There are many reports on the neurological sequelae of wasp stings, including antibody development leading to autoimmune neuromyotonia.1 We report a complete therapy failure of botulinum neurotoxin A due to antibody formation after a wasp sting and discuss its implications.
In a 47-year-old woman with idiopathic cervical dystonia (Tsui score, 6; Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] score, 10), treatment was initiated with botulinum neurotoxin A complex (BoNT/A; 200 mouse units [MU] of Dysport; dilution, 500 MU per 2.5 mL; Ipsen Pharma GmbH, Ettlingen, Germany). It was her first contact with botulinum neurotoxins. For the second treatment 13 weeks later, dosage and injection protocol were modified (340 MU of Dysport), and an excellent control of symptoms was obtained (4 weeks after injection: Tsui score, 1; TWSTRS score, 2). The third and fourth treatments, which were identical to the second, had the same success (intervals of 12 and 14 weeks, respectively), each time with an onset of BoNT/A effect about 5 days after injection and maximal clinical benefit reached on day 10.
Paus S, Bigalke H, Klockgether T. Neutralizing Antibodies Against Botulinum Toxin A After a Wasp Sting. Arch Neurol. 2006;63(12):1808–1809. doi:10.1001/archneur.63.12.1808
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