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      Thunderstorm Asthma: Looking Back and Looking Forward

      review-article
      Author(s): 1 , 2
      Publication date (Electronic):
      Journal: Journal of Asthma and Allergy
      Publisher: Dove
      Keywords: asthma, epidemics, spores, pollen, critical care

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          Abstract

          Epidemic thunderstorm asthma has been reported to have occurred around twenty times over the past three decades in locations around the world. Thunderstorm asthma events are characterized by a significant increase in asthma presentations, which on occasion can overwhelm local medical services and result in fatalities. This review article presents the epidemiological data underpinning previous thunderstorm asthma events and analyzes what is known about the etiology of this unusual phenomenon. The evidence behind published risk factors, both at the individual and population level, is discussed. Research from the fields of allergy, pulmonology, meteorology, and climatology is drawn together and critically reviewed to surmise future predictions regarding thunderstorm asthma episodes. Finally, evidence-based individual, community, and environmentally targeted preventive strategies are presented.

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          Epidemic asthma and the role of the fungal mold Alternaria alternata.

          Thomas Pulimood, Julie M Corden, Clare Bryden … (2007)
          After July 29, 2002, an epidemic of asthma admissions was associated with a thunderstorm in the United Kingdom. We sought to study the cause of epidemics of asthma associated with thunderstorms. We performed a case-control study of 26 patients presenting to Cambridge University Hospital with asthma after the thunderstorm. Control subjects were 31 patients with summer seasonal asthma. Subjects underwent skin tests and specific IgE serology to inhaled aeroallergens. Meteorologic and aerobiologic data correlated with asthma admissions were analyzed. Twenty-three of 26 cases had IgE sensitization to Alternaria species. Eleven of 31 control subjects gave a history of asthma exacerbation during thunderstorms. Ten of these 11 control subjects were sensitive to Alternaria species on skin testing, but Alternaria species sensitivity was only identified in 4 of the 20 remaining control subjects who did not report thunderstorm-related asthma symptoms. The odds ratio of having epidemic thunderstorm-related asthma if sensitive to Alternaria species was 9.31 (95% CI, 2.305-37.601; P = .0008) and 63.966 (95% CI, 3.577-1143.9; P < .0001) if sensitive to Alternaria species, Cladosporium species, or both. Poisson regression analysis showed that counts of broken Alternaria species and Didymella and Cladosporium species were significantly correlated with each other and with asthma admissions. The thunderstorm was associated with increased levels of Alternaria, Cladosporium, and Didymella species. Alternaria alternata sensitivity is a compelling predictor of epidemic asthma in patients with seasonal asthma and grass pollen allergy and is likely to be the important factor in thunderstorm-related asthma. Alternaria species sensitization in asthmatic subjects with grass pollen sensitivity predicts susceptibility to thunderstorm-associated asthma.
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            Thunderstorm-related asthma: what happens and why.

            G D'Amato, C. Vitale, M D'Amato … (2016)
            The fifth report issued by the Intergovernmental Panel on Climate Change forecasts that greenhouse gases will increase the global temperature as well as the frequency of extreme weather phenomena. An increasing body of evidence shows the occurrence of severe asthma epidemics during thunderstorms in the pollen season, in various geographical zones. The main hypotheses explaining association between thunderstorms and asthma claim that thunderstorms can concentrate pollen grains at ground level which may then release allergenic particles of respirable size in the atmosphere after their rupture by osmotic shock. During the first 20-30 min of a thunderstorm, patients suffering from pollen allergies may inhale a high concentration of the allergenic material that is dispersed into the atmosphere, which in turn can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. All subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events.
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              Mechanism of grass-pollen-induced asthma

              P. Holmes, R Puy, C Suphioglu … (1992)
              Many asthmatics are sensitive to rye-grass pollen, but pollen grains are too large to penetrate the lower airways. Our aim was to investigate the mechanism by which rye-grass pollen causes asthma. A major allergen of rye-grass pollen, Lol pIX, is located in intracellular starch granules within pollen grains. In-vitro tests showed that pollen grains are ruptured in rainwater by osmotic shock, each grain releasing about 700 starch granules into the environment. These granules are small enough to enter the airways (less than 3 microns in diameter). The starch granules were present in atmospheric samples taken during the pollen season, and showed a 50-fold increase in atmospheric concentration on days following rainfall. Isolated granules elicited IgE-mediated responses in asthmatic patients, and 4 patients with rainfall-associated asthma who underwent an inhalation challenge test had striking bronchial constriction after exposure to starch granules. Starch granules released from rye-grass pollen seem to be capable of causing asthma.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Asthma Allergy
                Journal ID (iso-abbrev): J Asthma Allergy
                Journal ID (publisher-id): jaa
                Journal ID (pmc): jaa
                Title: Journal of Asthma and Allergy
                Publisher: Dove
                ISSN (Electronic): 1178-6965
                Publication date (Electronic): 08 September 2020
                Publication date Collection: 2020
                Volume: 13
                Pages: 293-299
                Affiliations
                [1 ]Department of Respiratory Medicine, Sydney Children’s Hospital , Sydney, New South Wales, Australia
                [2 ]Faculty of Medicine, University of New South Wales , Sydney, New South Wales, Australia
                Author notes
                Correspondence: Ajay Kevat Department of Respiratory Medicine, Sydney Children’s Hospital , High Street, Randwick, Sydney, New South Wales, AustraliaTel +61 2 9382 1477 Email a.kevat@unsw.edu.au
                Author information
                http://orcid.org/0000-0001-9881-6478
                Article
                Publisher ID: 265697
                DOI: 10.2147/JAA.S265697
                PMC ID: 7501467
                PubMed ID: 32982317
                SO-VID: ec6140db-4922-412b-a8c0-e35adfac8d9a
                Copyright © © 2020 Kevat.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 10 June 2020
                Date accepted : 06 August 2020
                Page count
                Figures: 2, Tables: 1, References: 39, Pages: 7
                Categories
                Subject: Review

                ScienceOpen disciplines: Immunology
                Keywords: asthma,epidemics,spores,pollen,critical care
                Data availability:
                ScienceOpen disciplines: Immunology
                Keywords: asthma, epidemics, spores, pollen, critical care

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