The authors state that 'a man with severe hay fever was given at
least one depot corticosteroid injection each year for 11 years' leading
to avascular necrosis of the femoral heads.'
Hay fever is common. Depot steroid use is widespread. Avascular
necrosis is a rare condition.
One case report is a poor basis for declaring a causal link, and
certainly no basis for what is effectively an accusation of negligence.
The authors give no grounds for their view that the risk of depot steroid
related avascular necrosis is greater than the risk of desensitisation
related death.
If the authors wish to use this case as a basis on which to justify
an expansion of their service, it would seem appropriate to carry out
adequate research to substantiate their hypothesis.
Competing interests; I am a GP who reluctantly uses Kenalog for a
limited number of patients with severe hay fever, in the absence of any
practical alternative.
Rapid Response:
One swallow does not a summer make
The authors state that 'a man with severe hay fever was given at
least one depot corticosteroid injection each year for 11 years' leading
to avascular necrosis of the femoral heads.'
Hay fever is common. Depot steroid use is widespread. Avascular
necrosis is a rare condition.
One case report is a poor basis for declaring a causal link, and
certainly no basis for what is effectively an accusation of negligence.
The authors give no grounds for their view that the risk of depot steroid
related avascular necrosis is greater than the risk of desensitisation
related death.
If the authors wish to use this case as a basis on which to justify
an expansion of their service, it would seem appropriate to carry out
adequate research to substantiate their hypothesis.
Competing interests; I am a GP who reluctantly uses Kenalog for a
limited number of patients with severe hay fever, in the absence of any
practical alternative.
Competing interests: No competing interests