Botox vs Xeomin Allergy?

Question

Hoping to get some opinions as my Allergist and Dermatologist advised me different. So a few years back I gotten Xeomin for my 11s about 3 times. It was great, no side effects. Than I stopped and had a baby. Three months post partum I went to get Botox instead of Xeomin and it was also good but the second time I got Botox 13 days later I developed full body hives. Allegist thinks its not related to Botox but Dermatologist thinks ive developed a Botox Allergy. Now I dont know what to do and who to listein to. Id like to go back to Xeomin but worried.

Eric M. Joseph, MD · Answer

Perhaps you could get Clarity by calling the manufacturers of these products. We have been using BOTOX for over 25 years, and we have not seen a single allergic reaction. We have been using Xeomin, since the product became available, and similarly, we have not seen a single allergic reaction. We have not heard of anyone developing a full body rash / hives. Since adverse reactions are reported to the companies, they may be the best source of information for you moving forward. I hope this helps! Sincerely, Dr Joseph

Anil R. Shah, MD · Answer

Allergic-type reactions to neuromodulators like Botox or Xeomin are extremely rare, but they can happen, and sorting out what really caused your hives is important before you try another treatment.

Ella Fedonenko, MD · Answer

Allergic reactions to Botox usually happen after a few days of having a Botox treatment. Most likely the hives you developed are unrelated to the Botox injections you had almost 2 weeks earlier. Additionally you are unlikely to have allergic reaction to Xeomin even if you had one after a Botox treatment. I would proceed with Xeomin injections.

Anna Chacon, MD, FAAD · Answer

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.

Camille Cash, MD · Answer

Botox and Xeomin are both neruomodulators, but they are created slightly differently.  You can have your doctor perform a patch test on your arm to check for allergy.  You can then proceed with treatment if you are nonreactive.

Drew Varano, MD · Answer

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

Leonard Grossman, MD · Answer

Allergic reactions to Botox and dysport are very rare, but can be quite severe. It is easy for any treating Physician to do a small skin test using Botox to see if you have an allergy. I hope this helps and good luck from Leonard Grossman MD, organic Plastic Surgery NYC

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