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Moss Jonathan MD PhD; Roizen, Michael F. MD; Nordby, Eugene J. MD; Thisted, Ronald PhD; Apfelbaum, Jeffrey L. MD; Schreider, Bruce D. MD, PhD; McDermott, Daniel J. PhD
Anesthesia & Analgesia: December 1985

A recognized side effect of chemonucleolysis is life-threatening anaphylaxis to chymopapain. In the clinical trials of chymopapain, 13 cases of anaphylaxis were reported in 1585 administrations (0.82%). Two patients died. Data from a postmarketing survey (48,239 questionnaires) were reviewed to identify factors influencing the incidence and severity of anaphylaxis. The results indicate the incidence of anaphylaxis decreased to 0.44% in the 1983–1984 period (126/23,736), a level significantly (P ≤ 0.001) below the incidence of 0.82% observed in initial clinical trials. Only three deaths from complications related to anaphylaxis occurred in approximately 75,000 administrations (producing 252 anaphylactic episodes) reported since DeceMDer 1982. The prophylactic use of antihistamines and pretreatment with intravenous fluids coincide with the dramatic reduction in mortality due to anaphylaxis. However, overdiagnosis of anaphylaxis in the clinical trials and avoidance of chemonucleolysis in patients with IgE antibodies to chymopapain may account, in part, for the reduction in incidence.

Address correspondence to Dr. Moss, Department of Anesthesia & Critical Care, 5841 S. Maryland Ave., Box 428, University of Chicago's Pritzker School of Medicine, Chicago, IL 60637.

© 1985 International Anesthesia Research Society