Botox suspected in 4 botulism cases
New Jersey, Florida health officials investigating
(CNN) -- Health officials in Florida and New Jersey are investigating whether four people -- hospitalized in those two states -- may have contracted botulism from Botox injections.
Two of the four -- identified as married couple Eric and Bonnie Kaplan -- are in critical condition in the intensive care unit at Palm Beach Gardens Medical Center in southeastern Florida.
Officials at the Palm Beach County hospital said the Kaplans have botulism, and both recently received Botox injections.
State health officials in Florida and New Jersey said they are looking into the possibility that an injection of the enzyme, which is commonly used as a temporary wrinkle concealer, caused the botulism cases. Doctors say Botox contains highly diluted, small amounts of the toxin.
The U.S. Food and Drug Administration reports on its Web site that the botulinum toxin is one of the most poisonous substances known, but can be "safely used, in a purified form, as a medicine to control certain conditions marked by involuntary muscle contractions."
The FDA approved Botox in 2002 for the treatment of moderate-to-severe frown lines between the eyebrows.
The hospital officials did not say if the Kaplans received FDA-approved injections from the company Allergan or whether they used knock-offs that doctors say have been circulating throughout the medical community. Those have more concentrated amounts of the poison.
Once in the body, the botulinum toxin attacks by binding to nerve endings at the point where the nerves join muscles, according to the FDA. When this happens, the nerves can't signal the muscles to contract. The result is weakness and paralysis that descends from the head down, affecting, among other things, the muscles that regulate breathing.
It is not clear whether the New Jersey patients received Botox injections, but Florida officials are investigating whether all four received the injections at the same time and at the same clinic in Ft. Lauderdale.
The Miami Herald reported that federal agents raided the suspected clinic, Advanced Integrated Medical Center in Oakland Park.
Broward County Sheriff's Department, the county health department and the FDA did not comment on the newspaper report.
Dr. Charles Schallop, a neurologist at Palm Beach Gardens Medical Center, called the Kaplans' situation "very serious."
"These are two young, healthy individuals who are now critically ill," he said. "They had a very dry throat, they had difficulty swallowing, they had a raspy voice, they had significant weakness in the eyelids."
Symptoms of poisoning can include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry-mouth and muscle weakness.
According to the trademarked Botox Cosmetic Web site, "there is no chance of botulism poisoning" from the injections, which are available by prescription only.
"Botox is extraordinarily safe," said Dr. Tina Alster, a dermatologic laser surgeon who performs thousands of Botox treatments a year. "There have literally been millions of people treated with Botox for cosmetic purposes over the past decade.
"We know that there has never been a case of botulism as a result of Botox injections."
The Botox label warns that people with pre-existing conditions, such as neuro-muscular disorders, could aggravate those conditions if they use the drug.
Officials at Allergan said they sent two vials of the drug this year to the Ft. Lauderdale clinic and have conducted an extensive review of those batches -- but have found no safety problems.
Allergan is cooperating with the Florida-New Jersey investigation.
CNN Correspondent Brian Todd contributed to this report.