SERUM SICKNESS AFTER COSMETIC ONABOTULINUMTOXIN A USE

Abstract

<h3>Introduction</h3> Onabotulinumtoxin A is one of the most commonly used drugs in cosmetic medicine, and neurotoxin treatment is the most common nonsurgical cosmetic procedure in all age groups of both women and men per the most recent Aesthetic Plastic Surgery National Databank statistics. This abstract will present a case report of serum sickness believed to be the first reported of this such complication with onabotulinumtoxin A. <h3>Case Description</h3> A 46 year-old woman with an unremarkable medical history including prior onabotulinumtoxin A use in Canada was seen in Michigan, US, for injectable fillers and neurotoxins on multiple occasions. She presents with interval history of onabotulinumtoxin A treatment in Canada followed 11 days later with a visit to the ER for pyrexia, symmetric arthralgias, and abdominal swelling. Two days prior to these symptoms, she developed utricaria at the injection sites. Concern about future onabotulinumtoxin A treatments were raised. Consultation with an allergist confirmed serum sickness likely due to albumin in onabotulinumtoxin A. Skin testing was performed with protein-free neurotoxin, and no reaction was noted. She has since undergone successful neurotoxin treatment. Serum sickness did not recur. <h3>Discussion</h3> Serum sickness is a Type III hypersensitivity reaction, mediated by IgE. It is reported in the product safety insert of onabotulinumtoxin A, but has never been reported in cosmetic onabotulinumtoxin A use. Discussion of this rare but reported complication is important as onabotulinumtoxin A use for cosmetic purposes is prevalent in medical spas and non-core physician practices where this complication could be overlooked.