Thunderstorm asthma

Thunderstorm asthma (also referred to in the media as thunder fever or a pollen bomb[1]) is the triggering of an asthma attack by environmental conditions directly caused by a local thunderstorm. It has been proposed that during a thunderstorm, pollen grains can absorb moisture and then burst into much smaller fragments with these fragments being easily dispersed by wind.[2][3] While larger pollen grains are usually filtered by hairs in the nose, the smaller pollen fragments are able to pass through and enter the lungs, triggering the asthma attack.[4][5][6][7]

A thunderstorm in Tamworth, New South Wales, Australia
Colourised scanning electron microscope image of pollen grains from a variety of common plants

History

The phenomenon has been recognised for a significant period of time with a study of an event in Birmingham, England, noting the correlation between thunderstorms and hospitalisations.[8] This fact that these were not isolated events and were part of an ongoing pattern of events is clearly documented in the review "Thunderstorm asthma, an overview of the evidence base".[9] A significant impetus in the study of the phenomenon occurred after an event in 2016 in Melbourne, Australia. Since then there have been further reports of widespread thunderstorm asthma in Wagga Wagga, Australia; London, England; Naples, Italy;[10] Atlanta, United States;[11] and Ahvaz, Iran.[12] The outbreak in Melbourne, in November 2016, that overwhelmed the ambulance system and some local hospitals, resulted in at least nine deaths.[13][14][15][16][17] There was a similar incident in Kuwait in early December, 2016 with at least 5 deaths and many admissions to the ICU.[18][19]

Statistics

Many of those affected during a thunderstorm asthma outbreak may have never experienced an asthma attack before.[20]

It has been found 95% of those that were affected by thunderstorm asthma had a history of hayfever, and 96% of those people had tested positive to grass pollen allergies, particularly rye grass.[21] A rye grass pollen grain can hold up to 700 tiny starch granules, measuring 0.6 to 2.5 μm, small enough to reach the lower airways in the lung.[22][23][24]

Prevention

Patients with a history of grass allergies should be tested for asthma and treated for the grass allergies and asthma if also present. Patients with known asthma should be treated and counseled on the importance of adherence to preventative medication protocols.[25] Preventative treatment found useful for severe asthma includes Allergen immunotherapy (AIT) particularly sublingual immunotherapy (SLIT).[26]

Significant events
  • 6 July 1983 (1983-07-06) – 7 July 1983 (1983-07-07): Birmingham, England
  • 8 November 1987 (1987-11-08): Melbourne, Australia
  • 29 November 1989 (1989-11-29) – 30 November 1989 (1989-11-30): Melbourne, Australia
  • 24 July 1994 (1994-07-24) – 25 July 1994 (1994-07-25): London, England
  • 30 October 1997 (1997-10-30): Wagga Wagga, Australia
  • 4 June 2004 (2004-06-04): Naples, Italy
  • 25 November 2010 (2010-11-25): Melbourne, Australia
  • 2 November 2013 (2013-11-02): Ahvaz, Iran
  • 21 November 2016 (2016-11-21): Melbourne, Australia
  • 1 December 2016 (2016-12-01): Kuwait and Riyadh, Saudi Arabia
  • 12 June 2023 (2023-06-12): Thames Valley, England

References
  1. "A change in the pollen season – but is it worse than normal?". UK Met Office. 10 June 2022. Retrieved 20 July 2022.
  2. Sample, Ian (25 November 2016). "Thunderstorm asthma: how seasonal weather can affect human health". The Guardian. Retrieved 11 December 2022.
  3. pubmeddev. "thunderstorm asthma - PubMed - NCBI". www.ncbi.nlm.nih.gov. Retrieved 27 August 2019.
  4. Suphioglu C. Thunderstorm Asthma Due to Grass Pollen. Int Arch Allergy Immunol 1998;116:253–260. doi:10.1159/000023953
  5. Taylor, P.E. & Jonsson, H. Thunderstorm asthma. Curr Allergy Asthma Rep (2004) 4: 409. doi:10.1007/s11882-004-0092-3
  6. Dabrera G, Murray V, Emberlin J, Ayres JG, Collier C, Clewlow Y, Sachon P. Thunderstorm asthma: an overview of the evidence base and implications for public health advice. QJM. 2013 Mar;106(3):207-17. doi:10.1093/qjmed/hcs234. PMID 23275386
  7. D'Amato G, Vitale C, D'Amato M, Cecchi L, Liccardi G, Molino A, Vatrella A, Sanduzzi A, Maesano C, Annesi-Maesano I. Thunderstorm-related asthma: what happens and why. Clin Exp Allergy. 2016 Mar;46(3):390-6. doi:10.1111/cea.12709. PMID 26765082
  8. Packe, G. E.; Ayres, JonG. (27 July 1985). "Asthma Outbreak During a Thunderstorm". The Lancet. Originally published as Volume 2, Issue 8448. 326 (8448): 199–204. doi:10.1016/S0140-6736(85)91510-7. ISSN 0140-6736. PMID 2862383. S2CID 22213257.
  9. Dabrera, G.; Murray, V.; Emberlin, J.; Ayres, J. G.; Collier, C.; Clewlow, Y.; Sachon, P. (1 March 2013). "Thunderstorm asthma: an overview of the evidence base and implications for public health advice". QJM: An International Journal of Medicine. 106 (3): 207–217. doi:10.1093/qjmed/hcs234. ISSN 1460-2725. PMID 23275386.
  10. D'Amato, G., Liccardi, G. and Frenguelli, G. (2007), Thunderstorm-asthma and pollen allergy. Allergy, 62: 11–16. doi:10.1111/j.1398-9995.2006.01271.x
  11. Grundstein A, Sarnat SE, Klein M, Shepherd M, Naeher L, Mote T, Tolbert P. Thunderstorm associated asthma in Atlanta, Georgia. Thorax. 2008 Jul;63(7):659-60. doi:10.1136/thx.2007.092882. PMID 18587040
  12. Forouzan A, Masoumi K, Haddadzadeh Shoushtari M, Idani E, Tirandaz F, Feli M, Assarehzadegan MA, Asgari Darian A. An overview of thunderstorm-associated asthma outbreak in southwest of Iran. J Environ Public Health. 2014;2014:504017. doi:10.1155/2014/504017. PMID 25093023
  13. Wright, Patrick (24 November 2016). "'Thunderstorm asthma': Three people remain critical, at least four dead". ABC Online. Retrieved 24 November 2016.
  14. "'Thunderstorm asthma': Four people now believed dead, could have been more, minister says" ABC News, 23 November 2016. Accessed 23 November 2016.
  15. "Sixth person dies from thunderstorm asthma emergency". ABC News. 27 November 2016. Retrieved 27 November 2016.
  16. "'Thunderstorm asthma' deaths in Melbourne rise to nine". BBC Online. 29 November 2016. Retrieved 29 November 2016.
  17. "Thunderstorm asthma: Ninth death in Victoria after freak weather event in 2016". ABC News. 25 January 2017. Retrieved 25 January 2017.
  18. Five expats die of asthma as rain lashes Kuwait. Gulf Digital News, 2016
  19. "KUNA: Five people die in 2 days due to asthma attacks - health official". kuna.net.kw. 2 December 2016. Retrieved 8 December 2016.
  20. Reed Alexander; James Griffiths (23 November 2016). "'Thunder asthma:' Deadly illness caused by freak weather". CNN. Retrieved 23 November 2016.
  21. "What is thunderstorm asthma? - ABC News (Australian Broadcasting Corporation)". ABC News. 21 November 2016. Retrieved 23 November 2016.
  22. Peter Dockrill (21 August 2015). "Thunderstorm asthma is a real thing that's killed 2 people in Australia". ScienceAlert.com. Retrieved 23 November 2016.
  23. D'Amato G, Annesi Maesano I, Molino A, Vitale C, D'Amato M. Thunderstorm-related asthma attacks.J Allergy Clin Immunol. 2017 Jun;139(6):1786-1787. doi:10.1016/j.jaci.2017.03.003. PMID 28342913
  24. "Thunderstorm asthma". ASCIA - Australasian Society of Clinical Immunology and Allergy. 2016. Retrieved 12 December 2017.
  25. Harun, Nur-Shirin; Lachapelle, Philippe; Douglass, Jo (2019). "Thunderstorm-triggered asthma: what we know so far". Journal of Asthma and Allergy. 12: 101–108. doi:10.2147/JAA.S175155. ISSN 1178-6965. PMC 6512777. PMID 31190900.
  26. Lombardi, Carlo; Savi, Eleonora; Ridolo, Erminia; Passalacqua, Giovanni; Canonica, Giorgio Walter (2017). "Is allergic sensitization relevant in severe asthma? Which allergens may be culprit?". The World Allergy Organization Journal. 10 (1): 2. doi:10.1186/s40413-016-0138-8. ISSN 1939-4551. PMC 5219672. PMID 28101292.
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