Anaphylactic Accidents Related to Chymopapain: Prevention and Treatment

Laxenaire, M; Monneret-Vautrain, D. A.

doi:10.1007/978-3-642-71182-4_12

Cited by 2 publications

(4 citation statements)

References 35 publications

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“…The aim of CN by intradiscal papain injection is lysis of the proteoglycans of the nucleus pulposus. The risk of anaphylaxis during this procedure is well known and concerns about 0-77% of potential patients [1,4]. The incidence of severe anaphylactic shock is reported to I. Non-atopic non-exposed.…”

Section: Discussionmentioning

confidence: 99%

“…range from 018% [13] to 0 45% [7]; it is considerably higher with a second CN [9,12,16]. Eight deaths due to an anaphylactic reaction to chymopapain were reported before 1974 and six more between 1982 and 1986 [5], Although the medical profession is as yet far from unanimous about CN, many surgeons are convinced of its value [1,4,8,19]. Yet, in a large retrospective study comparing CN and surgical treatment for lumbar disk protrusion, surgery was associated with six times the number of untoward events and 10 times the number of severe accidents [1], Allergic reactions are probably responsible for half of all known complications of CN [20].…”

Section: Discussionmentioning

confidence: 99%

“…Lumbar disc protrusion can be treated by intradiscal injection of purified chymopapain [1,2]. This technique, called chemonucleolysis (CN), carries a risk of anaphylaxis from 0-18 to 0 45% with the first injection [3][4][5][6]. A second CN Correspondence: D. A. Moneret-Vautrin, Service de Medicine "D", lmmunologie Clinique et Allergologie, Centre Hospitalier Universitaire de Nancy-Hopital de Brabois, Rue du Morvan, 54511 Nancy-Vandoeuvre, Cedex, France.…”

Section: Introductionmentioning

confidence: 99%

“…carries a much greater risk-17% [7,8]. This has led to the recommendation of routine pre-operative skin-prick testing (SPT) with chymopapain [9,10,4], Latent sensitization to chymopapain, as revealed by skin tests and serological tests for specific IgE antibodies (RAST), has been linked to the ingestion of the papain in papaya [11]. This may explain the relatively high risk for anaphylaxis associated with first CN [2,12].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors for latent sensitization to chymopapain: predictive skin‐prick tests in 700 candidates for chemonucleolysis

Moneret-Vautrin

Feldmann

Kanny

et al. 1994

Clin Experimental Allergy

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Seven hundred patients were investigated prospectively before undergoing chemonucleolysis. A past history of allergy and/or previous exposure to papain, either in food, beverages or drugs, was sought, and a skin-prick test with chymopapain was performed. Based on the results obtained, the subjects were classified into four groups: Group I--225 non-atopic non-papain-exposed subjects; Group II--285 non-atopic papain-exposed subjects; Group III--69 atopic non-papain-exposed subjects; and Group IV--121 atopic papain-exposed subjects. Latent sensitization to papain was observed in 0.4% of subjects in Group I, 3.16% in Group II, 5.8% in Group III and 7.4% in Group IV. The odds ratios were 13.8 for atopy and 7.3 for exposure to papain. Interaction between atopy and papain exposure did not result in a significantly greater risk. Neither sex nor age nor a history of a previous drug reaction were risk factors. Only one patient out of the 23 who were sensitive to papain had no risk factor. The 677 skin-test negative patients then underwent chemonucleolysis and none of them had an anaphylactic reaction. This was significantly less frequent: (P = 0.04) than the incidence in a random population (0.45%). Prick tests performed 6 weeks and 6 months after chemonucleolysis revealed newly acquired sensitization in 36% of the patients. Atopy was not a risk factor for this event.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and risk factors for latent sensitization to chymopapain: predictive skin‐prick tests in 700 candidates for chemonucleolysis

Moneret-Vautrin

Feldmann

Kanny

et al. 1994

Clin Experimental Allergy

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Valutazione comparativa fra chemonucleolisi ed approccio chirurgico tradizionale nell'ernia discale lombare

Vasciaveo¹,

Degobbis²,

Regeni³

1989

Rivista di Neuroradiologia

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Dal luglio 1985 al dicembre 1988 sono stati trattati con chemonucleolisi 247 pazienti affetti da ernia discale lombare e con discectomia 123 pazienti. La percentuale di successo è stata del 77% per la chemonucleolisi e del 75% per il trattamento operatorio. Non ci sono state complicazioni importanti per nessuna delle due metodiche. I pazienti trattati con chemonucleolisi hanno avuto una degenza ospedaliera post-operatoria più breve. La chemonucleolisi si conferma come un'eccellente alternativa al trattamento chirurgico in pazienti accuratamento selezionati. In caso di insuccesso l'intervento non complicato data l'assenza di fibrosi.

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Anaphylactic Accidents Related to Chymopapain: Prevention and Treatment

Cited by 2 publications

References 35 publications

Incidence and risk factors for latent sensitization to chymopapain: predictive skin‐prick tests in 700 candidates for chemonucleolysis

Incidence and risk factors for latent sensitization to chymopapain: predictive skin‐prick tests in 700 candidates for chemonucleolysis

Valutazione comparativa fra chemonucleolisi ed approccio chirurgico tradizionale nell'ernia discale lombare

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