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Rooney G, Cluzeau FA, Daniels D, FitzGerald M, Ahmed-Jushuf I, Radcliffe K, Welch J. Getting the guidance right: optimizing the quality of the UK national guidelines on sexually transmitted infections and closely related conditions. Int J STD AIDS 2004; 15:297-8. [PMID: 15117495 DOI: 10.1177/095646240401500503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Low N, Welch J, Radcliffe K. Developing national outcome standards for the management of gonorrhoea and genital chlamydia in genitourinary medicine clinics. Sex Transm Infect 2004; 80:223-9. [PMID: 15170010 PMCID: PMC1744841 DOI: 10.1136/sti.2003.005165] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Measuring clinical performance within a framework of clinical governance is increasingly important for monitoring improvements in patient care. Standards for quality indicators must, however, be achievable and evidence based. We describe an approach to the development of national standards for measuring outcomes of care for gonorrhoea and genital chlamydia in genitourinary medicine clinics. METHODS Two standards for each infection, one reflecting quality of case management and one reflecting partner management were chosen by consensus. A systematic review of published and unpublished UK studies about gonorrhoea and chlamydia management was carried out and weighted averages calculated for each parameter, stratified by location. Genitourinary medicine practitioners around the country were also asked for their opinion about desirable values for each standard and the results compared. Variability in performance between centres was examined using Shewhart's control charts. RESULTS We identified 17 reports about gonorrhoea outcomes and 14 about chlamydia. There was marked heterogeneity in results according to geographical location and different standards were set for clinics in and out of London. Opinions from practitioners suggested much higher standards than the values obtained from the systematic review. There was evidence for special cause variation related to management of gonorrhoea and chlamydia in London clinics. CONCLUSIONS Standards set using expert opinion are unrealistic when compared to evidence of what is achievable. Evidence based methods should therefore be used to derive outcome standards for case management gonorrhoea and chlamydia. The control chart method identified clinics where investigation to find reasons for special cause variation in performance should be undertaken to change practice.
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Rooney G, Cluzeau FA, Daniels D, FitzGerald M, Ahmed-Jushuf I, Radcliffe K, Welch J. Getting the guidance right: optimizing the quality of the UK national guidelines on sexually transmitted infections and closely related conditions. Int J STD AIDS 2004. [DOI: 10.1258/095646204323012742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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79
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Rooney G, Daniels D, FitzGerald M, Ahmed-Jushuf I, Radcliffe K, Welch J. Specifications for the development of guidelines on the management of sexually transmitted infections and closely related conditions. Int J STD AIDS 2004. [DOI: 10.1258/095646204323012751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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80
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Wall E, Welch J. Protocols for managing the victims of sexual assault. Assoc Med J 2004. [DOI: 10.1136/sbmj.0405186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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81
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Larbalestier N, Mullen J, O'Shea S, Cottam F, Sabin CA, Chrystie IL, Welch J, Zuckerman M, Hay P, Rice P, Taylor GP, de Ruiter A. Drug resistance is uncommon in pregnant women with low viral loads taking zidovudine monotherapy to prevent perinatal HIV transmission. AIDS 2003; 17:2665-7. [PMID: 14685064 DOI: 10.1097/00002030-200312050-00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zidovudine monotherapy is used to reduce perinatal HIV transmission in women with low viral loads. There are few data on the risk of drug resistance in this select cohort of women. We determined the prevalence of newly acquired mutations conferring reduced sensitivity to zidovudine after exposure during pregnancy, and found that the development of mutations was uncommon and was restricted to women treated before 1998 who had higher baseline viral loads than those currently recommended monotherapy.
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Kerr E, Cottee C, Chowdhury R, Jawad R, Welch J. The Haven: a pilot referral centre in London for cases of serious sexual assault. BJOG 2003; 110:267-71. [PMID: 12628265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Several schemes have been reported to improve treatment of rape and to encourage reporting. The development of a comprehensive forensic and follow up service for complainants of sexual assault is described, and activities of the first year are reviewed. DESIGN Retrospective review of case records of complainants examined in The Haven. SETTING Department of Sexual Health in a London teaching hospital. SAMPLE All case records, 676 complainants, from the first year of cases seen in The Haven. METHODS Description of setting up a service in partnership between the National Health Service and the Metropolitan Police, called The Haven. Analysis of a standardised proforma used for case records. RESULTS Mean age of complainants is 26 years (range 11-66); 6% were male. Assailant was categorised as a stranger in 52% of cases; attack involved physical violence in 50% of cases; 24% of victims had genital injuries; 39% had other physical injuries. Immediate care given at time of forensic examination included 30% of women receiving emergency contraception and 5% of clients receiving post-exposure prophylaxis against HIV. Fifty-five percent of clients returned for a sexual health screen and/or counselling. Thirty-one percent received screening for sexually transmitted infections and 12% were diagnosed with one or more infections. CONCLUSIONS Requirements following sexual assault include forensic examination, first aid, postcoital contraception, prevention and management of sexually transmitted infections and psychosocial support. Provision of these services within a sexual health setting is feasible.
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Kerr E, Cottee C, Chowdhury R, Jawad R, Welch J. The Haven: a pilot referral centre in London for cases of serious sexual assault. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.02233.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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85
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Hardison RC, Chiaromonte F, Kolbe D, Wang H, Petrykowska H, Elnitski L, Yang S, Giardine B, Zhang Y, Riemer C, Schwartz S, Haussler D, Roskin KM, Weber RJ, Diekhans M, Kent WJ, Weiss MJ, Welch J, Miller W. Global predictions and tests of erythroid regulatory regions. COLD SPRING HARBOR SYMPOSIA ON QUANTITATIVE BIOLOGY 2003; 68:335-44. [PMID: 15338635 DOI: 10.1101/sqb.2003.68.335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Creighton S, Edwards S, Welch J, Miller R. News from the frontline: sexually transmitted infections in teenagers attending a genitourinary clinic in south east London. Sex Transm Infect 2002; 78:349-51. [PMID: 12407238 PMCID: PMC1744541 DOI: 10.1136/sti.78.5.349] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To define the incidence and characterise the clinical presentation of sexually transmitted infections (STI) in people aged <or=16 years old attending a genitourinary clinic in south east London. METHODS Cross sectional analysis of clients aged <or=16 years attending one genitourinary clinic. A subgroup was identified for priority treatment. Data collected included age, reason for presentation, diagnosis, contraceptive use, and adherence to therapy. Diagnoses were compared to the KC60 codes for female attendances of all ages. RESULTS 144 females and 18 males with a mean age of 15.4 years attended, of whom 49% were symptomatic. Compared to other attenders, clients aged <or=16 years were significantly more likely to have an STI (64% versus 22%, p <0.00000001); 27 were pregnant (of whom 96% requested a termination of pregnancy); 47% did not return for follow up; and 12% did not adhere to treatment plan. Those diagnosed with an STI were significantly less likely to reattend (p<0.001). CONCLUSIONS There is a high rate of STIs in 16 year olds compared to national figures and to general clinic attenders. Poor contraception is often overlooked within the genitourinary medicine clinic. Young attenders frequently fail to reattend for follow up. Priority treatment did not affect outcome. Further strategies are needed to identify ways to improve young people's access to genitourinary medicine clinics.
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Avidan MS, Groves P, Blott M, Welch J, Leung T, Pozniak A, Davies E, Ball C, Zuckerman M. Low complication rate associated with cesarean section under spinal anesthesia for HIV-1-infected women on antiretroviral therapy. Anesthesiology 2002; 97:320-4. [PMID: 12151919 DOI: 10.1097/00000542-200208000-00006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elective cesarean section decreases the likelihood of vertical human immunodeficiency virus (HIV) transmission from mother to infant. This study aimed to determine whether cesarean section done with spinal anesthesia on HIV-1-infected pregnant women taking antiretroviral therapy is associated with intraoperative hemodynamic instability, postoperative complications, or changes in immune function or HIV-1 viral load. METHODS A case-controlled study was conducted over a 3-year period in a London academic hospital. Forty-four women infected with HIV-1 and a control group of 45 HIV-negative women undergoing cesarean sections were included. The main outcome measures included intraoperative blood pressure, heart rate, blood loss, and ephedrine requirements, and postoperative infective complications, blood transfusion, changes in blood HIV-1 viral load and lymphocyte subsets, and time to hospital discharge. RESULTS There were no differences in hemodynamic stability and postoperative complications between the HIV-infected group and the controls. There was an acute postoperative increase in the CD4T lymphocyte count (P = 0.01), but the CD4T:CD8T ratio and viral load did not change. CONCLUSIONS Elective cesarean section under spinal anesthesia for women infected with HIV-1 taking antiretroviral therapy was not associated with intraoperative or postoperative complications.
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Fitzgerald MR, Ahmed-Jushuf I, Radcliffe KW, Rooney G, Welch J, Wilson JD. Revised UK national guidelines on sexually transmitted infections and closely related conditions 2002. Sex Transm Infect 2002; 78:81-2. [PMID: 12081188 PMCID: PMC1744434 DOI: 10.1136/sti.78.2.81] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cook AL, Pollock PM, Welch J, Walsh MD, Bowman RV, Baumann KC, Hayward NK, Leonard JH. CDKN2A is not the principal target of deletions on the short arm of chromosome 9 in neuroendocrine (Merkel cell) carcinoma of the skin. Int J Cancer 2001; 93:361-7. [PMID: 11433400 DOI: 10.1002/ijc.1352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The majority of small-cell lung cancers (SCLCs) express p16 but not pRb. Given our previous study showing loss of pRb in Merkel cell carcinoma (MCC)/neuroendocrine carcinoma of the skin and the clinicopathological similarities between SCLC and MCC, we wished to determine if this was also the case in MCC. Twenty-nine MCC specimens from 23 patients were examined for deletions at 10 loci on 9p and 1 on 9q. No loss of heterozygosity (LOH) was seen in 9 patients including 2 for which tumour and cell line DNAs were examined. Four patients had LOH for all informative loci on 9p. Ten tumours showed more limited regions of loss on 9p, and from these 2 common regions of deletion were determined. Half of all informative cases had LOH at D9S168, the most telomeric marker examined, and 3 specimens showed loss of only D9S168. A second region (IFNA-D9S126) showed LOH in 10 (44%) cases, and case MCC26 showed LOH for only D9S126, implicating genes centromeric of the CDKN2A locus. No mutations in the coding regions of p16 were seen in 7 cell lines tested, and reactivity to anti-p16 antibody was seen in all 11 tumour specimens examined and in 6 of 7 cell lines from 6 patients. Furthermore, all cell lines examined reacted with anti-p14(ARF) antibody. These results suggest that neither transcript of the CDKN2A locus is the target of deletions on 9p in MCC and imply the existence of tumour-suppressor genes mapping both centromeric and telomeric of this locus.
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Welch J, Millar D, Goldman A, Heenan P, Stark M, Eldon M, Clark S, Martin NG, Hayward NK. Lack of genetic and epigenetic changes in CDKN2A in melanocytic nevi. J Invest Dermatol 2001; 117:383-4. [PMID: 11511321 DOI: 10.1046/j.0022-202x.2001.01391.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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91
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Low N, Lambe C, Welch J, Kennedy J, Stallard A, Clements V, White J. HIV testing in antenatal care: a cross-sectional study. ACTA ACUST UNITED AC 2001. [DOI: 10.12968/bjom.2001.9.6.7971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Edwards SG, Larbalestier N, Hay P, de Ruiter A, Welch J, Taylor GP, Easterbrook P. Experience of nevirapine use in a London cohort of HIV-infected pregnant women. HIV Med 2001; 2:89-91. [PMID: 11737384 DOI: 10.1046/j.1468-1293.2001.00059.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the experience of four London HIV centres prescribing nevirapine (NVP) to HIV-1 infected pregnant women with respect to immunological and virological response, tolerability and pregnancy outcome. METHODS We identified all HIV-1-infected women who received NVP as part of a triple antiretroviral regimen during pregnancy between January 1997 and September 1999. Laboratory results, clinical events, side-effects and pregnancy outcome were abstracted using a standardized proforma from the medical records. RESULTS Forty-six women were identified, 85% of whom were black African. At initiation of NVP, the median age was 29 years and the median baseline CD4 cell count and viral load were 242 cells/microL and 4.15 log10 copies/mL, respectively. Thirty-two out of 36 women who had a plasma sample obtained at, or just prior to, delivery had an undetectable viral load (< 50 to < 400 copies/mL). Adverse events that were definitely attributed to NVP included a generalized rash (n = 2) and hepatitis (n = 2). Obstetric complications occurred in nine women (19.5%), which was not statistically different (P = 0.36) from that found in a historical (1990-96) control group 7/51 (14%). The rate of preterm delivery (13%) was similar to that previously reported in HIV-1 infected pregnant women (18%). CONCLUSIONS NVP (as part of highly active antiretroviral therapy) reduced plasma viraemia to below the limit of detection in 89% of women. It was generally well tolerated and clinical and laboratory adverse events were infrequent. There was no evidence of an increase in obstetric complications including preterm delivery during the second and third trimesters of pregnancy.
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Pollock PM, Welch J, Hayward NK. Evidence for three tumor suppressor loci on chromosome 9p involved in melanoma development. Cancer Res 2001; 61:1154-61. [PMID: 11221846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Cytogenetic and loss of heterozygosity (LOH) studies have long indicated the presence of a tumor suppressor gene (TSG) on 9p involved in the development of melanoma. Although LOH at 9p has been reported in approximately 60% of melanoma tumors, only 5-10% of these tumors have been shown to carry CDKN2A mutations, raising the possibility that another TSG involved in melanoma maps to chromosome 9p. To investigate this possibility, a panel of 37 melanomas derived from 35 individuals was analyzed for CDKN2A mutations by single-strand conformation polymorphism analysis and sequencing. The melanoma samples were then typed for 15 markers that map to 9p13-24 to investigate LOH trends in this region. In those tumors demonstrating retention of heterozygosity at markers flanking CDKN2A and LOH on one or both sides of the gene, multiplex microsatellite PCR was performed to rule out homozygous deletion of the region encompassing CDKN2A. CDKN2A mutations were found in tumors from 5 patients [5 (14%) of 35], 4 of which demonstrated LOH across the entire region examined. The remaining tumor with no observed LOH carried two point mutations, one on each allele. Although LOH was identified at one or more markers in 22 (59%) of 37 melanoma tumors corresponding to 20 (57%) of 35 individuals, only 11 tumors from 9 individuals [9 (26%) of 35] demonstrated LOH at D9S942 and D9S1748 the markers closest to CDKN2A. Of the remaining 11 tumors with LOH 9 demonstrated LOH at two or more contiguous markers either centromeric and/or telomeric to CDKN2A while retaining heterozygosity at several markers adjacent to CDKN2A. Multiplex PCR revealed one tumor carried a homozygous deletion extending from D9S1748 to the IFN-alpha locus. In the remaining eight tumors, multiplex PCR demonstrated that the observed heterozygosity was not attributable to homozygous deletion and stromal contamination at D9S1748, D9S942, or D9S974, as measured by comparative amplification strengths, which indicates that retention of heterozygosity with flanking LOH does not always indicate a homozygous deletion. This report supports the conclusions of previous studies that a least two TSGs involved in melanoma development in addition to CDKN2A may reside on chromosome 9p.
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Kerr E, Jawad R, Butler B, Welch J. Time to talk about rape. Joint initiatives can improve services for complainants of sexual assault. BMJ (CLINICAL RESEARCH ED.) 2001; 322:232. [PMID: 11159604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Welch J. A Physician's Guide to Clinical Forensic Medicine.: Ed Margaret M Stark. Pp 326; $79.95. Totowa: Humana Press, 2000. ISBN 0-896-03742-8. Sex Transm Infect 2000. [DOI: 10.1136/sti.76.6.497-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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van Dellen A, Welch J, Dixon RM, Cordery P, York D, Styles P, Blakemore C, Hannan AJ. N-Acetylaspartate and DARPP-32 levels decrease in the corpus striatum of Huntington's disease mice. Neuroreport 2000; 11:3751-7. [PMID: 11117485 DOI: 10.1097/00001756-200011270-00032] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Huntington's disease (HD) is an autosomal dominant condition involving progressive neurodegeneration, primarily the corpus striatum and cerebral cortex. We have used in vivo magnetic resonance spectroscopy (MRS) to assess specific neuronal markers in transgenic mice (R6/1 line) expressing exon I of the human huntingtin gene with an expanded CAG repeat. Levels of N-acetylaspartate (NAA), an indicator of healthy neuronal function, were significantly reduced (26%) in the corpus striatum of HD mice relative to wild-type littermates at 5 months of age. However, levels of cholines and creatine-phosphocreatine were not altered in the HD mice. Expression of dopamine- and cAMP-regulated phosphoprotein, 32 kDa (DARPP-32), was assessed by immunohistochemistry in the striatum of HD mice and found to be downregulated by 5 months and, even more dramatically, at 11 months of age. In contrast, expression of calbindin was not significantly decreased in HD mice. Our results suggest that the observed decreases in DARPP-32 and NAA may contribute to aberrant receptor signalling and neuronal dysfunction in HD.
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Welch J. Book: Caring for Women with Circumcision: A Technical Manual for Health Care Providers. BMJ : BRITISH MEDICAL JOURNAL 2000. [DOI: 10.1136/bmj.320.7247.1481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bradbeer C, Welch J. Obituary. Int J STD AIDS 2000. [DOI: 10.1177/095646240001100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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99
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Welch J, Jones MG, Cullinan P, Coates OA, Newman Taylor AJ. Sensitization to oilseed rape is not due to cross-reactivity with grass pollen. Clin Exp Allergy 2000; 30:370-5. [PMID: 10691895 DOI: 10.1046/j.1365-2222.2000.00763.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oilseed rape is an important crop grown in the UK which can cause specific immunological sensitization with clinical symptoms in a relatively small number of the general population. Individuals with immunoglobulin (Ig) E-mediated allergy to oilseed rape have also been found to be sensitized to other pollen allergens, most frequently being grass pollen. Cross-reactivity between common grass and oilseed rape would have important implications, especially as their flowering period coincides. OBJECTIVE We have investigated whether the cosensitization found in individuals sensitized to both oilseed rape and grass pollen is due to cross-reactivity. METHODS Cross-reactivity between oilseed rape and grass pollen was determined using RAST, RAST inhibition, Western blotting and inhibition studies with Western blotting. RESULTS Competitive RAST inhibition studies between pollen of oilseed rape and grass failed to show any cross-reactivity between the pollen types. Self-inhibition with oilseed rape resulted in 90% inhibition, whereas there was less than 10% inhibition with grass pollen. Western blotting revealed allergens of similar molecular weight in both oilseed rape and grass pollen. Despite allergens of similar molecular weights being present in both pollen types, inhibition immunoblot studies confirmed that the allergens in the two allergens were immunologically distinct. CONCLUSION The allergens of oilseed rape and grass pollen, although similar in molecular weights, are immunologically distinct and there is no evidence of cross-reactivity between them. Individuals allergic to grass pollen will not necessarily develop a specific nasal or airway response to inhaled oilseed rape pollens.
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Jones MG, Welch J, Cullinan P, Newman Taylor AJ, Coates OA. Allergenicity of grass and oil seed rape pollen. IMMUNOLOGY TODAY 2000; 21:155-6. [PMID: 10689305 DOI: 10.1016/s0167-5699(00)01591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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