Mariangela Tosca

IRCCS Istituto G. Gaslini, Genova, Liguria, Italy

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Publications (21)48.98 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: Allergen immunotherapy (AIT) is indicated in IgE-mediated respiratory allergy. Recently, it has been reported that serum-specific IgE (sIgE) levels >10 kU/l may predict AIT efficacy in adults with allergic rhinitis. The aim of the present preliminary study was to investigate whether this cut-off could also be associated with perception of effective AIT in children with allergic asthma and/or rhinitis due to house dust mites (HDM). Methods: A total of 31 allergic children (17 males; mean age of 12.5 years) with levels of serum sIgE to HDM >10 kU/l were evaluated. Eight allergic children (five males; mean age of 13.4 years) with levels of serum sIgE to HDM <10 kU/l were considered as control. All patients were treated with sublingual immunotherapy for 3 years with HDM allergen extract. Children's perception of AIT efficacy was assessed by visual analog scale (VAS), considering both symptom severity and drug use. Responder patients were defined with >6 VAS. Severity of nasal symptoms was assessed by nasal VAS, and asthma control was evaluated by asthma control test; both were considered before and after AIT. Results: All children (but one) with sIgE >10 kU/l perceived AIT efficacy, whereas only one child with sIgE <10 kU/l perceived AIT benefit (p < 0.001). There was a strong relationship between perception of AIT efficacy by VAS and serum sIgE levels (r = 0.615; p < 0.001). Also, nasal VAS and asthma control tests significantly improved only in children with sIgE >10 kU/l (p < 0.001 for both). Conclusion: Allergen-sIgE assessment before AIT prescription might represent a useful tool to individuate potential responders.
    Immunotherapy 01/2014; 6(1):29-33. DOI:10.2217/imt.13.145 · 2.39 Impact Factor
  • Pediatrics International 02/2012; 54(1):170-1. DOI:10.1111/j.1442-200X.2011.03540.x · 0.73 Impact Factor
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    ABSTRACT: Forced expiratory volume in 1 second (FEV1) is considered an important parameter for asthma diagnosis and follow-up. However, it has been proposed that forced expiratory flow at 25-75% (FEF(25-75)) could be more sensitive than FEV1 to detect slight airways obstruction. In this regard, a cutoff FEF(25-75) value has been recently established in a group of asthmatic children: FEF(25-75) < 65% of predicted has been considered impaired. However, the considered population was specifically selected. Therefore, the aim of the present study was to confirm an FEF(25-75) cutoff value in a large cohort of asthmatic children. Seven hundred allergic children (493 male subjects; median age, 11 years) with controlled and partly controlled asthma were evaluated by performing spirometry and skin-prick tests. Three hundred thirteen (44.7%) patients had FEF(25-75%) values of <65% of predicted. Two predictors were significantly associated with impaired FEF(25-75) values: (i) sensitization to perennial allergens (adjusted odds ratio [OR(Adj)], 3.4) and (ii) FEV(1) ≤ 86% of predicted (OR(Adj), 3.8). This study, conducted in real life, could suggest that FEF(25-75) value of <65% of predicted may be considered abnormal.
    Allergy and Asthma Proceedings 01/2012; 33(1):e5-8. DOI:10.2500/aap.2012.33.3524 · 3.35 Impact Factor
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    ABSTRACT: It is well known that allergy evolves at clinical level from the birth to adulthood, and this has been clearly demonstrated also at a level of sensitization. However, little information is available on the evolution of the IgE repertoire directed to single allergenic components. In this cross-sectional, observational study, the evolution of the IgE repertoire was analysed at component level. Serum samples from 901 allergic patients, stratified in 6 groups according to age, were analysed by ImmunoCAP ISAC, a microarray chip that allows to identify the presence of specific IgE towards 103 different allergen components. Total IgE were also evaluated. The behaviour of total IgE according to age strictly paralleled that of the sum of specific IgE directed to molecular components. As expected, food-related components (in particular those of milk and egg) were the most frequently recognized in the earliest ages, whereas specific IgE to plant allergens appeared invariably later. Nonetheless, IgE specific to mite components was the most represented in all age classes. Of note, specific IgE against cross-reacting allergens was virtually absent in the first years and tended to appear only after the age of 6. Despite this was not a study performed on a cohort of patients followed up from birth to adolescence, the molecular patterns of allergen recognition resulted modified according to age. These findings may support, at molecular level, the clinical features of the allergic march.
    Pediatric Allergy and Immunology 11/2011; 23(5):433-40. DOI:10.1111/j.1399-3038.2011.01228.x · 3.38 Impact Factor
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    ABSTRACT: Allergic rhinitis (AR) is a very frequent disease which is not only characterized by nasal symptoms, but also with behavioural changes. This study evaluated the serum serotonin levels in patients with pollen-induced AR during and outside the pollen season.One-hundred-two (56 females, 46 males, median age: 28.7 years) were included in this study: 56 with seasonal AR (SAR) evaluated outside the pollen season and so without allergic inflammation and symptoms, and 46 with SAR evaluated during the pollen season with symptoms. Blood specimens were collected to assess serum concentrations of serotonin and to compare results to scores of a Quality of Life (QoL) questionnaire which was performed in all subjects. Serotonin serum concentrations were higher in AR patients out of pollen season than in (p<0.01). There was a very strong direct relationship between QoL and serotonin concentrations.This preliminary study demonstrates that SAR influences serotonin concentrations and that serum serotonin could serve as a biomarker in AR patients with behavioural symptoms.
    Iranian journal of allergy, asthma, and immunology 09/2011; 10(3):183-8. DOI:10.03/ijaai.183188 · 1.01 Impact Factor
  • Giorgio Ciprandi, Mariangela Tosca
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 09/2011; 107(3):287; author reply 287-8. DOI:10.1016/j.anai.2011.05.014 · 2.75 Impact Factor
  • European Journal of Internal Medicine 04/2011; 22(2):e9-11. DOI:10.1016/j.ejim.2010.11.015 · 2.30 Impact Factor
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    ABSTRACT: This study evaluates serum tryptophan, kynurenine, kynurenine-to-tryptophan ratio, and neopterin levels in patients with pollen-induced allergic rhinitis (AR) during and outside of the pollen season, along with these values in healthy subjects. A total of 102 patients (56 female and 46 male, median age 28.7 years) were included in this study: 56 with seasonal AR evaluated outside of the pollen season and thus without allergic inflammation and symptoms, and 46 with seasonal AR evaluated during the pollen season with symptoms. A skin prick test and blood sampling for assessing serum concentrations of tryptophan and kynurenine and of immune activation marker neopterin were performed in all subjects. Tryptophan and kynurenine serum concentrations were higher in AR patients than in controls and were also higher out of pollen season than during this season. In conclusion, this preliminary study demonstrates that serum tryptophan metabolism could serve as a biomarker in patients with AR.
    Human immunology 09/2010; 71(9):911-5. DOI:10.1016/j.humimm.2010.05.017 · 2.55 Impact Factor
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    ABSTRACT: A few studies have outlined a possible relationship between an increased body mass index and allergic rhinitis. A single study reported that males with seasonal allergic rhinitis (SAR), evaluated outside the pollen season, had increased serum adiponectin levels. The aim of this preliminary study was to evaluate the serum adiponectin levels in a cohort of SAR normo-weight patients evaluated during the pollen season, comparing them with SAR patients evaluated out of pollen season and a group of healthy controls. The study included 137 subjects; 62 SAR patients evaluated in their pollen season, while symptomatic, 41 SAR patients studied out their pollen season, while they were without symptoms, and 34 normal subjects. All subjects were consecutively evaluated. All of them were normo-weight. A skin prick test and blood sampling for assessing serum adiponectin levels were performed in all subjects. After analysing genders separately, symptomatic male patients had significantly higher levels than both symptomless and normal males (p=0.0041 and 0.0001 respectively), symptomatic female patients showed significantly higher levels than both symptomless and normal females (p=0.0001 and 0.0071 respectively). This study provides the preliminary evidence that adiponectin serum levels might depend on allergen exposure in SAR normo-weight patients.
    International immunopharmacology 02/2010; 10(5):635-8. DOI:10.1016/j.intimp.2010.02.008 · 2.21 Impact Factor
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    ABSTRACT: Allergic rhinitis (AR) is characterized by inflammation sustained by dysregulated immune response. T-regulatory cells are involved in AR pathogenesis, mainly producing IL-10 and transforming growth factor (TGF)-beta. Indeed, there is a functional and allergen-specific defect of T-regulatory cells in AR. However, there are no data about the influence of allergen exposure on TGF-beta serum levels. Therefore, the aim of this preliminary study was to evaluate TGF-beta serum levels in patients with seasonal AR. Patients were evaluated either outside the pollen season and after 1 preseasonal sublingual immunotherapy (SLIT) course (38 subjects) or during the pollen season (57 subjects). All patients were allergic to Parietaria and/or grasses alone. TGF-beta was measured by a commercially available kit. Symptoms, drug use and eosinophils were evaluated.Serum allergen-specific IgG and IgA levels were also measured by the ELISA method. TGF-beta serum levels were significantly lower in patients evaluated outside the pollen season in comparison with the other 2 situations. SLIT induced the significantly highest TGF-beta serum levels. There was a significant negative relationship between TGF-beta and eosinophils in patients after SLIT. IgG and IgA levels were higher in SLIT-treated patients. This preliminary study provides evidence that TGF-beta serum levels are significantly dependent on allergen exposure.
    International Archives of Allergy and Immunology 11/2009; 152(1):66-70. DOI:10.1159/000260085 · 2.25 Impact Factor
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    ABSTRACT: It has been demonstrated that serum leptin is elevated in females with allergic rhinitis. Recently, it has been reported that one course of sublingual immunotherapy (SLIT) does not affect serum leptin levels. The aim of this study was to evaluate the serum leptin levels in a cohort of patients with pollen-induced allergic rhinitis, before and after two pre-seasonal SLIT courses. Forty-one patients (22 males and 19 females, median age 39 years) with AR, due to pollen allergy, and 34 healthy subjects (16 males and 18 females, median age 43 years) were included in the study. Blood sampling for assessing serum leptin was performed in all subjects before and after the second SLIT course. All patients were responders to SLIT. Serum leptin was significantly increased only in males (p=0.0056) after the second SLIT course. This preliminary study shows that at least two pre-seasonal SLIT courses were required to induce significant modifications in serum leptin levels, but it occurred only in males. Some hypotheses might be outlined, including a leptin protective effect, however further studies must clarify this issue.
    International immunopharmacology 07/2009; 9(10):1244-6. DOI:10.1016/j.intimp.2009.05.007 · 2.21 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 04/2009; 102(3):262-3. DOI:10.1016/S1081-1206(10)60095-6 · 2.75 Impact Factor
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    ABSTRACT: Several studies have outlined a possible relationship between an increased body mass index (BMI) and respiratory allergic diseases, such as asthma and rhinitis. The aim of the study was to analyse the relationship between BMI and allergic diseases, including allergic rhinitis and asthma, and functional parameters, such as nasal airflow, FEV(1), and non-specific BHR to methacholine, in a cohort of navy army subjects. The study included 100 patients with moderate-severe persistent allergic rhinitis alone, 100 with intermittent allergic asthma alone, and 100 healthy controls. All subjects were evaluated performing skin prick test, spirometry, and bronchostimulation test with methacholine. Rhinomanometry was performed in patients with rhinitis. BMI values were significantly lower in control subjects with respect to patients with rhinitis (P=0.0002) and with respect to patients with asthma (P<0.0001). BMI was also significantly higher in males with respect to females (P=0.005). A significant relationship has been observed between some categories of BHR and BMI either in patients with rhinitis (P<0.01) or in patients with asthma (P<0.01), whereas there was no association between BMI and functional parameters. This study provides the first evidence of a significant relationship between BMI and allergic rhinitis and between BMI and BHR in both allergic disorders.
    Respiratory medicine 10/2008; 103(2):289-95. DOI:10.1016/j.rmed.2008.08.008 · 2.33 Impact Factor
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    ABSTRACT: Nasal obstruction depends on allergic inflammation. Decongestion tests evaluate the reversibility of nasal airflow limitation. It has been previously reported that duration of persistent allergic rhinitis (PER) may involve important functional consequences. The purpose of the study was to evaluate the impact of the duration of rhinitis on the response to nasal decongestion test in a cohort of patients with PER. A total of 312 patients with moderate-severe PER were prospectively and consecutively evaluated: 234 males and 78 females, mean age 23.6 years. A detailed clinical history was taken and complete physical examination, nasal endoscopy, skin prick test, rhinomanometry, and nasal decongestion test were performed for all patients. A strong inverse correlation was observed (Pearson's r = -0.81) between rhinitis duration (years) and posttest percentage change of nasal airflow values. The duration of PER may induce a progressive impairment of the response to nasal decongestion test.
    The Laryngoscope 08/2008; 118(7):1139-41. DOI:10.1097/MLG.0b013e3181715160 · 2.03 Impact Factor
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    ABSTRACT: A remarkable relationship exists between the upper and lower airways. Bronchial obstruction is a paramount feature of asthma, and its reversibility is considered a main step in asthma diagnosis. To investigate the degree of bronchodilation and possible risk factors related to it in patients with moderate-severe persistent allergic rhinitis alone. A total of 375 patients with moderate-severe persistent allergic rhinitis and 115 controls were prospectively and consecutively evaluated by means of clinical examination, skin prick testing, spirometry, and bronchodilation testing. Patients with rhinitis showed a significant increase in forced expiratory volume in 1 second (FEV) after bronchodilation testing compared with basal values and levels in controls (P < .001). Two-thirds of the rhinitic patients had reversibility (> or = 12% basal levels). Patients with reversibility had lower FEV1 levels, longer rhinitis duration, and mite and tree allergies. This study highlights the close link between the upper and lower airways and the relevance of performing bronchodilation testing in patients with moderate-severe persistent allergic rhinitis.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 08/2008; 101(1):42-6. DOI:10.1016/S1081-1206(10)60833-2 · 2.75 Impact Factor
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    ABSTRACT: Probiotic milk has been previously demonstrated to reduce the number of respiratory infections (RI) among children attending day care centres. Thus, this pilot study was aimed to assess the efficacy and the safety of 3 month treatment with Bacillus clausii in the prevention of recurrent respiratory infections (RRI) in children. Eighty children with RRI were studied: 40 of them were randomly treated with B. clausii for 3 months, and followed up for further 3 months; 40 were included in the control group during the same period. Children treated with B. clausii had shorter duration of RI in comparison with the control group both during the treatment phase (mean 11.7 days vs 14.37; p=0.037) and the follow-up period (mean 6.6 days vs 10.92; p=0.049). This effect was evident also in allergic children during the follow-up. In conclusion, this pilot study provides the first preliminary evidence that B. clausii may exert a significant and persistent impact on RI in children and is safe and well tolerated.
    Therapeutics and Clinical Risk Management 04/2007; 3(1):13-7. DOI:10.2147/tcrm.2007.3.1.13 · 1.34 Impact Factor
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    ABSTRACT: Specific immunotherapy (SIT) is the only treatment capable of modifying the natural history of the allergic subjects. Several aspects of the immunopathological response modified by sublingual immunotherapy (SLIT) have been investigated; the first parameter historically studied was the production of allergen-specific antibodies. An increase of allergen-specific IgG4 and a decrease of IgE may appear after SLIT. A shift from Th2-polarized immune response toward Th1-oriented pattern has been reported after SLIT. More recently, a crucial role for a subpopulation of T cells has been evidenced: T regulatory (T-reg.) cells. Allergic patients have a defect of T-reg cells. SLIT should be able to induce a specific T-reg. response. SLIT is an alternative route of administration for SIT. Recent evidence shows that SLIT is also able to induce a T-reg. response as detected by IL-10 production.
    Allergy and Asthma Proceedings 12/2006; 28(1):40-3. DOI:10.2500/aap.2007.28.2974 · 3.35 Impact Factor
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    ABSTRACT: Allergic rhinitis may be associated with asthma. Forced expiratory flow between 25 and 75% of vital capacity (FEF2575) is a measure of small airways narrowing. The aim of this study was to evaluate whether patients with seasonal allergic rhinitis (SAR) without symptoms of asthma might, nevertheless, have airways obstruction both in and out of the pollen season. Fifty patients (mean age, 23.7+/-4.9 years) with SAR were evaluated both during and outside the pollen season. All of them had moderate-severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, spirometry, and methacholine (MCH) bronchial challenge were assessed in all subjects. Although data on forced vital capacity and response to MCH were similar in and out of the pollen season, all other parameters were markedly different. The major finding of the study was that FEF25-75 was significantly associated with nearly all of the parameters considered, including bronchial hyperreactivity, with Pearson R ranging from 31 to 75% and differences in mean FEF25-75 ranging between 14.5 and 16.5% of predicted. The more significant association was with nasal airflow in the pollen season (R = 82.8%; p < 0.001). A significant association persisted for all parameters while controlling for season. This study highlights the link between upper and lower airways and the role of FEF25-75 as an early marker of bronchial impairment in those patients with SAR alone.
    American Journal of Rhinology 11/2006; 20(6):641-7. DOI:10.2500/ajr.2006.20.2914 · 1.36 Impact Factor
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    ABSTRACT: The small airways may play an important role in the clinical manifestations of asthma. Forced expiratory flow between 25% and 75% (FEF25%-75%) has been proposed as an approximate measure of the caliber of distal airways. Bronchial hyperreactivity (BHR) is a feature of asthma. To evaluate the possible role of FEF25%-75% as a predictor of BHR in allergic patients with asthma and rhinitis. A total of 726 patients (mean +/- SD age, 24.7 +/- 6.3 years) were evaluated. Spirometry and methacholine bronchial challenge were evaluated in all the participants. A difference between forced expiratory volume in 1 second and FEF25%-75% greater than 20 or a ratio between these variables greater than 1.24 discriminates between patients with no response to a mild response to methacholine vs patients with a moderate-to-severe response with high sensitivity (P < .001). This study highlights the possible role of FEF25%-75% in predicting BHR in allergic individuals with airway disorders.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 05/2006; 96(5):692-700. DOI:10.1016/S1081-1206(10)61067-8 · 2.75 Impact Factor
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    ABSTRACT: The pathogenesis of allergic rhinitis and its link with asthma are well known. Nevertheless, a complete cross-sectional evaluation of the usually available clinical, functional and immunological parameters has never been made. We assessed nasal symptoms and flow, cytology, cytokines, pulmonary function and methacholine positivity in a large number of patients with pure pollinosis. Young men presenting at a military hospital for routine follow-up were recruited for the study. They had to suffer from rhinitis alone (without asthma) for at least 2 years and had to have a positive skin prick test to pollens only. During the pollen season, they underwent symptom evaluation, measurement of nasal flow, nasal scraping and lavage (cell count and assay for IL-4, IL-5, IL-8 and IFNgamma), pulmonary function tests and methacholine challenge. Fifty subjects (23.7+/-4.9 years old) were enrolled. All patients had high clinical scores (9.5+/-1.6) and inflammatory cells (eosinophils: 10.5+/-4 and neutrophils 21.3+/-6) and low nasal flow (482+/-111 ml/s). We found that the number of eosinophils in nasal scrapings highly correlated with all the above-mentioned parameters, including nasal flow, cytokines and spirometric values. A significant positive correlation was found between all inflammatory cells and all cytokines. IL-8, IL-4 and neutrophils displayed only a partial correlation with pulmonary parameters (FEV1, FVC and FEF25-75%), at variance wit IL-5 and eosinophils. Methacholine test positivity significantly correlated with the number of eosinophils in the nasal smear. Eosinophils in the nasal smear display the best correlation with all the clinical and immunological parameters in allergic rhinitis and also correlate well with methacholine response.
    International Archives of Allergy and Immunology 04/2005; 136(3):266-72. DOI:10.1159/000083953 · 2.43 Impact Factor