By Dr Victoria McBride
Every spring and summer, I see patients whose lives are genuinely disrupted by hay fever.
Not just a bit of sneezing or itchy eyes, but people who are exhausted from poor sleep, unable to concentrate at work, struggling to exercise outdoors, avoiding social events and feeling miserable for weeks on end despite trying multiple medications.
Hay fever, or seasonal allergic rhinitis, is often dismissed as something minor. For some people, it absolutely is. But for others, it can significantly affect quality of life.
At Courtyard Health Clinic, we take a careful, evidence-based approach to hay fever management. Occasionally, patients ask about “the hay fever injection”. This is usually referring to Kenalog (triamcinolone acetonide).
This article explains what it is, when it may be considered, and importantly, why it is not something that should be given routinely or casually.
What is Kenalog?
Kenalog is a long-acting corticosteroid injection.
It works by reducing inflammation and dampening down the immune response that drives allergic symptoms such as:
- Sneezing
- Nasal congestion
- Itchy eyes
- Runny nose
Unlike antihistamines or nasal sprays, which are taken daily, Kenalog is given as a single intramuscular injection and can continue working for several weeks.
The injection is usually given into the upper outer part of the buttock.
Is it recommended?
This is where things become important.
Current UK guidance does not recommend the routine use of depot steroid injections for hay fever because they are systemic steroids, meaning they affect the whole body rather than just the nose or eyes.
Most patients should first be treated with:
- Non-sedating antihistamines
- Nasal steroid sprays
- Eye drops
- Avoidance measures where possible
Used properly and consistently, these treatments work very well for most people.
However, medicine is rarely black and white. Occasionally, I see patients who have genuinely severe symptoms despite appropriate treatment. In carefully selected cases, after a full discussion of risks, benefits, and alternatives, Kenalog may sometimes be considered.
It is not a “quick fix” or a routine seasonal injection.
Why are doctors cautious about it?
Because steroids are powerful medications.
While many people tolerate Kenalog without significant problems, systemic steroids can cause side effects and complications. Some are relatively mild and temporary, while others are rare but potentially serious.
Possible side effects include:
- Sleep disturbance
- Mood changes
- Increased appetite
- Raised blood sugar levels
- Increased susceptibility to infection
There are also rare but important complications associated with steroid use, including avascular necrosis, a condition affecting bone tissue, most commonly the hip.
The risk is low, but not zero. Patients deserve to understand this properly before making a decision.
This is one of the reasons many NHS practices no longer routinely provide steroid injections for hay fever.
What happens at an appointment?
At Courtyard Health Clinic, patients requesting assessment for severe hay fever undergo a full consultation before any treatment decision is made.
This includes:
- Reviewing symptoms carefully
- Assessing what treatments have already been tried
- Discussing medical history and any contraindications
- Exploring safer or more appropriate alternatives where relevant
If Kenalog is considered appropriate, the injection is administered intramuscularly by a clinician.
Patients are monitored clinically and given clear information regarding possible side effects and aftercare.
Who may not be suitable?
Kenalog is not appropriate for everyone and is generally avoided in:
- Those under 18 years old
- Pregnancy or breastfeeding
- Poorly controlled diabetes
- Active infection
- Certain chronic medical conditions
Every patient requires individual assessment.
The importance of good hay fever management
One thing I often tell patients is that hay fever treatment works best when started early and used consistently.
Nasal steroid sprays, for example, are often far more effective when used properly every day during allergy season rather than occasionally when symptoms become severe.
Simple measures can also help:
- Showering after being outdoors
- Keeping windows closed during high pollen days
- Changing clothes after outdoor exposure
- Wearing sunglasses outside
- Using saline nasal rinses
Small things can make a surprisingly meaningful difference.
A balanced approach
Private healthcare should still be evidence-based healthcare.
At Courtyard Health Clinic, our approach is not to simply provide whatever treatment is requested. It is to assess patients carefully, explain risks honestly, and help people make informed decisions about their health.
For some patients with severe, treatment-resistant symptoms, Kenalog may occasionally form part of that discussion.
For many others, optimising standard treatment is safer and entirely sufficient.
Good medicine is rarely about extremes. It is usually about careful judgement, context, and individualised care.
If you are struggling with severe hay fever symptoms and would like to discuss treatment options, appointments can be arranged at Courtyard Health Clinic in Musselburgh.
