title: Skin testing for chymopapain allergy in chemonucleolysis.
abstract: Chemonucleolysis with chymopapain (Chymodiactin, Discase) bears the risk of unpredictable anaphylactic reactions. The rate of anaphylaxis is reported to be between 0.35% and 1.5%. Serological in vitro tests such as RAST (radio-allergo-sorbent test) or ChymoFAST (fluorescent allergo-sorbent test) are used to determine increased specific immunoglobulin E antibody titers against chymopapain in patients submitted to chemonucleolysis. Alternatively, skin prick tests have also been applied in clinical trials. A skin prick test including Discase, Chymodiactin, and Solutrast 250 M, which is a radiopaque dye, has been performed in a total of 257 patients; 222 patients were tested before, and 35 patients were tested after chemonucleolysis with chymopapain. From the group tested before chemonucleolysis, 2.3%-3.3% had positive skin tests. After chemonucleolysis, the overall allergy rate to chymopapain increased to 42.9%. Positive skin reactions seem to be time-dependent--between the 3rd and 12th weeks after chemonucleolysis, more than 70% of the patients had positive skin tests. There was no correlation between a history of previous allergy and the skin test result. Patients with positive skin tests should be excluded from chemonucleolysis. This procedure increases the safety for patients submitted to chemonucleolysis. No anaphylactic reaction has been observed hitherto in more than 350 patients who were treated with the intradiskal injection of chymopapain after a negative skin prick test.
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced; D002917:Chymopapain / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D011300:Preoperative Care; D012882:Skin Tests
chemical_list: D002917:Chymopapain