Increased risk of late‐onset, immune‐mediated, adverse reactions related to dermal fillers in patients bearing HLA‐B *08 and DRB1 *03 haplotypes

Abstract

Even though manufacturers claim that the dermal fillers are nontoxic and nonimmunogenic, adverse events may occur. Clinically and histologically, most of the late onset adverse events present as an inflammatory response. To assess whether HLA polymorphisms are associated with late‐onset inflammatory adverse events related to dermal fillers. A total of 211 patients were included, of whom 129 experienced late‐onset inflammatory adverse events to different fillers (Inflammation group) and 82 who did not (Reference group). Patients completed a standardized questionnaire and provided a blood sample or oral swap for HLA testing. The study population consisted of 188 (89%) women and 23 (11%) men. The two study groups were similar in the distributions of filler type, location of injecting, allergy, autoimmune disease, gender, age, ethnicity, and smoking status. Of the 211 patients in the sample, 25 had the combination of HLA subtype‐B*08 and HLA subtype‐DRB1*03. This was 16.3% of the inflammatory group and 4.9% of the reference group. This combination of HLA subtypes was associated with an almost 4‐fold increase in the odds of developing immune mediated adverse events (odds ratio = 3.79, 95% CI 1.25‐11.48). Genetic polymorphisms such as HLA combinations may identify patients at risk of developing late onset immune mediated adverse events to dermal fillers.

The Immunogenicity of Hyaluronic Fillers and Its Consequences

“…Some authors also described a genetic predisposition underlying the reaction in individuals with the following subtypes: HLA B * 08 or DRB1 * 03.4 (a fourfold increase in the risk). 13,62 Diagnostics DIR-related lesions are of inflammatory nodular character. They should be differentiated with nodules caused by biofilm, abscesses (softening, fluctuance), granulomatous reactions (hard, inflammatory nodules).…”

“…Such a combination of HLA subtypes was related to an almost fourfold increase in the probability of developing adverse reactions (OR 3.79). 13 …”

“…Some authors also described a genetic predisposition underlying the reaction in individuals with the following subtypes: HLA B * 08 or DRB1 * 03.4 (a fourfold increase in the risk). 13 , 62 …”

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

“…25-11.48). 18 HLA subtyping poses future possibilities for preidentifying individuals at risk of delayed reactions.…”

“…Two recent literature reviews state that patients with autoimmune conditions may be safely treated with a variety of fillers. 17 , 18 During active disease stages, we still advise against filler treatments.…”