Thunderstorm allergy and asthma: state of the art

Abstract

Thunderstorm-triggered asthma (TA) can be defined as the occurrence of acute asthma attacks immediately following a thunderstorm during pollen seasons. Outbreaks have occurred across the world during pollen season with the capacity to rapidly inundate a health care service, resulting in potentially catastrophic outcomes for allergicpatients. TA occurs when specific meteorological and aerobiological factors combine to affect predisposed atopic patients with IgE-mediated sentitization to pollen allergens. Thunderstorm outflows can concentrate aeroallergens, most commonly grass pollen but also other pollens such as Parietaria and moulds in TA, at ground level to release respirable allergenic particles after rupture by osmotic shock related to humidity and rainfall. Inhalation of high concentrations of these aeroallergens by sensitized individuals can induce early asthmatic responses which can be followed by a late inflammatory phase. There is evidence that, during pollen season, thunderstorms can induce allergic asthma outbreaks, sometimes also severe asthma crisis and sometimes deaths in patients suffering from pollen allergy. It has been observed that changes in the weather such as rain or humidity may induce hydratation of pollen grains during pollen seasons and sometimes also their fragmentation which generates atmospheric biological aerosols carrying allergens. Asthma attacks are induced for the high concentration at ground level of pollen grains which may release allergenic particles of respirable size after rupture by osmotic shock. In other words, it is a global health problem observed in several cities and areas of the world that can strike without sufficient warning, inducing sometimes severe clinical consequences also with deaths of asthma patients. Due to constant climate change, future TA events are likely to become more common, more disastrous and more unpredictable, as a consequence it is important to have deep knowledge on this topic to prevent asthma attacks. Other environmental factors, such as rapid changes in temperature and agricultural practices, also contribute to causing TA.

Climate change, air pollution, pollen allergy and extreme atmospheric events

“…Extreme weather phenomena such as thunderstorms trigger exacerbations of asthma attacks and need to be prevented with a correct information and therapy [30 ▪ ,31–33,38–40,41 ▪ ,42].…”

“…1) a risk to human health in pollinosis patients during pollen seasons. Thunderstorms that occur during the pollen season can induce severe asthma attacks and also deaths in pollen allergic patients [30 Asthma by thunderstorm is a term used to describe an increase in cases of acute bronchospasm after the appearance of thunderstorms in an area of presence of grasses or other allergenic plants [30 & ,31-37]. Exacerbations of asthma due to a thunderstorm are characterized, at the beginning of the storms, by a rapid increase in visits to the general practitioner or in the emergency department services of hospitals due to attacks of asthma.…”

“…1) a risk to human health in pollinosis patients during pollen seasons. Thunderstorms that occur during the pollen season can induce severe asthma attacks and also deaths in pollen allergic patients [30 ▪ ,31–37].…”

“…In particular, fresh grass pollen can break under high humidity conditions releasing an allergenic aerosol characterized by fragments of pollen cytoplasm in microdroplet. The released particles, such as the cytoplasm of the fragmented pollen, form an ultrafine aerosol of microparticles carrying allergens and able to induce asthma attacks penetrating into lower airways [30 ▪ ,31].…”

“…The increasing prevalence of allergic respiratory symptoms due to the inhalation of pollen grains, and the associated increasing medical and social costs make pollen allergy a public health problem. Changes in pollen patterns due to climate change can result in an allergy that causes difficulty working, disabilities, medical consultations and medication requirements with a significant impact on the cost of healthcare [24–29,30 ▪ ].…”