New research suggests a need for guidelines around the storage and dosing for hyaluronidase (HYAL) when using hyaluronic acid (HA) fillers. 

"Hyaluronic acids continue to be the fillers of choice worldwide and their popularity is growing," the authors wrote in Aesthetic Surgery Journal. "Adverse events (AEs) are able to be resolved through the use of HYAL. However, routine HYAL use has been at issue due to perceived safety issues."

The researchers noted that there are currently no established guidelines for HYAL use in aesthetic procedures, leading to inconsistent practices in storage, preparation, skin testing, and adverse event management. Their study utilized a 39-question survey about HYAL usage (completed by 264 healthcare practitioners: 244 from selected databases and 20 from a consensus panel). Responses from the database group were compared with those from the consensus panel.

The consensus group was more confident in the preparation of HYAL, stored reconstituted HYAL for longer periods, and were less inclined to perform skin tests for HYAL sensitivity, according to the results. They were also more likely to use HYAL in emergencies, even for patients with a history of anaphylaxis due to bee or wasp stings. Most (92%) respondents had never observed an acute reaction to HYAL, and only slightly over 1% witnessed anaphylaxis. Long-term adverse effects were reported by 5% of practitioners.  The majority (74%) of practitioners routinely obtained informed consent regarding the potential need for HYAL before HA injections.

"There is a need for evidence-based guidelines on the storage and dosing for different indications, because practitioner habits varied significantly," the authors wrote in the study. "Concerns around allergy to HYAL appear to be overstated, considering its rarity and that it may be leading to unusual practices. Skin testing, if ever required, would be best addressed in specialist allergy clinics rather than in the injecting clinic."

Source: Currie E, et al. Aesthetic Surgery Journal. 2024;44(6):647–657. Doi: 10.1093/asj/sjae009