Proteolytic enzymes have analgesic effects in addition to their well-recognized antiinflammatory and antiedemic properties. Enzyme-derived analgesia is based on inhibition of the inflammatory cascade as well as exerting a direct influence on nociceptors.3 Bromelain (pineapple; Ananas comosus) is used orally to treat acute swelling and inflammation following trauma. Bromelain is a grouping of proteolytic enzymes obtained from the stem and fruit of pineapple.4 Bromelain is thought to exert its anti-inflammatory effect by altering leukocyte migration and activation. Other mechanisms of action include proteolysis at point of inflammation, fibrinolysis via the plasminogen-plasmin system, depletion of kininogen, inhibition of inflammatory prostaglandins, and induction of prostaglandin E1 (an anti-inflammatory prostaglandin). Side effects of taking bromelain may include GI upset with diarrhea. Immunoglobulin E (IgE)-mediated allergic reactions are possible but this has not yet been widely documented.5
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