Enzymes and enzyme inhibitors

Abstract

Publisher Summary This chapter discusses enzymes and enzyme inhibitors. The use of chymopapain for the enzymatic dissolution of herniated lumbar disks (chemonucleolysis) is rapidly increasing. The drug is marketed as Chymodiactin by Smith Laboratories and as Discase by Travenol Laboratories. As a foreign protein, chymopapain is very immunogenic and special measures must be taken to prevent and combat anaphylactic reactions, which occur in about 0. 7% of treated patients. Much research has been done on the pathogenesis, recognition, and prevention of chymopapain allergy. This has resulted in a number of published studies and the development of various tests. The skin prick test is a simple and low-cost procedure with a good predictive value, as none of the patients with a negative test in the 3 cited studies developed an anaphylactic reaction during chemonucleolysis. As yet there is no indication that the test itself will sensitize patients to chymopapain. In the only comparative study of the skin prick and RAST tests , the 3 patients who had a positive skin prick test (and thus were presumably hypersensitive to chymopapain), were not detected by the RAST test. No comparative study between the ChymoFAST and skin prick tests has yet been published. On the basis of the above results, skin prick testing with chymopapain can be recommended for patients in whom chemonucleolysis is considered. These studies further demonstrate that the injection of chymopapain leads to sensitization in a high percentage of patients, as shown by positive skin prick tests and RAST tests.