Can Botox Cause Chronic Idiopathic Urticaria?

Hi, I've had glabellar Botox 3 times, ~8 months apart. The last time was on 21-July and 3 weeks later, on 10-Aug, I developed hives. I had a skin prick test, only showed a mild reaction to dust mites, and was diagnosed with chronic idiopathic urticaria. I did not have mastocytosis. I had forgotten about the Botox and didn't mention it to the allergist. Is it possible that a component of the Botox caused the reaction? Would it be safe to get again? The hives lasted 3 months. Thanks.

Doctor Answers 4

Botox probably did not cause your hives

Although neither I nor any colleagues of mine with whom I have discussed Botox, have ever known a cases of hives secondary to the Botox treatment.  You may, however, ask your allergist to do a skin prick test to the botox and your doctor can supply the allergist with the botox in a syringe diluted with the same liquid they used on you. It would be doubtfuly, but possibly a preservative in the liquid has caused the hives. It would be very rare that this reaction would occur weeks later and last a while, so I don't think it is the cause of your chronic urticaria.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox "allergy"

Dear Gina,

Chronic idiopathic urticaria [CIU] is a common codition. The cause remains elusive in the majority of cases , even after an exhaustive work up. I have not seen a single case of urticaria related to botox in 16 years of using botox. By contrast , I see an average of 2-3 cases of CIU every week, in my practice.

I do not think Botox is what caused your CIU. However there is no conclusive test that can confirm, [or rule out] the causation. Skin tests are NOT helpful in cases of urticaria.

My advise is to carry on with your Botox treatments. 

Khaled El-Hoshy, MD
Detroit Dermatologic Surgeon

Just being injected with saline can cause urticaria is some individuals.


I would advise caution in having BOTOX in the future.  Allergies to BOTOX and the agents in the BOTOX preparation are rare but can occur.  I think if you are interested in having BOTOX in the future, a skin test with a tiny amount of BOTOX on the forearm would be appropriate.  If you react, I cannot advise future treatment.  If you feel that you must have BOTOX treatment in the future, you might consider a consultation with an allergist.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Most likely unrelated

I very much doubt your Botox had anything to do with your hives and breakout. Any type of reaction to Botox would have been much more immediate and would have happened the additional times you received the treatment. It's merely a coincidence these were done within weeks of each other and in my opinion, not at all related.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.