Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.22.6 (chymopapain)
 407 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chemonucleolysis and lumbar laminectomy after unsuccessful chemonucleolysis are now common and accepted surgical procedures that require precise perioperative management based on a thorough understanding of the pathophysiology of chymopapain-induced anaphylaxis and the herniating nucleus pulposus syndrome. Preoperative management with appropriate screening tests, antihistamines, and steroids, combined with thoughtful premedication and vigilant monitoring during local or general anesthesia, can provide safe anesthetic management of patients having chemonucleolysis with chymopapain.
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PMID:Anesthetic management of chemonucleolysis with chymopapain. 353 30

The risk of anaphylaxis in candidates for chemonucleolysis for herniated lumbar discs is approximately 1%. An investigation was designed to eliminate or reduce the incidence of chymopapain anaphylaxis. The procedure was to restrict chemonucleolysis to patients who are prick test-negative to chymopapain at a concentration of 10 mg/ml. The authors skin-tested 292 chemonucleolysis candidates; five were positive and 287 were negative. None of the positive patients were injected with chymopapain. There were no instances of unequivocal chymopapain anaphylaxis in the skin test-negative group. This 0% incidence of anaphylaxis in skin test-negative patients was compared with a population estimate of 1%, based on historical data. The resulting value of p = 0.08 value fell short of the conventional level of significance of 0.05. The p value will reach 0.05 when the series of skin test-negative patients without anaphylaxis reaches 360. It is important that this information is readily available to physicians concerned about anaphylactic reactions to chymopapain.
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PMID:Prevention of chymopapain anaphylaxis by screening chemonucleolysis candidates with cutaneous chymopapain testing. A preliminary report. 360 99

In a retrospective study, complications following 157 chemonucleolyses (CNL) with chymopapain in 139 patients wer studied and the kind of pathological changes as found in the operation after CNL compared with those found in patients who were operated on because free sequesters were suspected on discography. The indications for CNL followed the accepted criterion of clinically, neuroradiologically or electromyographically detected alteration of a lumbar nerve root with clinical signs of sciatica. Free sequesters were found at subsequent operation much more often in those cases with primary indications for CNL, which showed signs of sequestration at discography, than in those who had had poor results after CNL. Discography as a means of finding previously undetected free sequesters should not be abandoned. In addition to procedure-related reactions and unspecific complications, as well as immediate or delayed occurrence of severe backache, significant leucocytosis was observed on the first postoperative day. Probably immunological reactions such as severe hypotension after several hours, nausea and vomiting or rise of temperature, also occurred. In ten cases delayed urticarial or large erythematous efflorescences were observed. These reactions do obviously not correspond to the picture of anaphylaxis of the reagine-type such as is mostly described in the mechanism of chymopapain allergy.
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PMID:[Clinical experience with intradisk chymopapain administration in lumbar intervertebral disk displacement]. 362 4

Three hundred fifty-nine patients with herniated nucleus pulposus syndrome were treated by chemonucleolysis with chymopapain. Good to excellent results were achieved in 71% with a minimum of six months follow-up observation. In a group followed for an average of ten years, the result was favorable in 86.6%; 58% of all patients injected had a good to excellent long-term result. Disc space narrowing averaged 2 mm, with no adverse effect on the result. Firm conclusions about the cause of failure of chemonucleolysis could not be drawn. Injection at two levels was recommended when a single offending level could not be identified. There were no cases of anaphylaxis with a premedication regimen of dexamethasone, diphenhydramine, and cimetidine. The procedure was safe and the results were reproducible.
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PMID:Chymopapain in perspective. 370 59

Following the approval in 1982 by the Federal Food and Drug Administration of chymopapain for public use by the medical profession in the treatment of ruptured lumbar intervertebral disk disease, chemonucleolysis has become widespread in the United States; a considerable experience has been obtained in the past 3 years, allowing for an appropriate examination of the original claims for the procedure. Chemonucleolysis is not as efficacious as surgery for simple ruptured lumbar intervertebral disk disease. Whereas the complication rates of chemonucleolysis are probably no greater than that for surgery, the incidence of unpreventable anaphylaxis and other untoward reactions makes it certainly no more safe. There is no biological basis for the belief that chemonucleolysis will result in a shorter convalescence than surgery, and it appears that chemonucleolysis has significantly increased the cost of invasive treatment of patients with ruptured lumbar intervertebral disk disease.
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PMID:Chemonucleolysis: a note of caution. 373 16

A nurse exposed accidentally to chymopapain by ocular exposure was treated vigorously for chymopapain anaphylaxis. Retrospective analysis of the case indicates that there was no evidence of IgE antibody against chymopapain, and the clinical events were inconsistent with anaphylaxis and could be explained by a vasovagal reaction and the cardiorespiratory effects of repeated intravenous epinephrine. Our assessment is that the nurse is currently in a state of good health; however, she did not accept our absence of allergic disease diagnosis and has sought "clinical ecology therapy." Although no litigation in this case has arisen, the legal implications of this case report are reviewed.
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PMID:Iatrogenic pseudoanaphylaxis. 380 43

Chemonucleolysis with Chymopapain (Chymodiactin, Disease) 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 IgE antibody titres against chymopapain in patients submitted to chemonucleolysis for lumbar disc disease. 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 used for discography, has been performed in a total of 208 patients. One-hundred and seventy-seven patients were tested before, 31 patients were tested after chemonucleolysis with chymopapain. From the group tested before chemonucleolysis, 2.3-3.5% had positive skin testes. After chemonucleolysis, the overall allergy rate to chymopapain increased to 41.9%. Positive skin reactions seem to be time-dependent: Between the 3rd and 12th week 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 nearly 350 patients who were treated with the intradiscal injection of chymopapain following a negative skin prick test.
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PMID:[Chymopapain allergy. Diagnostic value of a skin test before and after chemonucleolysis]. 388 96

To extent the safety information for Chymodiactin (chymopapain for injection), 37 neurologic and orthopedic surgeons conducted an open-label, multicenter, phase 3 clinical study. A total of 1,498 patients with one or two herniated lumbar intervertebral discs were enrolled. Therapeutic results were generally favorable, with the percentages of patients achieving either excellent or good (or successful) results ranging from 79.6% to 88.9%, depending on criteria employed in the tabulation. There were 13 cases of anaphylaxis, and 2 of these patients died of complications of anaphylaxis. Two additional patients experienced serious neurologic problems. The first of these two patients developed transverse myelitis and paraplegia approximately 3 weeks following chemonucleolysis. Transdural discograms at three levels had been done approximately 2 days prior to chemonucleolysis, in violation of the protocol. The second patient developed acute cauda equina syndrome, and, despite emergency laminectomy, had permanent neurologic sequelae. Back spasm and stiffness/soreness were the most frequently encountered adverse experiences.
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PMID:Chymodiactin in patients with herniated lumbar intervertebral disc(s). An open-label, multicenter study. 388 87

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.
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PMID:Skin testing for chymopapain allergy in chemonucleolysis. 394 10

Discolysis (chemonucleolysis) with chymopapain, the proteolytic enzyme, is currently being used in the treatment of herniated lumbar discs. Of the patients receiving treatment, approximately 1% experience an anaphylactic reaction. This reaction is thought to be mediated by IgE antibodies to chymopapain. Because of this, it may be possible to predict potential reactors using in vitro testing. In the current study, five out of seven patients who experienced allergic anaphylaxis during discolysis demonstrated high IgE serum levels to chymopapain before treatment.
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PMID:Pretreatment serum levels of IgE to chymopapain in reactive patients. 406 73


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