Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study

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“…27 Thunderstorm asthma, Wong went on, is particularly dangerous because it can affect people who do not have asthma, with one study finding 65% of people with seasonal allergic rhinitis experienced it. 28 They have never learnt to recognise the symptoms, meaning they do not necessarily understand how to manage the symptoms with an inhaler, or when to seek help," he explained. In 2016, a thunderstorm asthma event in Victoria, Australia, led to 3,365 people presenting to an emergency department with acute respiratory symptoms.…”

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“…Secondly, despite the absence of prognostic/predictive values of specific IgE titres in MITRA, these are associated with worse asthma symptoms and asthma attacks in thunderstorm asthma [11]. This may be due to the fact that specific IgE and allergen load predict early allergic responses' severity, whereas the type 2 inflammatory response arises during the late asthmatic response [12].…”

UpToDate®

“…The mechanism appears to involve rupture of water-logged pollen grains, which releases allergenic debris that is swept up by strong cross currents and deposited in concentrated form at ground level. In a multicenter study of adults with a past diagnosis of thunderstorm asthma and/or seasonal allergic rhinitis, risk factors for thunderstorm asthma included higher pollen-specific immunoglobulin E levels, eosinophil counts, fractional exhaled nitric oxide levels, and asthma that was not optimally controlled 3. Clinicians should be aware that thunderstorms can precipitate asthma and counsel patients with pollen allergies and asthma to avoid the outdoors during and after thunderstorms occurring during pollen seasons.…”