Editing Botulism (section)

=== Injection (iatrogenic botulism) ===

Symptoms of botulism may occur away from the injection site of [[botulinum toxin]].<ref name=Product2019/> This may include loss of strength, blurred vision, change of voice, or trouble breathing which can result in death.<ref name=Product2019/> Onset can be hours to weeks after an injection.<ref name=Product2019>{{cite web |title=Botox |url=https://media.allergan.com/actavis/actavis/media/allergan-pdf-documents/product-prescribing/20190620-BOTOX-100-and-200-Units-v3-0USPI1145-v2-0MG1145.pdf |access-date=6 December 2019 |archive-date=5 December 2019 |archive-url=https://web.archive.org/web/20191205180954/https://media.allergan.com/actavis/actavis/media/allergan-pdf-documents/product-prescribing/20190620-BOTOX-100-and-200-Units-v3-0USPI1145-v2-0MG1145.pdf |url-status=live }}</ref> This generally only occurs with inappropriate strengths of botulinum toxin for cosmetic use or due to the larger doses used to treat movement disorders.<ref name=Sobel2005/> However, there are cases where an off-label use of botulinum toxin resulted in severe botulism and death.<ref>{{cite journal |last1=You |first1=Geoffrey |last2=Khan |first2=Ahmed |last3=Shor |first3=Julia |last4=Forester |first4=Gary P. |title=Rapidly Progressive Muscle Paralysis and Acute Respiratory Failure Following Endoscopic Botulinum Toxin Injection |journal=ACG Case Reports Journal |date=2016 |volume=3 |issue=1 |pages=e166 |doi=10.14309/crj.2016.139 |pmid=27921065 |pmc=5126502 }}</ref> Following a 2008 review the FDA added these concerns as a [[boxed warning]].<ref>{{cite web |title=Update of Safety Review of OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc) |website=[[Food and Drug Administration]] |url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174959.htm |access-date=29 December 2019 |date=15 November 2017|archive-url=https://web.archive.org/web/20171115034159/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174959.htm |archive-date=15 November 2017 }}</ref> An international grassroots effort led by NeverTox to assemble the people experiencing Iatrogenic Botulism Poisoning (IBP) and provide education and emotional support serves 39,000 people through a Facebook group who are suffering from adverse events from botulinum toxin injections.<ref>{{cite web | url=https://www.toxsafety.com/resources | title=Resources }}</ref>