injection. Some practitioners may disinfect the skin prior to injection, but this is not a requirement. The skin will be gently pinched prior to treatment and the actual injection can cause a stinging or burning sensation that can vary in intensity. Some people find that it is quite painful, whereas most just experience a mild stinging. The actual injection will last for a few seconds only.

Following the procedure, your skin may be cleaned again, or gentle pressure applied if there has been some bleeding at the site. You may be asked to remain for 15 minutes after your injection to allow time for you to recover and for the practitioner to ensure that you do not have a reaction to the injection.

Your practitioner will record the batch number, expiry, and site of injection on your treatment record and will provide you with appropriate verbal and/or written aftercare.

If you have never previously had a Kenalog ™ injection, it is important to allow 15 minutes for observation after the treatment.

You may not be suitable for treatment if any of the following apply:

• If you are under the age of 18 years.
• If you are pregnant or breast-feeding.
• If you have had a previous allergy to Kenalog™.
• If you have had a recent infection or antibiotic usage.
• If you have undergone a recent surgical procedure, including bowel surgery.
• If you have a low immune system or are taking medication that lowers your immunity.
• If you are taking oral steroids, such as Prednisolone.
• If you are taking diltiazem, verapamil, itraconazole, ketoconazole or ritonavir.
• If you have high blood pressure or heart failure.
• If you are on insulin or other medication for diabetes.
• If you have or had a stomach or duodenal ulcer.
• If you are known to have glaucoma or have a family member with glaucoma.
• If you have a history of a severe mental health condition.
• If you have kidney, liver, or thyroid problems.
• If you have had a blood clot previously.
• If you suffer with osteoporosis (bone thinning).
• If you have a severe needle phobia.

Side effects and risks increase with age, and it is important to consider the risks versus the benefits before deciding whether a Kenalog™ injection is suitable for you.

It is important to be honest about your medical history, and any medication taken, so that you can have a safe and effective treatment.

• Avoid taking anti-inflammatories (such as aspirin, ibuprofen, naproxen) for 3 days prior to treatment (unless this has been prescribed by your doctor) as this increases the risk of bruising.
• Alcohol, fish oils, St. John’s Wort, Gingko Biloba, garlic, and Vitamin E should also be avoided for 3 days prior to treatment to lessen the risk of bruising.
• If you are unwell on the day of your appointment, contact your practitioner to reschedule.
• Ensure your practitioner is informed if there are any changes in your medical history or medication taken before receiving any treatment.
• Wear appropriate clothing to allow an injection into the top of the buttock.

After treatment, most people can resume their normal daily activities. Immediately after treatment, there may be some discomfort, redness, and minor swelling at the injection site, which should settle in time. If you develop any bruising, which may be apparent at the time of treatment, it is usually minor and settles within a few days. Occasionally, more significant bruising can occur. Rarely, you may develop a headache after treatment which can last a few days. Simple analgesia can be taken for this if needed.

It is recommended that you do not aggravate the injection site and keep it clean and dry for 24 hours. The benefits of Kenalog™ are generally noticed 24 hours after the injection, however it can take a few days for the full effects. The injection can be repeated after 4 weeks if the symptoms return, but it is not recommended to have more than 3 injections in a 12-month period. You may continue to use other hay fever treatments, such as antihistamine tablets, eye drops and nasal sprays.

You must contact your treating practitioner if you suffer from any reaction that was not expected.

Ensure you know the following information:

• Practitioner’s full name
• Practitioner’s profession
• Practitioner’s contact details (address, telephone number, and email)
• An emergency contact number in case a complication occurs.

Practitioners should be registered with a professional body (General Medical Council, General Dental Council, Nursing and Midwifery Council, General Pharmaceutical Council or Health and Care Professions Council) and you can check their current registration status online. Practitioners are accountable to these bodies and are legally required to have indemnity insurance in place for all the treatments they perform.

If you are not happy with your treatment outcome, you should attempt to resolve this with your treating practitioner in the first instance. If you need to see a different practitioner, you are entitled to receive a copy of your treatment record.