Prevention of chymopapain anaphylaxis by screening chemonucleolysis candidates with cutaneous chymopapain testing. A preliminary report

L. C. Grammer, M. Schafer, D. Bernstein, J. Dolovich, M. Schatz, R. Zeiger, F. Cogen, J. J. Shaughnessy, M. J. Chandler

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)202-206
Number of pages5
JournalClinical orthopaedics and related research
VolumeNo. 221
StatePublished - 1987

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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