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Abnormal reactions requiring attention Contact your provider if you observe: Erythema spreading beyond 5 cm diameter or continuing to expand after 4 hours (suggests cellulitis or allergic reaction) Severe pain that prevents normal movement or sleep (suggests intradermal injection or nerve proximity) Pus or drainage from the injection site (suggests infection, though rare with proper technique) Systemic fever above 100.4°F within 24 hours of injection (suggests systemic infection or severe allergic response) Hives or welts appearing at the injection site or elsewhere on the body (suggests IgE-mediated allergic reaction to a component) A 2020 case series documented 14 cases of delayed hypersensitivity reactions to benzyl alcohol preservative in compounded injections, presenting as expanding erythema 24-72 hours post-injection (Kumar et al., Dermatitis , 2020)