Local ocular anaphylaxis to papain enzyme contained in a contact lens cleansing solution

This is a case report of a patient who developed IgE-mediated sensitization and subsequently ocular angioedema and conjunctivitis from papain contained in a commercial contact lens cleansing solution. Serum-specific IgE and positive cutaneous prick tests to papain and chymopapain were detected. When the lens solution containing papain was stopped, there was resolution of her allergic symptoms. Recognition of this route of papain-induced sensitization may be important in those patients undergoing chemonucleolysis with chymopapain who may be at greater risk to develop a systemic allergic reaction after injection of this enzyme.