First case of anaphylaxis after botulinum toxin type A injection

Area of Science:

• Allergy and Immunology
• Dermatology
• Pharmacology

Background:

• Botulinum toxin type A (BTA) injections are a common cosmetic dermatology procedure.
• Adverse events are rare, and life-threatening reactions have not been previously documented.

Observation:

• A 35-year-old woman developed angioedema and anaphylaxis 5 minutes after receiving an intramuscular BTA injection into her masseter muscles.
• She had received the same BTA product previously without any adverse effects.
• The reaction was managed with intramuscular epinephrine.

Findings:

• The patient exhibited elevated total serum IgE levels.
• Diagnostic testing for BTA was not feasible due to the risk of re-inducing anaphylaxis.
• Negative results from sterile saline intradermal tests and topical anesthetic patch tests supported BTA as the likely allergen.

Implications:

• This case suggests that anaphylaxis is a potential, albeit rare, adverse event associated with intramuscular BTA injections.
• Clinicians should be aware of the possibility of severe allergic reactions to BTA, even in patients with prior uneventful treatments.
• Further research may be needed to understand the mechanisms and risk factors for BTA-induced anaphylaxis.