Explaining to you patient that systemically when you are unwell, it’s the physical effect of the immune system and its inflammatory and immune response that causes you to feel unwell as opposed to the pathogen itself. This tells us that our body is doing what is required of it to fix and rid our body of the virus or bacteria causing that has invaded it.

Triggers to the immune system response can be attributed to a few things, one of them being neurotoxin associated proteins or NAPs. They are responsible for protection of the toxin when exposed to acidic environments. NAPs also include proteins that cause blood to coagulate. Surface viruses have these in part, which play differing roles in attachment and penetration of cell membranes. Pathogen invasion and reproduction is an eventual result.

The coagulation proteins, known as hemagglutinins are one of the major triggers when infection is identified and the immune system is triggered.

Armed with this underpinning knowledge, it will come as no surprise that they are one of the proteins included in botulinum toxin preparations. Naturally and organically hemagglutinins adopt the role of assisting a toxin by altering and disrupting ecosystem balances of the epithelium. This said, they are not needed to enter the neuron once they have penetrated where they need to.

Once the toxin has been constituted the NAPs almost entirely disassociate themselves with it. This happens even before the solution has been injected, whilst still in the vial. They have still however, been shown to trigger an immune system response in animal studies, reactions to hemagglutinin evoke a stronger immune response than the toxin itself.

The immune system can identify these as proteins as being related to infection, hence the prompted immune system response. The inflammatory response is why the patient feels unwell, not because there is a physical threat or infection.