How do you test for Botox allergy?

Question

I've had Botox before with no incident and then two years ago I had Botox and juvederm and 10 days later I had reoccurring angioedema and hives on and off for three months. I don't know how it could be the Botox but I don't want to risk it. I have an appointment with my allergist who is going to explore options and I want to get feedback from anyone who has had/done an allergy test.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your questions regarding Botox.  There is no specific test for allergy to Botox cosmetic.  You allergist may consider injecting 1 unit in a test site.  Dermal filler allergies may also be tested for in the say way with the recommendation of having hyaluronidase available to dissolve the product if necessary.  It would be quite unlikely that Botox or Juvederm caused angioedema 10 days after injection as a Botox injection would likely be immediate and Juvederm lasts for 6 months or more.  Follow-up with an allergist for further exploration.  Good luck.

Stephen Prendiville, MD · Answer

In 16 years of practice, preceded by 7 years of training, I have never seen a Botox allergy.  However, angioedema is very  concerning and you are correct in following up with your Allergist.  Many medications are associated with angioedema, most commonly with ACE inhibitors used for hypertension.  It would also be useful for you to obtain the lot and serial numbers of the Botox and Juvederm to establish that these were FDA approved products designed for use in the Unites States.  I have not seen atypical responses with Juvederm, but a hyaluronic acid filler that was not FDA approved (Expressions) was associated with numerous adverse reactions.

John Tang, MD · Answer

I am not aware of any tests that would test for a Botox allergy.  In the 17 years of doing Botox, I have not seen any person who has a Botox allergy.  I have seen 1 patient with an allergy to HA filler.

Anthony P. Terrasse, MD · Answer

Thanks for your question and I certainly understand your concern. However, an allergic reaction to Botox is extremely rare, if it happens at all. You can ask your allergist to inject a unit into a test site to determine whether the liquid medication was the culprit. Juvederm reactions are also quite rare, but you could have an allergy test for that as well. Keep in mind that if an allergic reaction to Botox did occur, it would likely happen immediately following the injections. At the same time, a reaction to Juvederm would probably last longer than three months, since the substance typically remains in the body for up to a year or more. It is also very important to have your Botox and Juvederm treatments with a reputable board certified to ensure that imitation, unauthorized, or substitute formulations are not used. There is a product (hyaluronidase) which is an enzyme that 'dissolves' hyaluronic acid products like Juvederm, Voluma, and Restylane, so there is a recourse if a problem is suspected with those injections.

Melvin Elson, MD · Answer

There is no test for Botox allergy as it is not necessary. I have been doing Botox for over 20 years and have never had a patient have an allergic reaction. I also doubt it was the Juvederm and most likely something totally unrelated to your treatment

Leonard Grossman, MD · Answer

If you've had a problem with the Botox treatment and you believe that the edema was related to the effect of Botox, you should visit an allergologist and ask them to tackle this problem. Good luck for New York City

Kristine Brecht, MD (license suspended) · Answer

I'm so sorry to hear about your traumatic experience.
I've never experienced or heard of Botox causing angioedema.
Juvedem however is very hydrophilic, liking water, aka swelling, and its longevity when injected is 3-6months.
I might suggest just 1-2uBotox test, and if no excessive issues, then try it again, but without fillers at the same time.
Kristine Brecht, MD
Seattle, WA

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