It's that time of year again. I've got mixed feelings about this, it's a
licensed medicine, known systemic steroid risks but no good evidence on how
often problems occur. Patients who have had Kenalog or Depo-medrone swear
its very effective and often want it repeated.
I thought it was probably worth written consent so drafted the following.
What do you think, overkill, just don't do it, refer em to an allergist and
let his MDU take the risk?
Saul
--------------------
Dear
You recently enquired about the use of long acting steroid injection for the
treatment of hayfever. Although there are 2 licensed injection products
available in the UK to treat hayfever, and such treatment does seem
effective at controlling symptoms, as a practice we feel it is important to
draw the potential hazards of such treatments to your attention in order
that you can make an informed decision about whether such treatment is
appropriate for you.
Firstly, although steroid injections have been fairly widely used in the UK
for treatment of hayfever in the past, it seems that the current (2009)
consensus view of the profession is that such treatments should be reserved
as a treatment of last resort because the risk of serious side effects is
considerably higher than with other treatments.
Before considering steroid injections you should have been tried on daily
antihistamine tablets, trying at least 3 different types. If that is
insufficient alone the doctor will add a steroid nasal spray and / or eye
drops to better control breakthrough symptoms. If that is not sufficient you
should be tried on an antihistamine at double the normal recommended dose.
There have been no reports of adverse effects of an increased double dose of
antihistamine.
If hayfever control for a particular event such as an exam or a wedding is
the issue a short course of steroid tablets can be used, which seems to pose
little to no risk and will give good symptom control for a week or two.
Steroid injections are long acting and will often affect the body for 2-3
months. They are known to affect the body's own hormone production and known
side effects include :-
. Cataracts
. Diabetes
. Weight gain
. Reduced resistance to infection
. Osteoporosis (thinning of the bones with increased risk of
fractures)
. Menstrual irregularities
. Skin/muscle tissue damage at the site of injection
There is little good quality, long term clinical trial data about the long
term risks of steroid injections, in effect we just don't know how likely it
is that you might have problems.
I enclose a printout summarising typical current guidance on the subject.
http://www.attract.wales.nhs.uk/question_answers.cfm?question_id=2229
If you still feel that you have tried all the above treatment approaches and
that you wish to go ahead with a steroid injection for your hayfever, please
bring this letter to your appointment signed below to confirm your consent.
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