Thunderstorm Asthma: Looking Back and Looking Forward

Figures & data

Table 1 Thunderstorm Asthma Events

Date	Location	Allergen Trigger(s)	Presentation
6–7 Jul 1983	Birmingham, UK^Citation4	Fungal spores	106 emergency presentations (compared to usual ~20), most with hayfever in the preceding week
20–21 Jun 1984	Nottingham, UK^Citation2	Fungal spores	22 emergency presentations (~5-fold increase), 9 with prior hayfever but not asthma
11 Nov 1984	Melbourne, Australia^Citation3	Not specified	86 emergency presentations and 16 admissions; 95% having a history of atopy
Nov 1987	Melbourne, Australia^Citation14	Not specified	154 presentations (5 to 10-fold increase in presentations and admissions); one death
22 Jul 1989	Leicester, UK^Citation32	Fungal spores	32 hospital admissions (~7-fold increase)
Nov 1989	Melbourne, Australia^Citation14	Grass pollen	277 presentations (5 to 10-fold increase)
1–5 Nov 1990	Tamworth, Australia^Citation35	Grass pollen	110 emergency presentations and 123 general practitioner presentations (>10-fold increase)
24 Jun 1994	London, UK^Citation24	Grass pollen	640 emergency presentations (~10-fold increase), 63% with prior hayfever
1 Dec 1996	Kuwait City, Kuwait^Citation28	Not identified	844 presentations (17 near-fatal), 11 deaths
30–31 Oct 1997	Wagga Wagga, Australia^Citation23	Grass pollen	215 presentations, 41 admissions, 95% with hayfever and 96% of skin-prick tested cases sensitized to rye grass
27 Oct 1998	Newcastle, Australia^Citation20	Grass pollen	6 presenting patients underwent skin-prick testing; rye grass median wheal 20mm, all had hayfever
31 Jul – 1 Aug 2000	Calgary, Canada^Citation8	Fungal spores	157 presentations (9-fold increase)
29–31 Jul 2002	Cambridge, UK^Citation13	Fungal spores	57 presentations (~10-fold increase), 1 death
Nov 2002	Al-Ahsa, Saudi Arabia^Citation9	Not identified	Steady influx of acute cases requiring involvement of neighbouring hospitals
20 Nov 2003	Melbourne, Australia^Citation27	Grass pollen	70 paediatric emergency presentations (>3-fold increase)
4 Jun 2004	Naples, Italy^Citation26	Weed pollen	7 emergency department presentations within half an hour
24 Jun 2005	South-East England, UK^Citation11	Not identified	4-fold increase in calls relating to difficulty breathing to a telephone advice line, doubling of out-of-hours attendances
27–28 May, 2010	Barletta, Italy^Citation7	Olive tree pollen	20 emergency presentations (~10-fold increase)
25 Nov, 2010	Melbourne, Australia^Citation15	Grass pollen	36 emergency presentations (5 to 10-fold increase)
8 Nov, 2011	Melbourne, Australia^Citation6	Grass pollen	10 ambulance attendances per hour for breathing difficulties (2-fold increase)
2 Nov, 2013	Ahvaz, Iran^Citation22	Not identified	>2100 emergency presentations across nine hospitals
26 Oct, 2014	Canberra, Australia^Citation5	Grass pollen	15 asthma presentations at a single emergency department (4-fold increase)
21 Nov, 2013	Melbourne and Geelong, Australia^Citation21	Grass pollen	>3300 more respiratory presentations than expected to emergency departments, 10-fold increase in asthma admissions, 35 to intensive care; 10 deaths
11 Sep, 2018	Yuling, China^Citation10	Plant pollen	16-fold increase in paediatric asthma admissions

Figure 1 Proposed mechanism explaining thunderstorm asthma. Adapted by permission from Springer Nature, Current Allergy and Asthma Reports.¹⁶ Taylor PE, Jonsson H. Thunderstorm asthma. Copyright 2004.

Figure 2 Picture of all elements required for a thunderstorm asthma epidemic: storm activity, presence of aeroallergen (in this case grass pollen), and human presence as shown by building.

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