Skip to main content

Anaphylactic Accidents Related to Chymopapain: Prevention and Treatment

  • Conference paper
  • 30 Accesses

Abstract

Allergy due to papaya derivatives - whether acquired by inhalation [41], ocular [4], digested [21], or parenteral administration - has been known and reported for 40 years [47]. It is therefore not surprising that these anaphylactic reactions had been verified by the time of the advent of nucleolysis using chymopapain, which is the principal proteolytic composant of the papaya [1, 3, 7, 13, 18, 24, 38, 52, 54, 61, 62].

This is a preview of subscription content, log in via an institution.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Agre K, Wilson RR, Brim M, McDermott DJ (1984) Chymodiactin postmarketing surveillance. Demographic and adverse experience data in 29 075 patients. Spine 9:479–485

    Article  PubMed  CAS  Google Scholar 

  2. Baker GJ, Collett P, Allen DH (1981) Bronchospasm induced by metabisulfite-containing foods and drugs. Med J Aust 2: 614–616

    PubMed  CAS  Google Scholar 

  3. Benoist M, Deburge A, Busson J (1984) Technique de la chimionucléolyse (pp 107–123). In: Benoist M and Deburge A (eds) La chimionucléolyse. Hôpital Beaujon, Clichy

    Google Scholar 

  4. Bernstein DI, Gallagher JS, Grad M, Bernstein L (1984) Local ocular anaphylaxis to papain enzyme contained in a contact lens cleaning solution. J Allergy Clin Immunol 74: 258–260

    Article  PubMed  CAS  Google Scholar 

  5. Bernstein DI, Gallagher JS, Bernstein IL (1984) Prospective evaluation of chymopapain sensitivity in patients undergoing chemonucleolysis. J Allergy Clin Immunol (Suppl) 73:180

    Google Scholar 

  6. Borgo J, Laxenaire MC, Fabre B, Noel F, Manel J, Burdin D (1985) Action de la tritoqualine sur le taux d’histamine du sang total. Ann Fr Anesth Réanim 4: 205–209

    Article  PubMed  CAS  Google Scholar 

  7. Bouillet R (1984) Chimionucléolyse: enquête sur les incidents et complications du traitement de la sciatique par la chymopapaïne (pp 147–157). In: Benoist M and Deburge A (eds) La chimionucléolyse. Hôpital Beaujon, Clichy

    Google Scholar 

  8. Bristow MR, Ginsberg R, Harrison DC (1982) Histamine and the human heart: the other receptor system. Am J Cardiol 49: 249–251

    Article  PubMed  CAS  Google Scholar 

  9. Bruno LA, Smith DS, Bloom MJ, Domino K, Bagshaw RJ, Star SM, Cohen AM, Lupo SE (1984) Sudden hypotension with a test dose of chymopapain. Anesth Analg (Cleve) 63: 533–535

    CAS  Google Scholar 

  10. Capurro N, Levi R (1975) The heart as a target organ in systemic allergic reactions. Comparison of cardiac anaphylaxis in vivo and in vitro. Circ Res 36: 520–528

    PubMed  CAS  Google Scholar 

  11. Chymodiactin post-marketing surveillance data. Interim report, Feb 14th 1985, Smith Laboratories, Northbrook, Illinois 60062

    Google Scholar 

  12. Cogen MD, Goldstein M, Zweiman B (1984) Skin tests in chymopapain anaphylaxis. J Allergy Clin Immunol (suppl) 73:179

    Google Scholar 

  13. Di Maio VJM (1976) Two anaphylactic deaths after chemonucleolysis. J Forensic Sci 21:187–190

    Google Scholar 

  14. Ezra D, Boyd LM, Feuerstein G, Goldstein RE (1983) Coronary constriction by leukotriene C4, D4 and E4 in the intact pig heart. Am J Cardiol 51:1451–1454

    Article  PubMed  CAS  Google Scholar 

  15. Garvin PJ, Jennings RB, Smith L, Gesler RM (1965) Chymopapain: pharmacologic and toxicologic evaluation in experimental animals. Clin Orthop 42: 204–222

    Google Scholar 

  16. Grammer LC, Ricketti AJ, Schafer MF, Patterson R (1984) Chymopapain allergy: case reports and identification of patients at risk for chymopapain anaphylaxis. Clin Orthop 188:139–143

    PubMed  Google Scholar 

  17. Grilliat JP, Moneret-Vautrin DA (1977) Traitement du choc anaphylactique. Rev Prat 27: 4099–4110

    PubMed  CAS  Google Scholar 

  18. Hall BD, McCulloch JA (1983) Anaphylactic reactions following the intradiscal injection of chymopapain under local anesthesia. J Bone Joint Surg 65 A: 1215–1219

    Google Scholar 

  19. Hamberger B, Fredholm BB, Farnebo LO (1980) Anaphylaxis and plasma catecholamines. Life Sci 26: 1465–1471

    Article  PubMed  CAS  Google Scholar 

  20. Hannaway PJ, Hopper GDK (1983) Severe anaphylaxis and drug-induced beta-blockade. N Engl J Med 308:1536

    PubMed  CAS  Google Scholar 

  21. Haverly RW, Manfield LE, Ting S (1984) The incidence of hypersensitivity to papain in an allergic population confirmed by blinded food challenges. J Allergy Clin Immunol (suppl) 73:179

    Google Scholar 

  22. Ishizaka T, Conrad DH (1983) Binding characteristics of human IgE receptors and initial triggering events in human mast cell for histamine release. Monogr Allergy, Karger, Basel 18:14–24

    CAS  Google Scholar 

  23. Jacobs RL, Rake GW, Fournier DC, Chilton RJ, Culver WG, Beckmann CH (1981) Potentiated anaphylaxis in patients with drug-induced beta-adrenergic blockade. J Allergy Clin Immunol 68:125–127

    Article  PubMed  CAS  Google Scholar 

  24. Jacobs DM, Lipton MH, Russell SM (1984) Anaphylactic reactions following intradiscal injection of chymopapain under local anesthesia. J Bone Joint Surg 66: 806–807

    PubMed  CAS  Google Scholar 

  25. Kahn M, Clement Ph, Charriaud A, Jorrot Cl (1983) L’anesthésie au cours des chimionucléolyses pour hernies discales. Cah Anesthésiol 31: 301–302

    Google Scholar 

  26. Kapsalis AA, Stern IJ, Bornstein I (1978) Correlation between hypersensitivity to parenteral chymopapain and the presence of IgE anti-chymopapain antibody. Clin Exp Immunol 33:150–158

    PubMed  CAS  Google Scholar 

  27. Lasser EC, Lang JH, Lyon SG, Hamblin AE (1979) Complement and contrast material reactors. J Allergy Clin Immunol 64:105–112

    Article  PubMed  CAS  Google Scholar 

  28. Laxenaire MC, Moneret-Vautrin DA, Sigiel M (1979) Allergie et anesthésie. Encycl Méd Chirurg, Paris, Anesth-Réanim, 36655 A 10,11

    Google Scholar 

  29. Laxenaire MC, Torrens J, Moneret-Vautrin DA (1984) Choc anaphylactoïde mortel chez un malade traité par bêta-bloquants. Ann Fr Anesth Réanim 3: 453–455

    Article  PubMed  CAS  Google Scholar 

  30. Laxenaire MC, Moneret-Vautrin DA, Vervloët D (1985) The French experience of anaphylactoid reactions. In: Sage D (ed) International Anesthesiology Clinics, vol 23: Anaphylactoid reactions in anesthesia. Little Brown, Boston

    Google Scholar 

  31. Levi R, Burke JA (1980) Cardiac anaphylaxis: SRS-A potentiates and extends the effects of released histamine. Eur J Pharmacol 62: 41–49

    Article  PubMed  CAS  Google Scholar 

  32. Levi R, Chenouda AA, Trzeciakowski JP, Guo ZG, Aaronson LM, Luskind RD, Lee CH, Gay WA, Subramanian VA, McCabe JC, Alexander JC (1982) Dysrhythmias caused by histamine release in guinea pig and human hearts. Klin Wochenschr 60: 965–971

    Article  PubMed  CAS  Google Scholar 

  33. Levi R, Owen DAA, Trzeciakowski J (1982) Actions of histamine on the heart and vasculature (pp 236–297). In: Ganelin CR and Parsons ME (eds) Pharmacology of histamine receptors. Wright PSG, Massachusetts

    Google Scholar 

  34. Levy JH (1985) Anaphylaxis to chymopapain after antihistamine pretreatment. Anesth Analg (Cleve) 64: 90

    Article  CAS  Google Scholar 

  35. Lichtenstein LM, Gillespie E (1975) The effects of the H1 and H2 antihistamine release and its inhibition by histamine. J Pharmacol Exp Thér 192: 441–450

    PubMed  CAS  Google Scholar 

  36. Lorenz W, Doenicke A, Shôning B, Mamorski J, Weber D, Hinterlang E, Schwarz B, Neugebauer E (1980) Histamine release: H1 + H2-receptor antagonists for premedication in anaesthesia and surgery: a critical view based on randomized clinical trials with Haemaccel and various antiallergic drugs. Agents Actions 10:114–124

    Article  PubMed  CAS  Google Scholar 

  37. Manchikanti L, Krauss JWK, Edds SP (1982) Cimetidine and related drugs in anaesthesia. Anesth Analg (Cleve) 61:595–608

    CAS  Google Scholar 

  38. McCulloch JA(1977) Chemonucleolysis. J Bone Joint Surg 59: 45–52

    CAS  Google Scholar 

  39. McManus LM, Hanahan DJ, Demopoulos CA, Pinckard RN (1980) Pathobiology of the intravenous infusion of acetyl glyceryl ether phosphorylcholine (AGEPC), a synthetic platelet-activating factor (PAF) in the rabbit. J Immunol 124: 2919–2924

    Google Scholar 

  40. Menkes CJ, Feldmann JL, Ben Sedrine H, Amor B, Chevrot A, Horreard P, Zenny JC, Pallardy J (1982) Traitement des hernies discales lombaires par chimionucléolyse. Rev Rhumatol 49: 621–628

    CAS  Google Scholar 

  41. Milne J, Brand S (1975) Occupational asthma after inhalation of dust of the proteolytic enzyme papain. B J Int Med 32: 302

    CAS  Google Scholar 

  42. Moneret-Vautrin DA, Laxenaire MC, Mouton C, Widmer S, Pupil P (1985) Modification de la réactivité cutanée dans I’anaphylaxie aux myorelaxants et hypnotiques après l’administration d’anti H1, d’anti H2 et de tritoqualine. Ann Fr Anesth Réanim 4: 225–230

    Article  PubMed  CAS  Google Scholar 

  43. Moneret-Vautrin DA, Benoist M, Laxenaire MC, Croizier A, Gueant JL (1985) Allergie à la chymopa- païne: intérêt de tests prédictifs avant chimionucléolyse. Ann Fr Anesth Réanim 4: 313–315

    Article  PubMed  CAS  Google Scholar 

  44. Moss J, Fahmy NR, Sunder N, Beaven MA (1981) Hormonal and hemodynamic profile of an anaphylactic reaction in man. Circulation 63: 210–213

    Article  PubMed  CAS  Google Scholar 

  45. Moss J (1985) Use of prophylactic combined H-j and H2 antagonists reduces mortality in chymopapain anaphylaxis. Ann Fr Anesth Réanim 4: 221–224

    Article  PubMed  CAS  Google Scholar 

  46. Noury D, Lavenac G, Milon D, Sauvage J, Bodin JM, Saint-Marc C (1984) Neuroleptanalgésie pour la nucléolyse chimique. Cah Anesthésiol 32: 397–401

    PubMed  CAS  Google Scholar 

  47. Osgood H (1945) A topic sensitivity to caroid (papaya). J Allergy 16: 245

    Article  Google Scholar 

  48. Paton W DM (1957) Histamine release by compounds of simple chemical structure. Pharmacol Rev 9: 269–280

    PubMed  CAS  Google Scholar 

  49. Pavek K, Wegmann A, Nordstrom L, Schwander D (1982) Cardiovascular and respiratory mechanisms in anaphylactic and anaphylactoid shock reactions. Klin Wochenschr 60: 941–946

    Article  PubMed  CAS  Google Scholar 

  50. Philbin DM, Moss J, Akins CW, Rosow CE, Kono K, Schneider RC, Verlee TR, Savarese JJ (1981) The use of Hi and H2 histamine antagonists with morphine anesthesia: a double blind study. Anesthesiology 55: 292–296

    Article  PubMed  CAS  Google Scholar 

  51. Product license (1979) Travenol Thetford Norfolk

    Google Scholar 

  52. Rajagopalan R, Tindal S, MacNab I (1974) Anaphylactic reactions to chymopapain during general anesthesia: a case report. Anesth Anaig (Cleve) 53:191–193

    CAS  Google Scholar 

  53. Schäffer J, Piepenbrock S (1984) Chemonucleolysis. General or local anesthesia. Br J Anaesth 56: 1306 P

    Google Scholar 

  54. Steib A, Cinqualbre M, Maitrot D, Prévost C (1984) Accident anaphylactoïde après injection intradiscale de chymopapaïne: conduite pratique. J Méd Strasbourg 15: 77–79

    Google Scholar 

  55. Stevenson DD, Simon RA (1981) Sensitivity to ingested metabisulfites in asthmatic subjects. J Allergy Clin Immunol 68: 26–32

    Article  PubMed  CAS  Google Scholar 

  56. Ting S, Rauls DO, Reiman BEF (1985) Inhibitory effect of hydroxyzine on antigen-induced histamine release in vivo. J Allergy Clin Immunol 75: 63–66

    Article  PubMed  CAS  Google Scholar 

  57. Troisier O (1984) Technique de la nucléolyse de l’hôpital Foch, après 8 ans de recul avec mention spéciale pour l’implantation des aiguilles et de l’analgésie (pp 87–105). In: Benoist M and Deburge A (eds) La chimionucléolyse. Hôpital Beaujon-CIichy

    Google Scholar 

  58. Tsay YG, Jones R, Calenoff E, Sun J, Arndt L, Crispin B, McDermott D, Stern L (1984) Chymopapain-in- duced hypersensitivity following chemonucleolysis. Spine 9: 769–771

    Article  PubMed  CAS  Google Scholar 

  59. Tsay YG, Jones R, Calenoff E, Sun J, Arndt L, Crispin B, Rock H (1984) A preoperative chymopapain sensitivity test for chemonucleolysis candidate. Spine 9: 764–768

    Article  PubMed  CAS  Google Scholar 

  60. Twarog FJ, Leung DY (1982) Anaphylaxis to a component of soetharine (sodium bisulfite). J Am Med Assoc 248: 2030–2031

    Article  CAS  Google Scholar 

  61. Watts C, Williams OB, Goldstein G (1976) Sensitivity reactions to intradiscal injection of chymopapain during general anesthesia. Anesthesiology 44: 437–439

    Article  PubMed  CAS  Google Scholar 

  62. Watts C (1977) Complications of the chemonucleolysis for lumbar disc disease. Neurosurgery 1: 2–5

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1986 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Laxenaire, M.C., Monneret-Vautrain, D.A. (1986). Anaphylactic Accidents Related to Chymopapain: Prevention and Treatment. In: Bonneville, JF. (eds) Focus on Chemonucleolysis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-71182-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-71182-4_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-71184-8

  • Online ISBN: 978-3-642-71182-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics