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April 20, 1984

Anaphylaxis From Chymopapain-Reply

Author Affiliations


JAMA. 1984;251(15):1953-1954. doi:10.1001/jama.1984.03340390017014

In Reply.—  It is reassuring to learn that commercial postmarketing surveillance of the chemonucleolysis procedure by company officials of Smith Laboratories, up to Aug 29, 1983, did not reveal additional mortality in 18,323 patients. Presumably, the anaphylactic death cited by these respondents occurred some time after August. However, their updated information also indicates that the current incidence (0.7%) of chymopapain-induced "significant allergic reactions" has not decreased as dramatically as the mortality experience. It would, therefore, be appropriate to assess how many of these "significant allergic reactions" were "near misses" with respect to fatal outcome and how therapeutic rescue was accomplished in the potentially lethal cases. Such information would be particularly germane inasmuch as their letter implies that anaphylaxis can be prevented or attenuated by preoperative use of H1- and H2-receptor blockers, 100% oxygen, and a test dose of 0.2 to 0.3 mL before the therapeutic intradiskal injection.