Botox vs Xeomin Allergy?

Thank you for sharing your experience. This is an important and valid concern. Allergic reactions to botulinum toxin products such as Botox or Xeomin are rare, but they can occur.

The fact that you tolerated Xeomin previously without issue is encouraging. Xeomin is a "naked" neurotoxin, meaning it contains only the active botulinum toxin type A without the complexing proteins found in Botox. These added proteins in Botox may increase the risk of developing antibodies or hypersensitivity in some individuals.

Since your hives appeared after your second dose of Botox, your dermatologist’s suspicion of a delayed-type hypersensitivity reaction is plausible. However, it’s also important to consider other contributing factors like hormonal changes post-partum or concurrent exposures to new medications, supplements, or environmental triggers.

If you’re considering returning to Xeomin, a cautious approach would be recommended. You may discuss options with your provider, such as:

Skin testing or allergy testing, although standardized tests for botulinum toxin products are limited.

Starting with a very small test dose under medical supervision.

Pre-treatment planning is needed in case a reaction occurs (e.g., antihistamines or corticosteroids are available).

Ultimately, shared decision-making between your allergist, dermatologist, and you, with close monitoring, can help guide the safest path forward.

Medicine isn’t a guessing game .. you should do a small subq spot test in the forearm with each and see if it causes a localized skin reaction then there is your answer .. xeomin doesn’t have associated toxin proteins so it is less likely to cause any adverse reactions but the real answer lies in the test