Urticaria-Like Hypersensitivity Reaction Following Botulinum Toxin Injection: A Case Report of Possible Interaction with β-Lactam Antibiotics

Feng W, Liu H. Int Med Case Rep J. 2025;18:367-371 https://doi.org/10.2147/IMCRJ.S510203

Abstract: 

After injection, urticaria-like manifestations occurred on the
upper face, with redness, swelling, and wheal formation.

Botulinum toxin serotype A (BTX-A) is commonly used for treating facial dynamic wrinkles. The clinical safety of BTX-A has been proven, and it has few side effects; despite this, BTX-A has the potential to cause an allergic reaction. This case raises concerns about a possible interaction between botulinum toxin serotype A (CBTX-A) and β-lactam antibiotics, contributing to the limited literature on hypersensitivity reactions. Herein, we described the case of a 35-year-old woman who was injected with Chinese botulinum toxin serotype A (CBTX-A) to treat crow’s feet. The treatment was performed after the patient had taken cefprozil for an upper respiratory tract infection. Subsequently, the patient developed urticaria-like symptoms that completely resolved within 24 hours after administration of antihistamines. This case emphasises the need for careful medication history review before botulinum toxin administration, especially in patients receiving β-lactam antibiotics, as hypersensitivity reactions may occur.

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