The pineapple enzyme is believed to inhibit the production of proinflammatory prostaglandins, initiate the production of anti-inflammatory series 1 prostaglandins, and reduce capillary permeability (Med. Hypotheses 1980;6:99–104).
A study of a commercial polyenzyme preparation containing bromelain showed that it induced cytokine production in vitro in peripheral blood mononuclear cells. This capacity to induce cytokine production has been cited as a reason for the antitumor effects of such bromelain-containing enzyme formulations (Oncology 1993;50:403–7).
On the Market
Bromelain has been approved by the German Commission E for postsurgical and/or posttraumatic edema, particularly of the nasal and paranasal sinuses characteristic of some plastic surgery. A patented cutaneous tape containing bromelain is also available in Europe for debriding scar tissue.
Although it is no longer commercially available, Ananase, used for healing wounds and resolving certain hematomas, contained bromelain as the main active ingredient and was included in the Physicians' Desk Reference in the early 1960s. Taken orally 1 hour before or 2 hours after meals, bromelain supplements are absorbed by white blood cells and enhance their enzymatic activity (Dermatol. Ther. 2003;16:106–13).
Bromelain has been known to cause allergic reactions such as asthma, rhinitis, and gastrointestinal symptoms (Clin. Allergy 1979;9:443–50). Such occurrences are rare, however.
The botanical is contraindicated in children, people with allergies to pineapple or bee stings, individuals with a history of heart palpitations, and patients taking blood thinners.
In My Practice
We began using bromelain supplements in our patients about a year ago, with spectacular results. We have them take 500 mg twice a day for 3 days after botulinum toxin injections, dermal fillers, surgeries, or other procedures that may result in bruising. We do not have patients take the supplements prior to the procedure because it seems to increase bruising. (Arnica tablets can be used prior to the procedure.)
I have seen bruising resolve much more rapidly when patients take these supplements. One of my patients had a facelift and ate pineapple three times a day, and her lack of bruising was amazing.
I had a basal cell carcinoma removed from my lid margin, which required a 1-cm-by-7-mm excision. I took bromelain supplements (even though the surgeon told me not to), and he was amazed at my lack of bruising. I have not seen any allergic reactions or complications.
I have not had time to do a formal study of this botanical, but I wanted to share my experience with you. Please send me your recommendations for preventing and treating bruising. I plan to do a future column on bruising and its treatment and prevention. Thanks to you all for your continued letters, suggestions, and input. Keep it coming!
Bromelain, a family of sulfhydryl-containing proteolytic enzymes derived from the stems of pineapples, is used to treat inflammation and soft tissue injuries. Donna Franki/Elsevier Global Medical News