title: [Sensitization to chymopapain in patients treated with chemonucleolysis].
abstract: BACKGROUND
  Chemonucleolysis (intradisk administration of chymopapain) is a procedure to treat intervertebral disk hernia. Recently, its use has been questioned due to the development of anaphylactic reactions in patients sensitized to chymopapain. The prevalence of sensitization to chymopapain has been evaluated before and after chemonucleolysis, and the possibility to establish risk groups through the allergy history has been assessed.
  
  
  METHODS
  104 consecutive patients who were candidates to chemonucleolysis were evaluated with an allergy questionnaire, cutaneous tests to aeroallergens and to chymopapain, and chymopapain-specific IgE. The two latter tests were repeated one month after chemonucleolysis.
  
  
  RESULTS
  Only 2 patients (1.9%) showed evidence of chymopapain sensitization before the procedure. Sixteen patients (16%) were sensitized after chemonucleolysis. None of the possible risk factors evaluated in the allergy questionnaire (atopy, drug allergy, papaya occupational exposure or use of additives, cosmetics or drugs containing papaine) were significantly related with the risk of sensitization to chymopapain.
  
  
  CONCLUSIONS
  The prevalence of chymopapain sensitization in the study group was low. The allergy questionnaire (atopy, drug allergy, use of papaya, occupational history did not identify sensitized patients. Cutaneous tests and specific IgE are the best method to detect chymopapain sensitization. The remarkable rate of sensitization after chemonucleolysis may partially limit the usefulness of the procedure.
authors.affiliation: Unidad de Alergia, Servico de Medicina Interna, Hospital Joan XXIII, Tarragona.
authors.forename: P
authors.initials: P
authors.lastname: García-Ortega
authors.forename: W
authors.initials: W
authors.lastname: Ramírez Ferreiras
authors.forename: A
authors.initials: A
authors.lastname: Sancho
authors.forename: S
authors.initials: S
authors.lastname: Urías
authors.forename: A
authors.initials: A
authors.lastname: Cisteró
mesh_terms: D000328:Adult; D002917:Chymopapain / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007404:Intervertebral Disc Chemolysis / Q000009:adverse effects*; D008875:Middle Aged; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E; D002917:Chymopapain
vernacular_title: Sensibilización a la quimopapaína en pacientes tratados con quimionucleólisis.