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Incidence and risk factors for latent sensitization to chymopapain: predictive skin‐prick tests in 700 candidates for chemonucleolysis
Author(s) -
MONERETVAUTRIN D. A.,
FELDMANN L.,
KANNY G.,
BAUMANN A.,
ROLAND J.,
PERE P.
Publication year - 1994
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/j.1365-2222.1994.tb00936.x
Subject(s) - chymopapain , medicine , incidence (geometry) , sensitization , dermatology , predictive value , immunology , surgery , physics , optics
. Seven hundred patients were investigated prospectively before undergoing chemonucleolysis. A past history of allergy and/or previous exposure to papain, either in food, beverages or drugs, was sought, and a skin‐prick test with chymopapain was performed. Based on the results obtained, the subjects were classified into four groups: Group I– 225 non‐atopic non‐papain‐exposed subjects; Group II–285 non‐atopic papain‐exposed subjects; Group III–69 atopic non‐papain‐exposed subjects; and Group IV– 121 atopic papain‐exposed subjects. Latent sensitization to papain was observed in 0.4% of subjects in Group I, 3.16% in Group II, 5.8% in Group III and 7.4% in Group IV. The odds ratios were 13.8 for atopy and 7.3 for exposure to papain. Interaction between atopy and papain exposure did not result in a significantly greater risk. Neither sex nor age nor a history of a previous drug reaction were risk factors. Only one patient out of the 23 who were sensitive to papain had no risk factor. The 677 skin‐test negative patients then underwent chemonucleolysis and none of them had an anaphylactic reaction. This was significantly less frequent: ( P = 0‐04) than the incidence in a random population (0.45%). Prick tests performed 6 weeks and 6 months after chemonucleolysis revealed newly acquired sensitization in 36% of the patients. Atopy was not a risk factor for this event. Three points are discussed: (i) the negative predictive value of skin‐prick tests with chymopapain is confirmed; (ii) subjects likely to be sensitized are atopic and/or have been exposed previously to food or drugs containing papain and therefore they can be identified pre‐operatively by a questionnaire; (iii) atopy is a risk factor for the induction of specific IgE to allergens internalized via a mucosal surface but not for those that are injected parenterally.