Immediate and delayed hypersensitivity reactions to restylane

We report two cases of hypersensitivity reactions to Restylane. In the first case, edema developed in a 57-year-old Hispanic woman 10 minutes after injection of 0.7 mL of Perlane around her upper commissures and Botox in her upper face. The patient had been skin tested for Restylane several months earlier and showed no positive reaction. In the second case, intermittent swelling and induration developed in a 77-year-old Caucasian woman 3 weeks after she received Restylane injections limited to the nasolabial folds. Currently, skin testing prior to hyaluronic acid treatment is not required. Our experience and reports in the literature suggest that while skin testing is unlikely to predict acute reactions to HA, it would be helpful in identifying patients at risk for delayed, long-term reactions.