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Biomedical subjects

M Tosca

Publications and source records attributed to M Tosca.

18 recordsLinked to original sources
PubMed2006

Practice parameters for sublingual immunotherapy.

The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, meta-analysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre co-seasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient's tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).

Administration, Sublingual↗
PubMed2006

Screening spirometry to detect respiratory allergy.

BACKGROUND: Recently, it has been evidenced that the forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF25-75) might be considered as a possible marker of early bronchial impairment in patients with allergic rhinitis alone. OBJECTIVES: The aim of this study was to determine whether a spirometric impairment may predict allergy during screening visit. METHODS: The study included 283 Navy soldiers (255 males, mean age 27.1 + 8.2) who had to undergo spirometry for attending specific courses. Fifty-four showed slight spirometric anomalies. Thus, they referred to Navy Hospital of La Spezia for standardized tests: skin prick test, spirometry, and methacholine bronchial challenge. RESULTS: Forty seven (87%) subjects were sensitized (47% monosensitized and 53% polysensitized). Allergic rhinitis was diagnosed in 25 subjects with median nasal TSS 5. FVC and FEV1 values were normal, whereas FEF25-75 values were reduced (61.8 + 14.8 % of predicted), bronchodilation test was significant for FEF25-75 (82.9 + 16.8% of predicted; p<0.001) only. Bronchial hyperreactivity (BHR) was detected in 28 subjects, all but 1 were sensitized. CONCLUSIONS: This study provides evidence, relevant to clinical care, that mild spirometric impairment may generate the suspect of allergic disorders, thus spirometry could be more frequently performed in general population screening.

Adult↗
PubMed2005

Seasonal and perennial allergic rhinitis: is this classification adherent to real life?

BACKGROUND: Allergic rhinitis is traditionally subdivided into seasonal (SAR) and perennial (PAR), although the new definitions of persistent and intermittent were recently proposed. We assessed the validity of the traditional classification in a large group of subjects suffering from allergic rhinitis alone. METHODS: Young males referred to a Navy Military Hospital for routine fitness visit, and reporting symptoms of rhinitis alone were selected. According to the sensitization they were subdivided into (i) sensitized to pollens only (seasonal, SAR), (ii) to perennial allergens only (perennial, PAR) and (iii) to both (mixed, MAR). Spirometry, methacholine challenge, severity and characteristics of symptoms were assessed in all participants. RESULTS: Of 19 325 subjects, 2347 had allergic rhinitis. Seventy-two percent of the subjects had MAR, 17% SAR and 11% PAR. Ocular involvement and irritative symptoms were more frequent in SAR (P < 0.03), whereas obstruction was predominant in PAR (P < 0.01). Nasal symptoms varied according to the period of the year in SAR (P < 0.01) and PAR (P < 0.03). An overt bronchial obstruction was detected in 12% of PAR patients, in 7.8% of MAR, and in 4.2% of SAR. forced expiratory volume/1 s was significantly lower during season in SAR patients only (P < 0.05). The FEF25-75 was impaired in 22.5% MAR patients, 21% PAR, and 14% SAR, with a seasonal change in SAR (P < 0.05) and PAR (P < 0.001). Bronchial hyperreactivity was present in 82.2% of PAR, 73.6% of MAR, and 53.5% of SAR, with a seasonal change in SAR (P < 0.001) and MAR (P < 0.05). CONCLUSIONS: This study provides evidence that up to 80% of allergic rhinitics have a mixed form, and SAR and PAR definitions are poorly adherent to real life. Lung involvement is frequent in patients reporting nose symptoms alone.

Adolescent↗
PubMed2005

Impact of children's respiratory allergies on caregivers.

BACKGROUND: Despite the great attention that has been paid to HRQoL in children with respiratory allergy, few studies have addressed this aspect in relation to caregivers. The aim of our study was to evaluate the impact of childhood respiratory allergies on caregivers by means of a new method. METHODS: 119 parents of children suffering from allergies (75 suffering from asthma and 44 suffering from rhinitis) were recruited from three Italian Allergy Units. Parents were asked to complete the Disease Impact On Caregiver (DIOC), a new non disease specific questionnaire, validated on the Italian population. The questionnaire consists of 31 items grouped in four factors (Performance, Personal gratification, Psychophysical endurance, Socio-emotional domain) and covers the life aspects that could be affected by the assistance duties towards an ill family member. RESULTS: Child's asthma resulted to have a worse impact on many aspects of a parents' life than rhinitis. Differences resulted to be statistically significant in 19 aspects out of the 31 assessed. The worse impact of asthma versus rhinitis was confirmed in the following domains: Performance (24.0 +/- 18.2 vs 11.5 +/- 17.8), Personal gratification (26.3 +/- 20.5 vs 12.1 +/- 16.5) and Psychophysical endurance (35.0 +/- 24.8 vs 18.8 +/- 21.7). In the Socio-emotional domain no difference emerged. CONCLUSIONS: Compared to parents of rhinitics, parents of asthmatic children appear to be more compromised in their resistance to stress, mood, emotional stability, amount of spare time and leisure activities. Our results suggest the need of giving the due attention to these problems both in clinical practice and in research, in order to avoid possible interferences of the caregiver's distress in the optimization of treatment outcome.

Adult↗
PubMed2001

Long-term cetirizine treatment reduces allergic symptoms and drug prescriptions in children with mite allergy.

BACKGROUND: Experimental data demonstrate that mite allergy is characterized by persistent chronic inflammation, even during asymptomatic periods. This suggests that long-term continuous treatment be included in the global strategy of allergy treatment. OBJECTIVE: We conducted a study to evaluate whether regularly administered cetirizine reduces allergic symptoms and drug prescriptions in children with mite allergy. METHODS: In this double-blind, randomized, placebo-controlled study, two parallel groups of 10 children with mite allergy (mean age: 6.5 years) received either cetirizine or placebo daily for 6 months. Participants were allowed to take rescue medications for rhinitis and/or mild asthma. The symptoms (nasal itching, sneezing, obstruction, rhinorrhea, conjunctival itching, lacrimation, conjunctival hyperemia, cough, wheezing, and chest tightness) were recorded on a diary card. The intake of cetirizine (as additional symptomatic treatment), antibiotics, acetaminophen, beta2-agonists, inhaled and systemic corticosteroids was also recorded. RESULTS: Symptom scores and drug consumption were significantly lower (P < 0.05) in the cetrizine-treated group versus the placebo group. The greatest reductions were in cetirizine itself, inhaled corticosteroids, beta2-agonists, and antibiotics. No side effects were reported in either group. CONCLUSIONS: In mite-allergic children, cetirizine administered daily for prolonged periods decreases symptoms of and drug prescriptions for allergic rhinitis and asthma compared with symptomatic treatment.

Allergens↗
PubMed2001

Underdiagnosis and undertreatment of asthma: a 9-year study of Italian conscripts.

BACKGROUND: During the last 20 years, the epidemiology of asthma has been investigated in various populations, thus providing interesting data including the accuracy of diagnosis and the adequacy of treatment. METHODS: We studied for 9 years the epidemiological features of asthma in a homogeneous population of 18-year-old males referred to La Spezia Military Navy Hospital for a call-up visit (conscripts). RESULTS: During the period of 1990-1998, 91,700 men were screened at their call-up visit; out of them 5,371 (7%) had asthma, but in 7.4% the disease had not been previously diagnosed. During the observation period there was a significant decrease of the level III severity of asthma, but about one quarter of the asthmatic subjects received no treatment at all. On the other hand, a significant increase in the prescription of inhaled steroids was observed. CONCLUSION: Despite educational efforts, a not negligible underdiagnosis and inadequate treatment of asthma in young adults still persist.

Administration, Inhalation↗
PubMed2000

Modulation of airway caliber by deep inhalation in children.

To elucidate whether deep inhalation (DI) modulates changes in airway caliber in childhood, we measured the effect of DI on respiratory impedance before and after inhaled methacholine or salbutamol in 4- to 7-yr-old children (n = 15) suffering from recurrent wheezing. In all children, the real part of impedance between 12 and 16 Hz (Re[Z](12-16)) increased after methacholine from 5.6 +/- 1.2 to 8.2 +/- 1.6 cmH(2)O. l(-1). s (P < 0.001) and resonance frequency from 18 +/- 3 to 25 +/- 5 Hz (P < 0.001). These changes were partially reversed by DI: Re[Z](12-16) decreased to 7.2 +/- 1.2 cmH(2)O. l(-1). s (P < 0.01) and resonance frequency to 19 +/- 5 Hz (P < 0.001). In nine children, on a separate occasion, Re[Z](12-16) decreased after salbutamol from 8.3 +/- 1.9 to 5.1 +/- 0.9 cmH(2)O. l(-1). s (P < 0.001) and resonance frequency from 21 +/- 6 to 15 +/- 3 Hz (P < 0.05). The decrease of Re[Z](12-16) was partially reversed by DI (to 6.2 +/- 1.4 cmH(2)O. l(-1). s, P < 0. 01), but resonance frequency did not change significantly (P = 0.75). We conclude that in 4- to 7-yr-old children pharmacologically induced changes in airway caliber are modulated by DI. These findings suggest that airway-to-parenchyma interdependence is operative in this age range.

Airway Resistance↗
PubMed1999

Continuous antihistamine treatment controls allergic inflammation and reduces respiratory morbidity in children with mite allergy.

BACKGROUND: Allergic reaction is characterized by a complex inflammatory process. Some of the new antihistamines have antiallergic effects and can affect the inflammatory cell recruitment via adhesion molecule downregulation. We aimed to assess in a 12-month study whether continuous treatment with an antihistamine (terfenadine) can reduce respiratory symptoms and local inflammation in children with mite allergy. METHODS: The study was double-blind and placebo-controlled: it involved two parallel groups of children suffering from rhinoconjunctivitis and/or mild intermittent asthma due to mite allergy. They received either terfenadine (1 mg/kg per body weight per day) or placebo for 1 year. Nasal, conjunctival, and bronchial symptoms were recorded by diary cards; at each of the programmed control visits, a nasal scraping for inflammatory cells and ICAM-1 was performed. Some additional clinical parameters were also recorded: days of school absence, extra visits for acute respiratory symptoms, and days of hospital admission. RESULTS: Only children treated with terfenadine achieved significant control of symptoms (P<0.05 in 8 out of 12 months) and allergic inflammation, as shown by inflammatory cell infiltrate and ICAM-1 expression at nasal level (P<0.001), and had significantly fewer extra visits and school absences than the placebo group (P<0.03). No side-effects were reported in either group. CONCLUSIONS: The present study demonstrates that continuous terfenadine treatment (1 mg/kg body weight per day) could decrease respiratory symptoms and allergic inflammation, and it had an additional antiallergic effect in reducing ICAM-1 expression on nasal epithelial cells. Therefore, the present results confirm the efficacy of a long-term therapeutic strategy in controlling allergic inflammation.

Adolescent↗
PubMed1997

Cetirizine treatment of allergic cough in children with pollen allergy.

Cetirizine, an antihistamine widely used in the treatment of allergic rhinoconjunctivitis, also has antiallergic activity. The present study aimed to evaluate cetirizine as a treatment for children with allergic cough due to pollen allergy. This was a parallel-group, double-blind, placebo-controlled, randomized study. Twenty children with pollinosis were enrolled: they were subdivided into two groups receiving a 1-month treatment during the pollen season. The following variables were monitored: 1) clinical symptoms and respiratory data (spirometry and PEF) evaluated at baseline and at the end of the study by allergists and by a daily diary card, and 2) pollen count. This study shows that cetirizine treatment reduces cough intensity (P < 0.05) and frequency (P < 0.01). In conclusion, cetirizine does clinically improve cough due to pollen allergy.

Adolescent↗
PubMed1997

Cetirizine treatment of rhinitis in children with pollen allergy: evidence of its antiallergic activity.

BACKGROUND: Cetirizine is an antihistamine, largely used in the treatment of allergic rhinoconjunctivitis, which also exerts anti-allergic activity. OBJECTIVE: To evaluate cetirizine as treatment for children with rhinitis due to pollen allergy, and to evaluate its anti-allergic activity in such a clinical condition. METHODS: The study was designed as parallel groups, double-blind, placebo-controlled, randomized. Twenty allergic children were enroled and subdivided in two groups, receiving a 4 week treatment during the pollen season. The following parameters were monitored: clinical symptoms evaluated by the allergist before and after treatment and by the patients through a daily diary card, inflammatory cells count, expression of ICAM-1 on nasal epithelial cells, inflammatory mediator levels in nasal lavage and peripheral blood before and after treatment, and pollen counts. RESULTS: This study shows that cetirizine treatment is able to reduce: clinical symptoms (P < 0.01), inflammatory cell infiltrate (P < 0.03), ICAM-1 expression on epithelial cells (P < 0.05), and soluble ICAM-1 (P < 0.05) and ECP (P < 0.05) in nasal lavage. CONCLUSION: Cetirizine is able to clinically improve nasal symptoms due to pollen allergy and to reduce allergic inflammation, which is related to allergen exposure.

Adolescent↗
PubMed1996

Olive oil and rapeseed oil differ in their effect on plasma low-density lipoprotein metabolism in the guinea-pig.

The effects of olive oil and rapeseed oil, two different high-oleic-acid oils, on plasma LDL and hepatic cholesterol metabolism were compared in guinea-pigs. Animals were fed on semipurified diet containing 150 g fat/kg as either olive oil (OL), rapeseed oil plus 100 g palm oil/kg (C-P) or olive oil plus 350 g safflowerseed oil/kg (OL-S). Olive oil was enriched with safflowerseed oil (OL-S diet) to increase linoleic acid and to decrease palmitic acid concentrations, in order to evaluate whether differences in plasma LDL concentrations were due to intrinsic effects of the specific oil (rapeseed or olive oil) or to differences in the content of specific fatty acids. No differences due to dietary fat source were found in plasma total and HDL-cholesterol levels or in LDL composition. Plasma LDL-cholesterol levels were lower on the C-P diet than the OL diet (P < 0.05) while plasma LDL-cholesterol levels in animals fed on the OL-S diet were not significantly different from either dietary group (P > 0.05). The number of hepatic apo B/E (LDL) receptors was on average 25% higher in animals fed on the C-P diet compared with those fed on diets containing olive oil. Likewise, cardiac muscle lipoprotein lipase (EC 3.1.1.34) activity was significantly higher in the C-P group than in the OL and OL-S dietary groups. Dietary fat source had no effect on hepatic cholesterol levels or 3-hydroxy-3-methylglutaryl (HMG) CoA reductase (EC 1.1.1.34) activity. The results indicate that olive oil and rapeseed oil, both rich sources of monounsaturated fatty acids, differ in their effect on LDL metabolism in the guinea-pig.

Animals↗
PubMed1995

Guar gum effects on plasma low-density lipoprotein and hepatic cholesterol metabolism in guinea pigs fed low- and high-cholesterol diets: a dose-response study.

Guinea pigs were fed semipurified diets containing either 0% or 12.5% guar gum (GG) with 0.04% cholesterol or increasing concentrations of GG (0%, 2.5%, 5%, 7.5%, 10%, and 12.5%) with 0.25% cholesterol (by wt). Compared to the 0% GG diet with 0.04% cholesterol, intake of the 12.5% GG diet with 0.04% cholesterol lowered plasma low-density-lipoprotein (LDL) concentrations, the ratio of LDL cholesteryl ester to protein, hepatic cholesterol concentrations, and the activity of acyl-CoA:cholesterol acyltransferase (ACAT), and increased 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase activity and hepatic apo B/E receptor number (P < 0.01). Intake of GG by animals fed 0.25% cholesterol diets resulted in modest effects on hepatic cholesterol pools and plasma LDL concentrations; however, significant negative correlations were found between both plasma LDL cholesterol and hepatic free cholesterol concentrations with the amount of dietary GG (P < 0.05). Hepatic HMG-CoA reductase was suppressed by the 0.25% cholesterol intake, and GG did not reverse this suppression. In contrast, ACAT activity was negatively correlated with the amount of dietary GG (P < 0.05), and GG intake increased the number of hepatic apo B/E receptors at all intakes with the 0.25% cholesterol diets. These results demonstrate that intake of GG significantly alters endogenous cholesterol metabolism by decreasing hepatic cholesterol pools, altering hepatic cholesterol homeostasis, and reducing plasma LDL concentrations.

Animals↗
PubMedDate not supplied

Azelastine eye drops reduce conjunctival hyperresponsiveness to hyperosmolar glucose challenge in children with asymptomatic mite conjunctivitis.

Mite allergy is characterized by a continuous allergen exposure. Persistent inflammation is therefore always detectable; and during symptomless periods as well. It has been reported that mite allergic patients also present a nonspecific hyperreactivity to different stimuli, including hyperosmolar solution. Since azelastine was previously demonstrated to be able to reduce allergic inflammation, the aim of the study was to investigate the effects of the drug on nonspecific conjunctival hyperreactivity in mite-allergic patients. Twenty children with mite allergy were studied. A hyperosmolar conjunctival challenge was performed before and after azelastine eye drops or placebo treatment for a period of 2 weeks. It was found that patients treated with azelastine eye drops showed a significant reduction in nonspecific conjunctival hyperreactivity compared to the placebo group (p = 0.018). It was concluded that azelastine eye drops are able to reduce the nonspecific hyperreactivity present in subjects with mite allergy.

Adolescent↗
PubMedDate not supplied

Topical acetylsalicylic acid in the treatment of allergic pollinosic conjunctivitis.

The pharmacological treatment of allergic conjunctivitis includes the use of topical antiinflammatory drugs, i.e. steroids and NSAIDs (nonsteroidal antiinflammatory drugs), such as acetylsalicylic acid (ASA). However, steroids are not suitable in prolonged treatment, as well as in pollinosis in the Mediterranean area, because of their side effects. The present double-blind study evaluates the topical use of acetylsalicylic acid eye drops (1% solution) compared to placebo in the treatment of patients with seasonal allergic conjunctivitis during the period June-July 1990. The patients were randomized and treated with ASA eye drops or placebo eye drops, both applied as one drop in each eye q.i.d. for 14 days. The severity of symptoms was evaluated before and after treatment by the investigator and the patient. An overall judgement of therapeutic response was expressed independently by the patient and the investigator at the end of the treatment. The ASA-treated group improved significantly compared to the placebo-treated group. No serious side effects were observed. The results confirm the clinical efficacy and safety of topical ASA in the treatment of pollen-induced allergic conjunctivitis.

Adolescent↗
PubMedDate not supplied

Topical anti-inflammatory drugs in the treatment of allergic pollinosic conjunctivitis: a comparative double-blind study.

Anti-inflammatory drugs, i.e. glucocorticosteroids and NSAIDs (nonsteroidal anti-inflammatory drugs), are often included in the treatment of allergic conjunctivitis. The present study compares the clinical efficacy and safety of topical hydrocortisone, acetylsalicylic acid (ASA) and piroxicam compared to placebo. The trial, designed as a double-blind, randomized and parallel-group treatment, was carried out in a group of 40 patients suffering from seasonal allergic conjunctivitis due to Parietaria pollen, during the pollen season (June-July, 1990). Patients received hydrocortisone 0.1% solution, ASA 1% solution, piroxicam 0.5% solution or placebo as eye drops, all one drop in each eye q.i.d. for 14 days. The symptoms were evaluated at baseline and at the end of treatment by the clinician and by patients on a diary card. The hydrocortisone group showed a rapid and significant improvement during the first week of treatment, while ASA and piroxicam reduced symptomatology during the second week of treatment; this difference was statistically significant. At the end of the trial, the active drugs were comparable with regard to clinical efficacy. A statistically significant difference was observed between the active drugs and placebo, while no statistically significant difference was observed among the three drugs. No serious side-effects were observed. The results demonstrate the clinical efficacy of anti-inflammatory drugs in the treatment of pollen-induced allergic conjunctivitis; they also suggest the use of NSAIDs in long-term treatment, as their efficacy has been shown to be closely comparable to that of steroids, while avoiding the well-known side-effects of the latter in prolonged treatment.

Administration, Topical↗
PubMedDate not supplied

Cetirizine reduces conjunctival nonspecific hyperreactivity in children with mite allergy.

As mite allergy is characterized by a continuous allergen exposure, persistent inflammation is always detectable even during symptomless periods. It has been reported that mite allergic patients present a nonspecific hyperreactivity to different stimuli, including hyperosmolar solution. Since it has been reported previously that cetirizine is able to reduce minimal persistent inflammation due to mite allergy, the aim of the study was to investigate the effect of cetirizine on nonspecific conjunctival hyperreactivity. Twenty children with mite allergy were studied; two hyperosmolar conjunctival challenges were performed before and after cetirizine or placebo treatment, lasting one week. Patients treated with cetirizine showed a significant reduction in nonspecific conjunctival hyperreactivity compared to the placebo group (p < 0.05). In conclusion, cetirizine was able to reduce nonspecific hyperreactivity related to allergic inflammation.

Animals↗