Mayer H M, Wehr M, Brock M, Kaden B
Surg Neurol. 1986 Mar;25(3):283-9. doi: 10.1016/0090-3019(86)90241-7.
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.
用木瓜凝乳蛋白酶（Chymodiactin、Discase）进行化学溶核术有发生不可预测的过敏反应的风险。据报道过敏反应发生率在0.35%至1.5%之间。血清学体外试验如RAST（放射变应原吸附试验）或ChymoFAST（荧光变应原吸附试验）用于确定接受化学溶核术患者中针对木瓜凝乳蛋白酶的特异性免疫球蛋白E抗体滴度升高情况。另外，皮肤点刺试验也已应用于临床试验。一项包括Discase、Chymodiactin和Solutrast 250 M（一种不透射线染料）的皮肤点刺试验共对257例患者进行；222例患者在化学溶核术前进行检测，35例患者在木瓜凝乳蛋白酶化学溶核术后进行检测。在化学溶核术前检测的组中，2.3% - 3.3%的患者皮肤试验呈阳性。化学溶核术后，对木瓜凝乳蛋白酶的总体过敏率升至42.9%。阳性皮肤反应似乎与时间有关——在化学溶核术后第3周至第12周之间，超过70%的患者皮肤试验呈阳性。既往过敏史与皮肤试验结果之间无相关性。皮肤试验呈阳性的患者应排除在化学溶核术之外。这一程序提高了接受化学溶核术患者的安全性。迄今为止，在超过350例皮肤点刺试验阴性后接受椎间盘内注射木瓜凝乳蛋白酶治疗的患者中未观察到过敏反应。
