Triamcinoline acetonide (kenalog) in treatment of cases of hay fever and its effect on pituitary-adrenal axis.

INTRODUCTION Since 1949, when Hench and Kendall introduced the use of cortisone and hydrocortisone, a voluminous literature has accumulated concerning the employment of these agents in allergic diseases. Steroid therapy requires careful thought in view of the evidence that long term treatment can react adversely on the pituitaryadrenal axis. Nevertheless, an injectable steroid may be used in the treatment of chronic hay fever, and I have undertaken a trial in my own practice. In this small series of cases a study of the clinical effects, and a laboratory investigation of adrenal function are compared. Hay fever is a hypersensitive state characterised by hyperactivity of the body to contact with a foreign substance in an amount which would not disturb a nonallergic individual. Allergy is a chronic and progressive disease, but hypo. sensitisation in some way alters the basic hypersensitivity and thereby helps to prevent the allergic symptoms from being multiple. Total avoidance of exposure to the incriminating allergen is usually impossible as it is airborne and inhaled, so hyposensitisation is the more practicable treatment. However, not every chronic case responds to this desensitisation programme, and in addition, it is time consuming for the patient and doctor alike, and new methods have to be explored which may be more efficacious. Hay fever has been treated with a variety of adrenocorticosteroids. Much research has been performed to develop new adrenocorticosteroids which would possess greater biological activity and maintain an adequate ratio of glucocorticoid to mineralocorticoid activity. Alterations in the chemical configurations of the steroid nucleus and its chains produced triamcinolone. 16 a hydroxlyation markedly decreased mineralocorticoid activity and abolished the sodium retaining properties of 9 a fluorosteroids without destroying their glucocorticoid activity. It is one and a half to two times more potent than prednisolone. The greater therapeutic activity of triamcinolone is not accompanied by a corresponding increase in production of adverse effects. Triamcinolone Acetonide (the corticosteroid used in this trial) suppresses the clinical manifestation of hay fever and affords symptomatic relief. The mechanism of action is not entirely clear. In allergic conditions the union of antigen and antibody acts as a stress and either alone, or with the stress stimuli, e.g., psychogenic influences or infection, causes a liberation of histamine, acetyl choline, serotonin, and unknown substances which trigger allergic tissue responses. The exact mode of action is not clearly understood. It is suggested that they act locally upon the sensitised tissue cells, decrease the reactivity of the shock organs to specific antigens and stress and suppress local tissue responses rendering the cells less subject to injury. They increase permeability