Thunderstorm asthma

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A thunderstorm in Tamworth, New South Wales, Australia Tamworth Storm 15th Feb 2006 a.sized.jpg
A thunderstorm in Tamworth, New South Wales, Australia
Colourised scanning electron microscope image of pollen grains from a variety of common plants Misc pollen colorized.jpg
Colourised scanning electron microscope image of pollen grains from a variety of common plants

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. Due to the acute nature of the onset and wide exposure of local populations to the same triggering conditions, severe epidemic thunderstorm asthma events can put significant and unmanageable stress on public health facilities.


Widely recognised but not fully understood, 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]


The phenomenon of thunderstorm asthma has been recognised since the 1980s, with an event in Birmingham, England, in July 1983 often considered the first prominent example. [8] A 2013 study which reviewed instances of abnormally high asthma-related admissions to emergency departments between 1983 and 2013 identified strong correlation between those instances and thunderstorms, while noting that such events were so rare that very little detailed research into the phenomenon had occurred. [9]

A significant impetus in the study of the phenomenon occurred after an event in November 2016 in Melbourne, Australia. Recognised as the most severe epidemic thunderstorm asthma event on record, the onset overwhelmed the city's ambulance system and some local hospitals, saw a ten-fold increase in asthma cases presenting to emergency departments compared with average, and resulted in ten deaths. [10] [11] [12] [13] [14] [15] One month later, an epidemic thunderstorm asthma event in Kuwait resulted in at least 5 deaths and many admissions to the ICU. [16] [17]

Since then there have been further reports of epidemic thunderstorm asthma events in Wagga Wagga, Australia; London, England; Naples, Italy; [18] Atlanta, United States; [19] and Ahvaz, Iran. [20]


Many of those affected during a thunderstorm asthma outbreak may have never experienced an asthma attack before. [21]

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. [22] 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. [23] [24] [25]


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. [26] Preventative treatment found useful for severe asthma includes Allergen immunotherapy (AIT) particularly sublingual immunotherapy (SLIT). [27]

Significant events

Related Research Articles

<span class="mw-page-title-main">Asthma</span> Long-term inflammatory disease of the airways of the lungs

Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.

<span class="mw-page-title-main">Pollen</span> Grains containing the male gametophytes of seed plants

Pollen is a powdery substance produced by most types of flowers of seed plants for the purpose of sexual reproduction. It consists of pollen grains, which produce male gametes. Pollen grains have a hard coat made of sporopollenin that protects the gametophytes during the process of their movement from the stamens to the pistil of flowering plants, or from the male cone to the female cone of gymnosperms. If pollen lands on a compatible pistil or female cone, it germinates, producing a pollen tube that transfers the sperm to the ovule containing the female gametophyte. Individual pollen grains are small enough to require magnification to see detail. The study of pollen is called palynology and is highly useful in paleoecology, paleontology, archaeology, and forensics. Pollen in plants is used for transferring haploid male genetic material from the anther of a single flower to the stigma of another in cross-pollination. In a case of self-pollination, this process takes place from the anther of a flower to the stigma of the same flower.

<span class="mw-page-title-main">Allergy</span> Immune system response to a substance that most people tolerate well

Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, coughing, a runny nose, shortness of breath, or swelling. Note that food intolerances and food poisoning are separate conditions.

An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies.

<span class="mw-page-title-main">Thunderstorm</span> Type of weather with lightning and thunder

A thunderstorm, also known as an electrical storm or a lightning storm, is a storm characterized by the presence of lightning and its acoustic effect on the Earth's atmosphere, known as thunder. Relatively weak thunderstorms are sometimes called thundershowers. Thunderstorms occur in a type of cloud known as a cumulonimbus. They are usually accompanied by strong winds and often produce heavy rain and sometimes snow, sleet, or hail, but some thunderstorms produce little precipitation or no precipitation at all. Thunderstorms may line up in a series or become a rainband, known as a squall line. Strong or severe thunderstorms include some of the most dangerous weather phenomena, including large hail, strong winds, and tornadoes. Some of the most persistent severe thunderstorms, known as supercells, rotate as do cyclones. While most thunderstorms move with the mean wind flow through the layer of the troposphere that they occupy, vertical wind shear sometimes causes a deviation in their course at a right angle to the wind shear direction.

<span class="mw-page-title-main">Anaphylaxis</span> Life-threatening allergic reaction

Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock. These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels. Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or has taken other medications in response, and even if symptoms appear to be improving.

<span class="mw-page-title-main">Allergic rhinitis</span> Nasal inflammation due to allergens in the air

Allergic rhinitis, of which the seasonal type is called hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. Signs and symptoms include a runny or stuffy nose, sneezing, red, itchy, and watery eyes, and swelling around the eyes. The fluid from the nose is usually clear. Symptom onset is often within minutes following allergen exposure, and can affect sleep and the ability to work or study. Some people may develop symptoms only during specific times of the year, often as a result of pollen exposure. Many people with allergic rhinitis also have asthma, allergic conjunctivitis, or atopic dermatitis.

<span class="mw-page-title-main">Rhinitis</span> Irritation and inflammation of the mucous membrane inside the nose

Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip.

<span class="mw-page-title-main">Latex allergy</span> Medical condition

Latex allergy is a medical term encompassing a range of allergic reactions to the proteins present in natural rubber latex. It generally develops after repeated exposure to products containing natural rubber latex. When latex-containing medical devices or supplies come in contact with mucous membranes, the membranes may absorb latex proteins. In some susceptible people, the immune system produces antibodies that react immunologically with these antigenic proteins. Many items contain or are made from natural rubber, including shoe soles, pen grips, hot water bottles, elastic bands, rubber gloves, condoms, baby-bottle nipples, and balloons; consequently, there are many possible routes of exposure that may trigger a reaction. People with latex allergies may also have or develop allergic reactions to some fruits, such as bananas.

<span class="mw-page-title-main">Allergen immunotherapy</span> Medical treatment for environmental allergies

Allergen immunotherapy, also known as desensitization or hypo-sensitization, is a medical treatment for environmental allergies, such as insect bites, and asthma. Immunotherapy involves exposing people to larger and larger amounts of allergens in an attempt to change the immune system's response.

<span class="mw-page-title-main">Pollen count</span> Method for quantifying airborne pollen

A pollen count is a measurement of the number of pollen grains in a given volume of air. Pollen counts, and forecasts of pollen conditions, are routinely produced and reported to the public because high aerial pollen concentration is associated with increased rates of allergic reaction for those with conditions such as hay fever and asthma. The pollen counted are usually identified to family; particularly families with hyperallergenic pollen and families that are prevalent in the relevant area. Thunderstorm asthma events as well as mild winters with warmer days lead to increases in pollen counts, while colder winters lead to delayed pollen release. Though not pollen, hyperallergenic fungal spores such as those of Alternaria may be counted as well.

<span class="mw-page-title-main">Anemophily</span> Wind pollination

Anemophily or wind pollination is a form of pollination whereby pollen is distributed by wind. Almost all gymnosperms are anemophilous, as are many plants in the order Poales, including grasses, sedges, and rushes. Other common anemophilous plants are oaks, pecans, pistachios, sweet chestnuts, alders and members of the family Juglandaceae. Approximately 12% of plants across the globe are pollinated by anemophily, including cereal crops like rice and corn and other prominent crop plants like wheat, rye, barley, and oats. In addition, many pines, spruces, and firs are wind-pollinated.

Oral allergy syndrome (OAS) or pollen-food allergy is a type of food allergy classified by a cluster of allergic reactions in the mouth and throat in response to eating certain fruits, nuts, and vegetables. It typically develops in adults with hay fever.

<span class="mw-page-title-main">Wheat allergy</span> Medical condition

Wheat allergy is an allergy to wheat which typically presents itself as a food allergy, but can also be a contact allergy resulting from occupational exposure. Like all allergies, wheat allergy involves immunoglobulin E and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat. Some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy is rare. Prevalence in adults was found to be 0.21% in a 2012 study in Japan.

<span class="mw-page-title-main">Eosinophil cationic protein</span> Mammalian protein found in Homo sapiens

Eosinophil cationic protein (ECP) also known as ribonuclease 3 is a basic protein located in the eosinophil primary matrix. In humans, the eosinophil cationic protein is encoded by the RNASE3 gene.

An aeroallergen is any airborne substance, such as pollen or spores, which triggers an allergic reaction.

<span class="mw-page-title-main">Extreme weather events in Melbourne</span>

Extreme weather events in Melbourne, Australia have occurred on multiple occasions. The city has experienced a number of highly unusual weather events and extremes of weather. An increase in heat waves and record breaking temperatures in the 21st century has led to much discussion over the effects of climate change in the country.

<span class="mw-page-title-main">Pathophysiology of asthma</span> Medical condition

Asthma is a common pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of respiratory smooth muscle, and episodes of bronchoconstriction. The Centers for Disease Control and Prevention estimate that 1 in 11 children and 1 in 12 adults have asthma in the United States of America. According to the World Health Organization, asthma affects 235 million people worldwide. There are two major categories of asthma: allergic and non-allergic. The focus of this article will be allergic asthma. In both cases, bronchoconstriction is prominent.

<span class="mw-page-title-main">Dust mite allergy</span> Medical condition

Dust mite allergy, also known as house dust allergy, is a sensitization and allergic reaction to the droppings of house dust mites. The allergy is common and can trigger allergic reactions such as asthma, eczema or itching. The mite's gut contains potent digestive enzymes that persist in their feces and are major inducers of allergic reactions such as wheezing. The mite's exoskeleton can also contribute to allergic reactions. Unlike scabies mites or skin follicle mites, house dust mites do not burrow under the skin and are not parasitic.

<span class="mw-page-title-main">Asthma trigger</span> Factor that provokes symptoms of asthma

Asthma triggers are factors or stimuli that provoke the exacerbation of asthma symptoms or increase the degree of airflow disruption, which can lead to an asthma attack. An asthma attack is characterized by an obstruction of the airway, hypersecretion of mucus and bronchoconstriction due to the contraction of smooth muscles around the respiratory tract. Its symptoms include a wide range of manifestations such as breathlessness, coughing, a tight chest and wheezing.


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