Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P052: EARLY EXPERIENCE WITH MESH ALLERGY TESTING
Negin Fadaee, BS1; Desmond Huynh, MD2; Isabel Capati, RN, BSN1; Shirin Towfigh, MD1; 1Beverly Hills Hernia Center; 2Cedars-Sinai Medical Center
INTRODUCTION: A subset of patients undergoing hernia repair will have a systemic reaction to their mesh materials. Preoperative mesh allergy testing may affect operative planning in patients with mesh reaction or at risk for reaction. The aim of this study is to review the validity of skin allergy testing to mesh and its clinical relevance to surgical planning of hernia repairs.
METHODS: Patients clinically suspected of having a systemic mesh reaction underwent skin allergy testing to mesh and sutures as part of their preoperative evaluation. This was performed by a Board certified Allergist/Immunologist. It involved hydration and 72-hour patching of various mesh and suture materials on the patient’s back.
All patients underwent mesh removal. The patients were then followed to determine if their preoperative mesh reaction symptoms resolved. Those with resolution of symptoms were considered to have a confirmed diagnosis of mesh reaction, while those who failed to resolve were considered not to have had a mesh reaction. These outcomes were then compared against findings from the patient’s mesh allergy testing to assess its validity.
RESULTS: Nine patients with implanted mesh were clinically suspected to have mesh reaction after complete surgical consultation, including history, examination, imaging, and blood testing. Skin allergy testing was positive in 4 (44%) and negative in 3 (33%) patients. Two (22%) patients could not tolerate completing the test, and their partial results were considered negative.
After undergoing mesh removal, 6 (67%) patients experienced resolution of preoperative mesh reaction symptoms. Of these, 4 (67%) had positive skin allergy tests and 2 (33%) were negative. Three (33%) patients failed to resolve their symptoms after mesh removal, and all 3 (100%) had negative skin allergy tests.
Overall, mesh allergy testing was concordant with clinical outcome in 7 (78%) patients. Based on these findings, skin patch testing for mesh reaction demonstrated 67% sensitivity, 100% specificity, 100% PPV, and 60% NPV.
CONCLUSIONS: Though rare, reactions due to mesh do occur. These reactions can be autoimmune or inflammatory in nature, recently dubbed as ASIA (Autoimmune/autoinflammatory Syndrome Induced by Adjuvants). We have no definitive testing yet for mesh reactions. Though skin patch testing for mesh and suture materials can be performed, our results show that it is not reliable as a routine test for mesh reaction, due to its low sensitivity. Perhaps this is because the test only captures Type IV hypersensitivity and thus those with other types of reactions would show a false negative reading. That said, given its high specificity and PPV, a positive skin test may help confirm clinical suspicion for mesh reaction. This may help the surgeon modify their surgical plan and biomaterial selection during hernia repair. In our practice, we do integrate skin testing to a limited group of eligible patients as we are evaluating their post-herniorrhaphy, but we do not rely on the testing and have yet to change our surgical planning based on the test results alone.
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