Metallic Taste: An Unusual Reaction to Botulinum Toxin A

Abstract

Metallic taste is associated with the use of numerous medications; however, the pathogenesis remains unclear. Alteration in zinc metabolism, which may occur with BTX-A administration, has been suggested as a possible mechanism. Although this is the first known report of dysgeusia after BTX-A, physicians and patients may be reassured that the taste alteration was self-limited and was not significantly problematic for the patient in our case.

Practical Aspects of Cosmetic Botulinum Toxin

“…[12][13][14][15] Contraindications to botulinum toxin include pregnancy and nursing; diseases of the neuromuscular junction, like Eaton-Lambert, myasthenia gravis, and ALS; any interacting drugs listed above; allergy to egg albumin; or a history of allergy to botulinum toxin. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] There have been case reports of systemic reactions to botulinum toxin treatment, including generalized botulism-like illness and myasthenic crisis. 10,11,[20][21][22][23][24][25][26] There are reports of cardiac deaths in patients with preexisting heart disease, and 1 patient developed temporary metallic taste.…”

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] There have been case reports of systemic reactions to botulinum toxin treatment, including generalized botulism-like illness and myasthenic crisis. 10,11,[20][21][22][23][24][25][26] There are reports of cardiac deaths in patients with preexisting heart disease, and 1 patient developed temporary metallic taste. 10,11,[20][21][22][23][24][25][26] Common systemic reactions seen consist of temporary or generalized weakness, fatigue, malaise, flu, nausea, upper respiratory infection, pain, erythema, and headache (severe headache may happen in 1% of patients).…”

“…10,11,[20][21][22][23][24][25][26] There are reports of cardiac deaths in patients with preexisting heart disease, and 1 patient developed temporary metallic taste. 10,11,[20][21][22][23][24][25][26] Common systemic reactions seen consist of temporary or generalized weakness, fatigue, malaise, flu, nausea, upper respiratory infection, pain, erythema, and headache (severe headache may happen in 1% of patients). [16][17][18][19][20][21][22][23][24][25][26][27] Local side effects include greater than desired weakening of a target muscle and unintended weakening of adjacent (nontargeted) muscles.…”

“…10,11,[20][21][22][23][24][25][26] Common systemic reactions seen consist of temporary or generalized weakness, fatigue, malaise, flu, nausea, upper respiratory infection, pain, erythema, and headache (severe headache may happen in 1% of patients). [16][17][18][19][20][21][22][23][24][25][26][27] Local side effects include greater than desired weakening of a target muscle and unintended weakening of adjacent (nontargeted) muscles. This is due to using too high a dose, inadvertent diffusion, or incorrect injection localization.…”

“…These side effects may involve double vision, strabismus, eyelid ptosis, corneal exposure, ectropion or lid retraction, dry eye, lagophthalmos, tearing, brow ptosis, brow asymmetry, brow contour abnormalities, lip and mouth ptosis, and difficulty articulating, chewing, or swallowing. [16][17][18][19][20][21][22][23][24][25][26][27] n Reconstitution, Dilution, Storage, and Handling BOTOX comes in a lyophilized form as a powder in a vacuum-sealed bottle. It should be stored frozen at 25°C (BOTOX Cosmetic package insert; Allergan, Inc., Irvine, CA, 2002).…”