Q:

7/25/2012
I was recently consulted by an urologist for a patient with possible polypropylene allergy. Patient had polypropylene mash for bladder suspension, had poor wound healing and uricaria. Mash was removed with good wound healing. I can do patch testing but wouldn’t lymphphocyte proliferation be more informative? Would like to have your input.

A:

Thank you for your inquiry.

We have dealt with a very similar question regarding a possible allergic reaction to polypropylene mesh. For your convenience, I have copied the previous question and our response below which was posted on 4/25/2012.

Unfortunately, I could find no additional studies in the literature since that response was posted. As you can see from our answer to the previous inquiry, there is a dearth of scientific literature in this area. I could find nothing on lymphocyte transformation testing to polypropylene mesh that I felt would be helpful, and I actually think, should you wish to test, a patch test would be far more appropriate since a lymphocyte transformation assay would indicate only immunologic recognition of this substance, and would not necessarily imply that this reactivity was associated with any adverse response; whereas a positive patch test, especially if you utilize yourself and office personnel and found negative controls, would be far more indicative that the immunologic recognition was associated with an adverse event.

However, I would interpret any testing in this area with caution since, at least according to the review of the literature that I have made, there is no available standardization of testing that has been published allowing one to distinguish normal from sensitized individuals.

Nonetheless, should you wish to evaluate this patient, I believe that a routine patch test would be the most appropriate test, and I would also contact the company who supplied the mesh to see if they had any further information regarding adverse responses to their product as well as any further suggestions for testing. On occasion, such companies do have kits which you can use for patch testing.

Thank you again for your inquiry and we hope this response is helpful to you.

Polypropylene mesh
Question:
4/25/2012
A female pt will have a pinnacle pelvic floor repair with a mesh made of polypropoline. She is concerned about the mesh and would like to be tested prior to the repair. Do you have any literature or knowledge of how to test for this mesh? I have written to the company for a sample or list of ingredients but have not yet heard back. Thanks.

Answer:
As you may well know, the issue of reactions to polypropylene mesh has become a heated topic as of late, and evidently there are a number of legal actions surrounding putative adverse events occurring in women who have received this type of mesh for pelvic floor repairs. In case you were unaware of this, I have copied for you below an example of a legal ad soliciting patients in this regard, and also a link to a lay website describing putative adverse reactions to mesh.

Unfortunately the scientific literature is sparse. There have been rare cases of what appears to be IgE-mediated-like reactions (contact urticaria and a possible systemic reaction) referenced in an abstract copied below, but I am not aware of, and could not find with a literature search, any specific protocol you might use to investigate a potential immunologic mechanism involved in a reaction to this mesh. Normally, in such cases, we do empiric patch testing and request, as you have, information from the company in this regard and a sample of the product to use. However, I have not specifically encountered any putative reaction to polypropylene mesh, and in view of the fact that I have not been able to find a protocol for testing in the literature, could only suggest applying the product to the back as you would a standard patch test. However, as you well know, in the absence of appropriate controls and large numbers of patients, the interpretation of any possible reaction must be guarded.

In summary, unfortunately, I am not aware of any standardized protocol for evaluation of patients with putative reactions to polypropylene mesh used for pelvic repairs, and my only suggestion would be to apply an empiric patch test with the caveat that the interpretation of any results due to the lack of appropriate controls and larger numbers would be difficult.

Thank you again for your inquiry and we hope this response is helpful to you.

Systemic allergic reaction to polypropylene mesh used in surgical treatment of cystocoele. A case report
Artur Matyszewski, Gra¿yna Macio³ek-Blewniewska, Tadeusz Paw³owski, Andrzej Malinowski
Prz Menopauz 2006; 4: 239-243
We report the case of a 38-year-old patient who presented symptoms of severe systemic allergic reaction to polypropylene mesh used in treatment of urinary stress incontinence andcystocoele with central and lateral defect repair using the double TOT approach technique. Disease process, complications, and diagnostic and therapeutic process are described. The patient was discharged from hospital 27 days after the procedure. 10 weeks after surgery a part of the polypropylene mesh was removed because of erosion. The final result of surgical treatment of urinary stress incontinence was very good. The authors are convinced that the "double TOT approach" is a safe and effective technique in the surgical management ofcystocoele. Prolene is a very valuable material for use in surgical practice. The authors also believe that use of obligatory screening tests for hypersensitivity to polypropylene is not economically efficient because that kind of allergy is extremely rare. If the patient's clinical and allergic history is positive for polypropylene, skin patch tests should be conducted before surgery using polypropylene materials.

Suffering In Silence From A Medical Device - Surgical Mesh (Part 4)
Read more: http://news.injuryboard.com/suffering-in-silence-from-a-medical-device---surgical-mesh-part-4.aspx?googleid=262334#ixzz1t51ree3n
Transvaginal Mesh LAWSUIT TRANSVAGINAL MESH LAWSUITS http://www.transvaginalmeshlawsuits.com/bard/pelvitex-polypropylene-mesh/

Contact Dermatitis
Volume 15, Issue 1, page 51, June 1986
Contact urticaria from polypropylene

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology