García-Ortega P, Ramírez Ferreiras W, Sancho A, Urías S, Cisteró A
Unidad de Alergia, Servico de Medicina Interna, Hospital Joan XXIII, Tarragona.
Med Clin (Barc). 1991 Mar 23;96(11):410-2.
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.
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.
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.
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.
化学髓核溶解术（椎间盘内注射木瓜凝乳蛋白酶）是一种治疗椎间盘突出症的方法。近来，由于对木瓜凝乳蛋白酶敏感的患者会发生过敏反应，该方法的应用受到质疑。在化学髓核溶解术前和术后评估了对木瓜凝乳蛋白酶敏感的发生率，并评估了通过过敏史确定危险人群的可能性。
对104例连续的化学髓核溶解术候选患者进行了过敏问卷调查、针对气传变应原和木瓜凝乳蛋白酶的皮肤试验以及木瓜凝乳蛋白酶特异性IgE检测。后两项检测在化学髓核溶解术后1个月重复进行。
仅2例患者（1.9%）在术前显示有木瓜凝乳蛋白酶敏感的证据。16例患者（16%）在化学髓核溶解术后出现敏感。过敏问卷调查中评估的所有可能危险因素（特应性、药物过敏、木瓜职业暴露或使用含木瓜蛋白酶的添加剂、化妆品或药物）均与木瓜凝乳蛋白酶敏感风险无显著相关性。
研究组中木瓜凝乳蛋白酶敏感的发生率较低。过敏问卷调查（特应性、药物过敏、木瓜使用情况、职业史）未识别出敏感患者。皮肤试验和特异性IgE是检测木瓜凝乳蛋白酶敏感的最佳方法。化学髓核溶解术后显著的敏感率可能会部分限制该方法的实用性。
