Allergic rhinitis is an increasing health problem and pollen allergens are amongst the main elicitors of hay fever symptoms. Allergenic pollen contains a set of differently allergenic proteins which are thought to play a role in the pollen germination and fertilisation process. They are released upon contact with the stigma or mucosa or upon pollen grain rupture. Although the determinants of allergenicity of these proteins are still largely undiscovered, accessibility and solubility are now thought to mainly influence allergenic potency. Pollen of 61 allergenic plants was investigated with scanning and transmission electron microscopy. Most of the minor allergenic plants like species of the families Salicaceae, Fagaceae or Ulmaceae show the typical pollen wall organisation with intine, compact endexine and ektexine whereas in the majority of the major allergenic plants like species of Betulaceae and Poaceae the endexine is not detectable. Ambrosia artemisiifolia exhibits a laminated endexine. In addition, pollen of these major allergenic plants does not have electron-dense pollenkitt and starch is stored in a high proportion of the examined pollen. The question is raised whether pollen morphology and ultrastructure might contribute to the accessibility and therefore allergenicity of allergenic proteins.
BackgroundThe ageing UK population needs safe approaches to reduce emergency hospital admissions. Predictive risk stratification modelling (PRiSM) estimates risk that individuals will suffer emergency admission to hospital within 12 months and selects patients for preventative community care to avoid admissions.AimTo evaluate the introduction of (PRiSM) into primary care.MethodFunded by NIHR, we used randomised stepped wedge design to estimate (cost) effectiveness of introducing PRiSM software into 32 participating practices in urban South Wales, supported by practice-based training, clinical support through two local ‘GP champions’, and technical support through telephone help-desk. Outcome measures included: emergency hospital admissions (primary), other hospital activity, and GP activity, all estimated from routine data; patient-reported SF-12 health-related quality of life scores; and NHS costs.ResultsAcross 230,000 participants, PRiSM implementation increased: emergency hospital admission rates by 1.1% (95% confidence interval [CI] = 1.0% to 1.3%); Emergency Department attendance rates by 3.0% (95%CI = 2.8% to 3.2%); outpatient visit rates by 5.5% (95%CI = 5.1% to 5.8%); GP activity by 1.1% (95% CI = 0.7% to 1.4%); and NHS costs per patient by £76 (95%CI = £46 to £106). Questionnaires completed by 1400 randomly sampled participants showed that: PRISM improved SF-12 physical scores by 1.5 points (95%CI = 0.8 to 2.2); but not SF-12 mental scores (95%CI = −1.5 points to +0.3). The direct cost of introducing PRiSM was £0.11/patient/year.ConclusionThe introduction of PRiSM increased emergency hospital admissions and other NHS activity without clear evidence of benefit.
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