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Thunderstorm Asthma


Do we need guidelines for prophylactic treatment as the season approaches and is there a role for prophylaxis guidelines in pollen sensitized asthmatics during the thunderstorm season?


By Mona Al-Ahmad, MD

Thunderstorm-induced asthma has been described as an observed increase in acute bronchospasm cases following thunderstorms in the local vicinity. Thunderstorms are considered a risk factor for asthma attacks in patients suffering from pollen allergy as evidenced by the occurrence of severe asthma epidemics during thunderstorms in the pollen season. Asthmatic patients allergic to pollen who stay indoors during thunderstorms and non-allergic subjects are not as affected. 

D’Amato et al concluded that 1) there is a temporal association between the start of the thunderstorm and the onset of asthma exacerbations; 2) Asthma epidemics related to thunderstorms are limited to pollen (and outdoor mould) seasons; 3) Subjects with pollen allergy who stay indoors with the window closed during thunderstorms are not involved; 4) patients who are not receiving asthma treatment and those with allergic rhinitis and without previous asthma can experience severe bronchoconstriction 5) and non-allergic subjects are not involved in thunderstorm-related asthma.

Prevention by avoiding exposure by remaining indoors has predominantly been the advice offered to highly sensitized individuals during severe thunderstorms. Could guidelines regarding adjustments in medication in this subset of individuals during this season improve outcomes? Identifying this subset of patients can prove challenging given patients without asthma symptoms, but affected by seasonal rhinitis are also at risk of asthma exacerbation. Is it possible to predict thunderstorm-related asthma?

  1. Cockcroft, Donald W. et al.Thunderstorm asthma: An allergen-induced early asthmatic response. Annals of Allergy, Asthma & Immunology , 2016; Volume 120 , Issue 2 , 120 – 123
  2. 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. 
  3. D’Amato G, Cecchi L, Annesi-Maesano I. A trans-disciplinary overview of case reports of thunderstorm-related asthma outbreaks and relapse. Eur Respir Rev 2012; 21:82–7.

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