Substances Included Synonyms

Therapeutic Toxic Class

A)

Specific Substances

1) Bromelain
2) Ananase
3) Bromelin
4) Extranase
5) Inflamen
6) Traumanase

Available Forms Sources

A)

1) Bromelain is a complex of sulfhydryl-containing proteolytic enzymes obtained from the stem of the pineapple plant (Ananas comosus). It is found in both the stem and the fruit.

B)

1) FOLK MEDICINE: Pinapple juice has been used against quinsy, as a digestive aid, and externally against horny skin (Lotz-Winter, 1990).
2) CURRENT RECOMMENDATIONS: Treatment for inflammation associated with edema, inflammation of the respiratory tract, inflammations of the circulation such as venous ulcers or thrombophebitis, and to enhance the activity of certain antibiotics (Lotz-Winter, 1990).

Overview

Life Support

A)

Clinical Effects

0.2.1)

A) Bromelain is being investigated for its keratolytic, hematologic, and antiedema properties in animals. When given orally, there are minimal effects. Possible gastritis and a few dermatologic effects due to its proteolytic nature have been noted.
B) Ingestions should not be treated aggressively.

0.2.5)

A) Mild hypotension and bradycardia were seen in dogs when bromelain was injected rapidly, but not slowly. These effects have not been seen in humans.

0.2.6)

A) Asthma has been reported following occupational exposure to bromelain.

0.2.8)

A) Mild gastritis or oral irritation may occur after ingestion of bromelain.

0.2.14)

A) Keratolytic effects may occur with chronic handling of plants containing bromelain. The enzyme has been used to remove horny epidermis.

0.2.19)

A) Sensitization has occurred in animals injected with bromelain.

0.2.20)

A) At the time of this review, no data were available to assess the potential effects of exposure to this agent during pregnancy or lactation.

0.2.21)

A) At the time of this review, no data were available to assess the carcinogenic potential of this agent.

Laboratory Monitoring

A)

Treatment Overview

0.4.2)

A) Ingestion of bromelain is minimally toxic, usually producing only mild gastritis. Gastric evacuation/decontamination would usually not be necessary, unless large amounts of actual bromelain were to be ingested. No specific toxic dose has been established in humans.
B) EMESIS - Is generally not necessary.
C) ACTIVATED CHARCOAL - Is generally not necessary.
D) Treatment is symptomatic and supportive.

0.4.4)

A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.

0.4.5)

A) OVERVIEW

1) DECONTAMINATION: Remove contaminated clothing and jewelry and irrigate exposed areas with copious amounts of water. A physician may need to examine the area if irritation or pain persists.

Range Of Toxicity

A)

Clinical Effects

Summary Of Exposure

A)

B)

Cardiovascular

3.5.1)

A) Mild hypotension and bradycardia were seen in dogs when bromelain was injected rapidly, but not slowly. These effects have not been seen in humans.

3.5.3)

A) ANIMAL STUDIES

1) HYPOTENSION

a) When injected rapidly, hypotension (a drop of 30 to 40 mmHg) and a reduction in heart rate of 22 to 26 beats per minute were seen in anesthetized dogs (Neiper, 1976). These effects did not occur when bromelain was injected slowly.

Respiratory

3.6.1)

A) Asthma has been reported following occupational exposure to bromelain.

3.6.2)

A) ASTHMA

1) Occupational exposure to bromelain has resulted in allergic reactions including asthma. In one case series, 4 patients developed bronchial asthma or wheezing in addition to symptoms such as rhinitis, eye irritation, and difficulty swallowing after handling bromelain. Skin prick tests done in 3 patients were positive. In another case, a 58-year-old female developed asthma and rhinitis after handling bromelain in a pharmaceutical plant, with RAST and skin prick tests showing positive reactions (Baur & Fruhmann, 1979; Gailhofer et al, 1988).

Gastrointestinal

3.8.1)

A) Mild gastritis or oral irritation may occur after ingestion of bromelain.

3.8.2)

A) GASTROINTESTINAL IRRITATION

1) Oral irritation, including a burning sensation of the mouth and lips may occur when eating bromelain containing fruit (Watt & Breyer-Brandwijmk, 1962).

Dermatologic

3.14.1)

A) Keratolytic effects may occur with chronic handling of plants containing bromelain. The enzyme has been used to remove horny epidermis.

3.14.2)

A) DISORDER OF SKIN

1) Workers who are exposed to the keratolytic effects of bromelain while picking pineapples had the stratum corneum of the fingers removed, resulting in the obliteration of fingerprints (Mitchell & Rook, 1979).

Immunologic

3.19.1)

A) Sensitization has occurred in animals injected with bromelain.

3.19.3)

A) ANIMAL STUDIES

1) ALLERGIC REACTION

a) Injection of bromelain produced sensitization in animals (Lotz-Winter, 1990).

Reproductive

3.20.1)

A) At the time of this review, no data were available to assess the potential effects of exposure to this agent during pregnancy or lactation.

3.20.2)

A) LACK OF INFORMATION

1) At the time of this review, no data were available to assess the teratogenic potential of this agent.

3.20.3)

A) LACK OF INFORMATION

1) At the time of this review, no data were available to assess the potential effects of exposure to this agent during pregnancy or lactation.

Carcinogenicity

3.21.2)

A) At the time of this review, no data were available to assess the carcinogenic potential of this agent.

3.21.3)

A) LACK OF INFORMATION

1) At the time of this review, no data were available to assess the carcinogenic or mutagenic potential of this agent.

Laboratory Monitoring

Monitoring Parameters Levels

4.1.1)

A) No specific measures are indicated after ingestion.

4.1.2)

A) OTHER

1) No specific laboratory measures are indicated.

Treatment

Life Support

A)

Monitoring

A)

Oral Exposure

6.5.2)

A) EMESIS

1) Is generally not required due to low oral toxicity.

B) ACTIVATED CHARCOAL

1) Is generally not required due to low oral toxicity.

6.5.3)

A) SUPPORT

1) Bromelain has not been shown to be significantly toxic orally. The potential gastritis can be handled with supportive care.

Eye Exposure

6.8.1)

A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).

Dermal Exposure

6.9.1)

A) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

Abstracts

Range Of Toxicity

Summary

A)

Therapeutic Dose

7.2.1)

A) GENERAL

1) HUMAN DATA -

a) Therapeutic benefits of bromelain have been observed with 160 milligrams daily, with best results occurring at 750 to 1000 milligrams daily (Anon, 1998).

Maximum Tolerated Exposure

A)

1) RATS - Chronic administration of 1 percent bromelain in the food of rats produced no significant changes (Lotz-Winter, 1990).
2) DOGS - Chronic administration of increasing levels of bromelain to dogs (up to 750 mg/kg daily) did not show any signs of toxic effects after 6 months (Anon, 1998). .

Toxicity Information

7.7.1)

A) LD50- (INTRAPERITONEAL)MOUSE:

1) 36.7 mg/kg (Batkin et al, 1988)

B) LD50- (ORAL)MOUSE:

1) > 10 g/kg (Batkin et al, 1988)

C) LD50- (INTRAPERITONEAL)RAT:

1) 85.2 mg/kg (Batkin et al, 1988)

D) LD50- (ORAL)RAT:

1) > 10 g/kg (Batkin et al, 1988)

Pharmacology Toxicology

Pharmacologic Mechanism

A)

B)

C)

D)

1) Reduction of capillary permeability is due to tissue kininogenins (DiRosa et al, 1971), and reduction of lung and bronchial edema are due to irritants (DiRosa et al, 1971) Suda et al, 1984).

E)

F)

1) Platelet aggregation inhibition
2) Increased prothrombin time
3) Increased antithrombin levels
4) Increased plasmin level

G)

1) Inhibition or degradation of bradykinin (Anon, 1998; Suda et al, 1984; Shigei et al, 1967).
2) Effects prostoglandin synthesis (Vellini et al, 1986).

Physicochemical

Physical Characteristics

A)

Molecular Weight

A)

Animal Toxicology

References

General Bibliography

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FeedBack

BROMELAIN

Classification | Detailed evidence-based information

Therapeutic Toxic Class

Specific Substances

Available Forms Sources

Life Support

Clinical Effects

Laboratory Monitoring

Treatment Overview

Range Of Toxicity

Summary Of Exposure

Cardiovascular

Respiratory

Gastrointestinal

Dermatologic

Immunologic

Reproductive

Carcinogenicity

Monitoring Parameters Levels

Life Support

Monitoring

Oral Exposure

Eye Exposure

Dermal Exposure

Summary

Therapeutic Dose

Maximum Tolerated Exposure

Toxicity Information

Pharmacologic Mechanism

Physical Characteristics

Molecular Weight

General Bibliography