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February 16, 1990


Author Affiliations

The Boots Company (USA) Inc Lincolnshire, Ill

The Boots Company (USA) Inc Lincolnshire, Ill

JAMA. 1990;263(7):948. doi:10.1001/jama.1990.03440070034021

To the Editor.—  The Diagnostic and Therapeutic Technology Assessment (DATTA) article on chemonucleolysis1 contains significant omissions and inaccuracies. For example, anaphylaxis is an important adverse effect of chemonucleolysis but its incidence is exaggerated. Postmarketing surveillance carried out by the manufacturers between 1982 and 1988 shows an overall incidence of 0.46%, but during 1987 and 1988 it was only 0.18%. A recent panEuropean survey of chemonucleolysis has suggested a similar rate of anaphylaxis at 0.2%.2 Also, while postmarketing surveillance suggests that anaphylaxis occurs more frequently in females (0.68%) than in males (0.18%), this difference is not as great as that (6- to 10-fold) suggested in the article. It is stated in the DATTA article that the dose of chymopapain to be used is between 1000 and 6000 U, whereas only 2000 to 4000 pKat is recommended for treatment of a single disk.Much space is taken up with summarizing