TWO CASES OF ACUTE ALLERGIC REACTION FOLLOWING INJECTION OF GENERIC, GOVERNMENT-PROVIDED BOTULINUM TOXIN A (GGP-BTA) FOR HEMIFACIAL SPASM AND BLEPHAROSPASM (P3.028)

Objective: To report the cases of two patients who developed facial angioedema one hour after receiving intramuscular Generic, Government-provide Botulinum Toxin A (GGP-BTA), with a five-month interval between the two cases. Background: Allergic reactions after administration of Botulinum Toxin A are rare and have been reported with the use of commercially available formulations, but not with generic formulations. Design/Methods: Case reports Results: Patient 1: A male patient with left hemifacial spasm, who had already been treated with commercially available BTA (Botox®) with no significant side-effects, was treated with intramuscular injections of GGP-BTA on the affected muscles of the left side and additional injections in the periocular region of the right side for symmetry. About one hour following the procedure he developed a purplish-red oedema of the eyelids, as well as the left nasolabial fold. He was treated with IV Methylprednisolone, followed by oral 60 mg qd of Prednisone, intramuscular Adrenaline and was started on oral Diphenhydramine with resolution of the angioedema. Patient 2: A female patient with blepharospasm who had already been previously treated with Botox® was also treated with intramuscular injections of GGP-BTA in the periocular regions. One hour after the procedure, she developed a purplish-red oedema of the eyelids. She was treated with oral anti-histaminic agents and refused to remain at the hospital as she lived in another town. There was resolution of symptoms in about four days, as per telephone contact. After a three-month interval, both patients underwent cutaneous testing for allergy with GGP-BTA, as well as three commercially available formulations of BTA (Botox®, Dysport® and Xeomin®). They both only had allergic reactions with GGP-BTA and with none of the commercially available BTAs. Conclusions: We reported two cases of facial angioedema following injection of GGP-BTA, with resolution after adequate systemic treatment with anti-allergic medications. Disclosure: Dr. Parolin has nothing to disclose. Dr. Germiniani has nothing to disclose. Dr. Teive has nothing to disclose. Dr. Scola has nothing to disclose. Dr. Borges has nothing to disclose. Dr. Parolin has nothing to disclose. Dr. Parolin has nothing to disclose. Dr. Parolin has nothing to disclose. Dr. Parolin has nothing to disclose. Dr. Parolin has nothing to disclose. Dr. Parolin has nothing to disclose.