Consent and consultation form for patients treated with BOTOX® (Botulinum Toxin Type A)for Hay fever and Rhinitis Symptoms

BOTOX® is indicated for the temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at maximum frown (glabellar lines); moderate to severe lateral canthal lines (crow’s feet lines) seen at maximum smile; moderate to severe crow’s feet lines seen at maximum smile and glabellar lines seen at maximum frown when treated simultaneously in adults, when the severity of these lines has an important psychological impact for the patient. 

Botox for the treatment of hay fever and Rhinitis is used ‘‘Off label’’. Off label use means that the medicine has a license for treating some conditions (e.g muscle spasticity, cosmetic use) but the manufactorer has not applied for a license for it to be used for hay fever or rhinitis.

Like all medicines, BOTOX® can have side effects, although not everybody gets them. In general, side effects occur within the first few days following treatment. They usually last only for a short time, but they may last for several months and in rare cases, longer. These adverse reactions may be related to treatment, technique or both. 

Possible side effects with using Botox for the treatment of hay fever/rhinitis are extremely rare. However, the following may occur:

  • Atomiser site discomfort

  • Bleeding from the nostrils

  • Redness, itching or irritation

  • Headache

  • Under eye puffiness

  • Flu-like symptoms

  • Anxiety symptoms

  • Lack of effect

    If you experience any of these, please inform your practitioner.

You cannot have this treatment if you have any of the following:

An allergy to Botox or materials used in the treatment

You currently have infected rhinitis

You are pregnant or breastfeeding

If you have a bleeding disorder that is poorly controlled on anti-coagulant therapy

You must tell us if you suffer from the following:

Severe anxiety

If you have a deviated septum or problems with inhalation

Aftercare

  • You must not use a nasal spray for 24 hours following your procedure

  • You may use all your other hay fever/rhinitis medication as normal

  • Results take 1-2 weeks to take effect

  • Your practitioner may review you at a 2 week period and may suggest a dose adjustment