Hay fever symptoms: is there an injection available on the NHS? Treatment options explained

Thanks to a mix of global warming, the weather and genetics, it looks like hay fever sufferers could be in for a difficult time as pollen season descends upon the UK. According to NHS Inform, hay fever will affect up to one in five people at some point in their lives.

While symptoms of hay fever can be mild, some sufferers may find that the usual over the counter medications and common tips and tricks just don’t do much in the way of providing relief from particularly bad symptoms. 

This is what you need to know about the treatment options available to you if your hay fever is severe. 

Can you get hay fever injections on the NHS?

If all other treatments for hay fever fail to work for you, your GP could refer you for immunotherapy. This entails being given small doses of pollen as an injection or tablet which will slowly build up your immunity to pollen. 

This is not intended for people with regular hay fever, but for those with severe symptoms who have found no relief with other treatments. The NHS website says that this kind of treatment “usually starts in the winter about three months before the hay fever season begins”. 

Immunotherapy is also a specialist service, which means that it may not be available everywhere. 

Allergy UK says: “Improvement with immunotherapy does not occur immediately. It usually takes at least 6 months before symptoms improve, often longer. It is recommended that immunotherapy is continued for about three to five years, to decrease the chance that the allergies will return. 

“Patients undergoing immunotherapy need to continue to use their usual medications until the effects of the immunotherapy are well-established.”

What is the Kenalog injection? 

Kenalog refers to the brand name for triamcinolone acetonide and is an injection that can relieve severe symptoms of hay fever for sufferers who have not had any results from other treatments. 

A leaflet about the Kenalog injection from the Glenfield Surgery in Leicester says: “Each Kenalog injection contains Triamcinolone acetonide 40mg/1ml as the active ingredient. Triamcinolone acetonide belongs to a group of medicines called corticosteroids (steroids). 

“The principal effect of corticosteroids is to reduce the body’s inflammatory and allergic response and they are used very commonly for many serious medical conditions. Their use has saved countless lives since their discovery in the 1940’s but they do have significant risks.”

It continues: “Kenalog injections were given routinely to severe hay fever sufferers via the NHS until about five to 10 years ago but have now fallen out of favour and the NHS no longer prescribes or administers Kenalog for hay fever as their guidelines have determined that the potential risks do not justify the benefits that people may gain from the treatment.” 

In 2019, Kenalog’s drug licence to be used as a hay fever treatment in the UK was withdrawn, however it is used routinely in other countries around the world and is available through some private clinics. 

Are there side effects?

As with most medical treatments, there are pros and cons to the Kenalog injection. 

The leaflet explains that a Kenalog injection “helps many people with their symptoms of severe hay-fever” and that “for many people it completely relieves the symptoms for the entire season and for others it reduces the severity of the symptoms to a point where adding other treatments can allow life as normal”.

In terms of side effects, it says: “Kenalog injections, like all steroids, can cause unwanted side-effects, although these are rare at the dose levels that you get from a Kenalog injection. The unique issue with a Kenalog injection that differentiates it from oral steroids is that once the injection is administered the effects last for at least three weeks. With tablets the effects are gone within about 24 hours or less. This is the main reason NHS guidelines have identified this method of administering steroids as a problem. 

“There are occasions when the body needs its immune system at top strength and there are theoretical concerns that having it partially suppressed like this for up to three weeks could cause significant problems.”

While anaphylactic reactions have been rarely reported, patients are instructed to seek medical assistance immediately if they notice any of the following symptoms of an anaphylactic reaction: 

• Swelling of the face, lips or throat
• Breathing difficulties
• Skin itching, redness or rash
• Sticky black stools
• Severe abdominal pain
• Vomiting blood

All steroids, including Kenalog, can also occasionally trigger mental health problems - although this is usually associated with much higher doses than what you would be given in a Kenalog injection.

Again, patients are instructed to get medical help immediately if they notice any of the following:

• Feeling depressed, including thinking about suicide
• Feeling high (mania), or moods that go up and down
• Feeling anxious, or having problems with sleeping, difficulty in thinking or being confused and losing your memory
• Feeling, seeing or hearing things which do not exist 

Other possible side effects specific to Kenalog also include:

• Increased risk of infections
• It is theoretically possible that if you were to get an infection such as measles or chickenpox within three weeks of having a Kenalog injection it would be a worse episode than would otherwise be the case
• Pain and skin colour changes at site of injection
• Sterile abscess at site of injection
• Dimpling of skin caused by loss of fat under the skin at injection site

Additional side effects that can occur generally with steroids, not just specifically Kenalog, include:

• Mood changes
• Indigestion, stomach pain, stomach ulcers, bloating, weight gain, pancreatitis
• Eye problems including glaucoma and cataracts
• Fungal infections e.g thrush
• Osteoporosis (thinner bones)
• Reduction in the body’s overall ability to respond to major stress resulting for serious injuries

 What other treatments are available for hay fever?

If your hay fever isn’t severe enough to warrant pursuing a Kenalog injection, or you don’t feel comfortable with the procedure and it’s possible side effects, then there are other treatments that you can 

Non-medical treatments include:

• Staying indoors on high pollen count days
• Reducing bare skin whilst outside as much as possible - the allergy can be made worse by pollen on the skin, not just the nose, eyes and mouth
• Having frequent showers to wash away any pollen
• Applying vaseline to your nostrils to trap pollen

Non prescription medications that you can get over the counter include:

• Antihistamine tablets
• Eye drops
• Nasal sprays

Your GP may also prescribe you medications like oral tablets and nasal sprays that are not available over the counter.