Journal of Inflammation Research (Sep 2021)
Managing Exacerbations in Thunderstorm Asthma: Current Insights
Abstract
Josh Chatelier,1,2 Samantha Chan,1– 3 Ju Ann Tan,1,2 Alastair G Stewart,4,5 Jo Anne Douglass1,2 1Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia; 2Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; 3Immunology Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia; 4Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Melbourne, Victoria, Australia; 5ARC Centre for Personalised Therapeutics Technologies, University of Melbourne, Melbourne, Victoria, AustraliaCorrespondence: Josh ChatelierDepartment of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, AustraliaTel +61 3 9342 7191Fax + 61 3 9349 3199Email [email protected]: Epidemic thunderstorm asthma (ETSA) occurs following a thunderstorm due to the interaction of environmental and immunologic factors. Whilst first reported in the 1980s, the world’s largest event in Melbourne, Australia, on November 21, 2016 has led to a wealth of clinical literature seeking to identify its mechanisms, susceptibility risk factors, and management approaches. Thunderstorm asthma (TA) typically presents during an aeroallergen season in individuals sensitized to perennial rye grass pollen (RGP) in Australia, or fungus in the United Kingdom, in combination with meteorological factors such as thunderstorms and lightning activity. It is now well recognized that large pollen grains, which usually lodge in the upper airway causing seasonal allergic rhinitis (SAR), are ruptured during these events, leading to sub-pollen particles respirable to the lower respiratory tract causing acute asthma. The identified risk factors of aeroallergen sensitization, specifically to RGP in Australians with a history of SAR, and individuals born in Australia of South-East Asian descent as a risk factor for TA has been key in selecting appropriate patients for preventative management. Moreover, severity-determining risk factors for ETSA-related asthma admission or mortality, including pre-existing asthma or prior hospitalization, poor inhaled corticosteroid adherence, and outdoor location at the time of the storm are important in identifying those who may require more aggressive treatment approaches. Basic treatments include optimizing asthma control and adherence to inhaled corticosteroid therapy, treatment of SAR, and education regarding TA to increase recognition of at-risk days. Precision treatment approaches may be more beneficial in select individuals, including the use of allergen immunotherapy and even biologic treatment to mitigate asthma severity. Finally, we discuss the importance of environmental health literacy in the context of concerns surrounding the increased frequency of ETSA due to climate change and its implications for the frequency and severity of future events.Keywords: epidemic thunderstorm asthma, thunderstorm asthma, seasonal allergic rhinitis
