Allergic Complications Related to Hyaluronidase Injection

A recent study, published in Aesthetic Plastic Surgery, utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to distill existing literature on hyaluronidase allergies and outline potential risk factors, clinical symptoms, and management strategies in plastic surgery.

The researchers aimed to equip professionals in the field with a deeper understanding of allergic complications associated with hyaluronidase injections, promoting safer practices and more informed patient care in plastic surgery. An extensive digital search across PubMed, Scopus, and Embase databases was conducted, screening 247 articles and ultimately selecting 37 that met the criteria. These studies collectively examined 106 patients, averaging 54.2 years in age. A history of allergic reactions to various substances (timothy grass, egg white, horse serum, penicillin, insect bites, wasp venom, thimerosal, potassium, histamine, phenylmercuric acetate, and nickel) and allergic conditions (asthma, dermatitis, atopy, and rhinitis) were commonly reported among the examined cases.

The study identified a significant number of patients who exhibited symptoms upon their second injection, particularly those with a history of repeated exposure (2–4 times). However, despite multiple exposures, there was no considerable link found between the time intervals of these repeated injections and the emergence of allergic reactions (P = 0.3). For those affected, treatment with steroids in combination with or without antihistamines demonstrated rapid and mostly complete relief from the symptoms.

The study authors concluded, “Prior injections or sensitization by insect/wasp venom might be the primary factor associated with hyaluronidase allergy development. The time between the repeated injections is not a likely contributor to the presentation.”

Reference

Guliyeva G, Huayllani MT, Kraft C, Lehrman C, Kraft MT. Allergic complications of hyaluronidase injection: risk factors, treatment strategies, and recommendations for management. Aesthetic Plast Surg. Published online May 5, 2023.. doi:10.1007/s00266-023-03348-5