Urgent botulism symptoms alert issued after 'adverse reactions' reported

The UK Health Security Agency (UKHSA) has issued a warning for people to stay vigilant for botulism symptoms after a group experienced "adverse reactions" after cosmetic treatments involving botulinum toxin.

Additional cases have surfaced, following those identified in the North East, with recent incidents reported in the East of England and East Midlands, according to the UKHSA. From June 4 to July 14, 2025, there have been 38 reported instances of iatrogenic botulism.

No direct connection has been established between the new cases and those from the North East, the UKHSA confirmed. Ongoing investigations hint at the use of an unlicensed Botox alternative.

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It is understood that the practitioners implicated in these latest events have halted their services and are actively participating in the investigation. Reported reactions include difficulties with swallowing, slurred speech, and severe breathing issues necessitating respiratory aid.

In response, the UKHSA has issued advice nationally to healthcare professionals to be on the lookout for botulism signs in patients who've recently undergone cosmetic procedures, ensuring timely administration of the necessary anti-toxin treatment. The agency is also urging the public to exercise caution when opting for aesthetic treatments, emphasising the importance of verifying the licensing status of the products used.

Dr Gauri Godbole, a consultant medical microbiologist at UKHSA, said: "We are working closely with our partners to reduce the public health risk and would advise people to make sure they take precautions when seeking aesthetic procedures. Botulism related to aesthetic procedures is rare, but it can be serious. It is caused by toxins produced by the bacterium Clostridium botulinum. These toxins (but not the bacteria) are the active ingredient in 'Botox' and similar products.

"Symptoms of botulism can take up to four weeks to develop and if you have had a recent botulinum toxin (Botox-like) treatment and are having symptoms such as difficulty swallowing or breathing, contact NHS 111 for further advice and seek treatment.

"If you are considering having a cosmetic procedure, please make sure to check that your practitioner is using a licensed product. there is more information on what sensible steps you can take when finding a practitioner on the NHS website."

Professor Meghana Pandit, co-national medical director, secondary care, at NHS England, said: "When these procedures go wrong, there is a risk of serious infections and permanent scarring, which is why only registered professionals like a doctor, a nurse or pharmacy prescriber should be prescribing these treatments.

"If you decide to undergo a cosmetic procedure like Botox or lip fillers, there is advice on the NHS.uk website on the questions to ask, including making sure that the person administering it is trained to do it."

Dr Alison Cave, MHRA chief safety officer, added: "Public safety is a top priority for the MHRA. Botulinum toxin is a prescription-only medicine and should only be sold or supplied in accordance with a prescription given by an appropriate practitioner such as a doctor or other qualified healthcare professional.

"Buying botulinum toxin in any other circumstances significantly increases the risk of getting a product which is either falsified or not licensed for use in the UK. This means that there are no safeguards to ensure products meet the MHRA's standards for quality and safety. As such, they can endanger the health of the people who take them.

"Our Criminal Enforcement Unit works hard to identify those involved in the illegal trade in medicines and takes robust enforcement action where necessary. This can include criminal prosecution."

Symptoms of botulism

drooping eyelids

blurred or double vision

facial muscle weakness

difficulty swallowing (dysphagia)

slurred speech

breathing difficulties

With aesthetic treatments gaining popularity on the high street, the UKHSA has suggested that anyone considering such procedures should follow a straightforward checklist to ensure safety.

If you suspect that you're experiencing a side effect from a botulinum toxin product, it's crucial to consult with your doctor, pharmacist or nurse and report it directly via the MHRA Yellow Card scheme. This can be done either through www.mhra.gov.uk/yellowcard or by using the MHRA Yellow Card app, which is available for download on Google Play or the Apple App Store.

The MHRA's FakeMeds campaign offers guidance to UK residents contemplating purchasing medication online, detailing how to access products from safe and legitimate sources.

For additional information on botulism, visit: https://www.nhs.uk/conditions/botulism/