Bernstein D I, Gallagher J S, Ulmer A, Bernstein I L
J Allergy Clin Immunol. 1985 Sep;76(3):458-65. doi: 10.1016/0091-6749(85)90727-4.
Immediate anaphylactic reactions after intradiscal chymopapain (CP) injection may occur in 1% of patients undergoing chemonucleolysis (CN). Skin prick testing to CP (10 mg/ml), a prescreening history, and CP serum-specific IgE determinations by the RAST method were performed in order to identify patients presensitized to CP before CN. Follow-up repeat CP skin testing and serum-specific IgE were done 2 to 6 weeks after CN to detect CP IgE-mediated sensitization resulting from the injection. Three of 84 patients who exhibited positive skin tests to CP before CN did not receive CP injections. Only one of the three patients (33%) was detected with elevated CP serum-specific IgE before CN. No immediate severe anaphylactic reactions caused by CP injection were encountered in the remaining 81 patients with negative CP skin tests and RASTs before CN. Eight (10%) nonlife-threatening immediate and late reactions were associated with conversion from negative skin tests and RASTs before CN to positive skin tests or RASTs after CN. Overall, 19 of 52 (37%) patients who returned for follow-up testing developed cutaneous sensitization to CP after CN. Despite the fact that RAST values after CN in these patients were significantly higher (p less than 0.002) than those with negative skin tests after CN, the sensitivity of the RAST was only 72% for identifying patients who developed positive CP skin tests after CN. This study demonstrated that CP skin testing is essential for prescreening patients because it was more sensitive than RAST for identification of CP sensitivity both before and after CN. Late allergic reactions and cutaneous sensitization to CP were common sequelae of CN.
在接受化学溶核术（CN）的患者中，1%可能会在椎间盘内注射木瓜凝乳蛋白酶（CP）后立即发生过敏反应。为了在CN术前识别对CP预先致敏的患者，对CP（10mg/ml）进行了皮肤点刺试验、询问筛查病史，并采用放射变应原吸附试验（RAST）方法测定CP血清特异性IgE。在CN术后2至6周进行随访重复CP皮肤试验和血清特异性IgE检测，以检测因注射导致的CP IgE介导的致敏情况。84例在CN术前CP皮肤试验呈阳性的患者中有3例未接受CP注射。这3例患者中只有1例（33%）在CN术前检测到CP血清特异性IgE升高。其余81例在CN术前CP皮肤试验和RAST均为阴性的患者中，未出现由CP注射引起的立即严重过敏反应。8例（10%）非危及生命的即刻和迟发反应与CN术前皮肤试验和RAST阴性转变为术后阳性有关。总体而言，在52例返回进行随访检测的患者中，有19例（37%）在CN术后出现了对CP的皮肤致敏。尽管这些患者在CN术后的RAST值显著高于术后皮肤试验阴性的患者（p<0.002），但RAST识别CN术后CP皮肤试验转为阳性患者的敏感性仅为72%。这项研究表明，CP皮肤试验对于患者的术前筛查至关重要，因为在CN术前和术后识别CP敏感性方面，它比RAST更敏感。迟发性过敏反应和对CP的皮肤致敏是CN常见的后遗症。
