Botulinum Toxin Type A Therapy and Human Serum Albumin
Notice bibliographique
Résumé
This letter is in reference to the recent article on the use of botulinum toxin type A (Botox®; Allergan Inc., Irvine, CA) in the role of chronic myofascial pain and the corresponding editorial.1,2Although the use of Botox® is regarded as a safe therapy for many patients,3,4it is our concern that Botox® contains 0.5 mg human serum albumin per 100-U vial and that this is not often discussed in the literature despite increasing usage.5Other preparations of botulinum toxin used in the world today also contain some amount of human serum albumin (Dysport®; Ipsen Ltd., Berkshire, United Kingdom, and Myobloc®; Elan Pharmaceuticals, Cambridge, MA).6The human albumin used in Botox® is purchased from a division of the Bayer Corporation (Leverkusen, Germany). Measures taken to prevent disease transmission to humans include screening of donors, plasma testing for human immunodeficiency virus (HIV) and hepatitis B, and pasteurization of the albumin preparation. Therefore, the risk of transmitting viruses such as hepatitis A, B, and C, non-A non-B hepatitis (NANB), and HIV is considered extremely remote. There still exists an extremely remote possibility that some prion causing disease such as Creutzfeldt-Jakob or variant Creutzfeldt-Jakob may be transmitted in the preparation because prions are not inactivated by current sterilization methods.6Bayer corporation also produces Plasbumin® (human albumin) as a plasma substitute, and there is a clear statement on its product monograph that no case of viral or prion disease transmission has ever been documented with its use.With the injection of human albumin, there is a possibility of inducing a hypersensitivity reaction resulting in symptoms such as fever, chills, urticaria, malaise, nausea, rash, and asthenia. The product monograph for Botox® indicates that the drug is contraindicated if a patient has a “… known hypersensitivity to any ingredient in the formulation,”7and therefore, patients should be questioned about previous exposure to human albumin or albumin transfusions.A survey of four other clinicians in our pain clinic indicated that although most knew there was albumin in each vial of Botox®, none knew exactly how much was in each vial, nor were any of the clinicians informing their patients of its presence. Obviously, a Jehovah’s Witness patient would want to know about the human albumin and would likely refuse treatment with this product. Further, we believe that all patients should be informed about the presence of human albumin in botulinum toxin therapy as part of their informed consent. Some non–Jehovah’s Witness patients may have a psychological and emotional reaction to the knowledge they are being injected with a blood product, although it is unlikely to create any adverse effect by its presence. We propose that this concern should be addressed before therapy with botulinum toxin and that medical literature should highlight this issue because dissemination of this information is vital to ethical practice.*Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. paul.tumber@uhn.on.ca
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».