Skip to main content
SpringerLink
Log in

Allergens and thunderstorm asthma

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Thunderstorm-related asthma is increasingly recognized in many parts of the world. This review focuses on important advances in the understanding of the mechanism of the role of allergens, in particular fungal spores such as Alternaria, in asthma epidemics associated with thunderstorms. From our observations, we have proposed that the prerequisites for this phenomenon are as follows: 1) a sensitized, atopic, asthmatic individual; 2) prior airway hyperresponsiveness before a sudden, large allergen exposure; 3) a large-scale thunderstorm with cold outflow occurring at a time and location during an allergen season in which large numbers of asthmatics are outdoors; and 4) sudden release of large amounts of respirable allergenic fragments, particularly fungal spores such as Alternaria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Packe GE, Ayres JG: Asthma outbreak during a thunderstorm. Lancet 1985, 2:199–204

    Article  PubMed  CAS  Google Scholar 

  2. Packe GE, Ayres JG: Aeroallergen skin sensitivity in patients with severe asthma during a thunderstorm. Lancet 1986, 1:850–851.

    Article  PubMed  CAS  Google Scholar 

  3. Alderman PM, Sloan JP, Basran GS: Asthma and thunderstorms. Arch Emerg Med 1986, 3:260–262.

    PubMed  CAS  Google Scholar 

  4. Pulimood TB, Corden JM, Bryden C, et al.: Epidemic asthma and the role of the fungal mold Alternaria alternata. J Allergy Clin Immunol 2007, 120:610–617.

    Article  PubMed  Google Scholar 

  5. Venables KM, Allitt U, Collier CG, et al.: Thunderstorm-related asthma—the epidemic of 24/25 June 1994. Clin Exp Allergy 1997, 27:725–736.

    PubMed  CAS  Google Scholar 

  6. Davidson AC, Emberlin J, Cook AD, Venables KM: A major outbreak of asthma associated with a thunderstorm: experience of accident and emergency departments and patients’ characteristics. Thames Regions Accident and Emergency Trainees Association. BMJ 1996, 312:601–604.

    PubMed  CAS  Google Scholar 

  7. Hajat S, Goubet SA, Haines A: Thunderstorm-associated asthma: the effect on GP consultations. Br J Gen Pract 1997, 47:639–641.

    PubMed  CAS  Google Scholar 

  8. Celenza A, Fothergill J, Kupek E, Shaw RJ: Thunderstorm associated asthma: a detailed analysis of environmental factors. BMJ 1996, 312:604–607.

    PubMed  CAS  Google Scholar 

  9. Bellomo R, Gigliotti P, Treloar A, et al.: Two consecutive thunderstorm associated epidemics of asthma in the city of Melbourne. The possible role of rye grass pollen. Med J Aust 1992, 156:834–837.

    PubMed  CAS  Google Scholar 

  10. Girgis ST, Marks GB, Downs SH, et al.: Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk? Eur Respir J 2000, 16:3–8.

    Article  PubMed  CAS  Google Scholar 

  11. Marks GB, Colquhoun JR, Girgis ST, et al.: Thunderstorm outflows preceding epidemics of asthma during spring and summer. Thorax 2001, 56:468–471.

    Article  PubMed  CAS  Google Scholar 

  12. Egan P: Weather or not. Med J Aust 1985, 142:330.

    PubMed  CAS  Google Scholar 

  13. Wardman AE, Stefani D, MacDonald JC: Thunderstorm-associated asthma or shortness of breath epidemic: a Canadian case report. Can Respir J 2002, 9:267–270.

    PubMed  Google Scholar 

  14. Grundstein A, Sarnat SE, Klein M, et al.: Thunderstorm associated asthma in Atlanta, Georgia. Thorax 2008, 63:659–a.

    Article  PubMed  CAS  Google Scholar 

  15. D’Amato G, Liccardi G, Gilder J, et al.: Thunderstorm-associated asthma in pollinosis patients [e-letter]. BMJ 2005.

  16. Grundstein A, Ebelt Sarnat S: Meteorological mechanisms explaining thunderstorm-related asthma. Geogr Compass 2009, 3:45–63.

    Article  Google Scholar 

  17. Newson R, Strachan D, Archibald E, et al.: Acute asthma epidemics, weather and pollen in England, 1987–1994. Eur Respir J 1998, 11:694–701.

    PubMed  CAS  Google Scholar 

  18. Suphioglu C: Thunderstorm asthma due to grass pollen. Int Arch Allergy Immunol 1998, 116:253–260.

    Article  PubMed  CAS  Google Scholar 

  19. Taylor PE, Jacobson KW, House JM, Glovsky MM: Links between pollen, atopy and the asthma epidemic. Int Arch Allergy Immunol 2007, 144:162–170.

    Article  PubMed  Google Scholar 

  20. D’Amato G, Liccardi G, Frenguelli G: Thunderstormasthma and pollen allergy. Allergy 2007, 62:11–16.

    Article  PubMed  Google Scholar 

  21. Lewis SA, Corden JM, Forster GE, Newlands M: Combined effects of aerobiological pollutants, chemical pollutants and meteorological conditions on asthma admissions and A & E attendances in Derbyshire UK, 1993–96. Clin Exp Allergy 2000, 30:1724–1732.

    Article  PubMed  CAS  Google Scholar 

  22. Wark PA, Simpson J, Hensley MJ, Gibson PG: Airway inflammation in thunderstorm asthma. Clin Exp Allergy 2002, 32:1750–1756.

    Article  PubMed  CAS  Google Scholar 

  23. McDonald JE: Collection and washout of airborne pollens and spores by raindrops. Science 1962, 135:435–437.

    Article  PubMed  Google Scholar 

  24. Schappi GF, Taylor PE, Pain MC, et al.: Concentrations of major grass group 5 allergens in pollen grains and atmospheric particles: implications for hay fever and allergic asthma sufferers sensitized to grass pollen allergens. Clin Exp Allergy 1999, 29:633–641.

    Article  PubMed  CAS  Google Scholar 

  25. Taylor PE, Jonsson H: Thunderstorm asthma. Curr Allergy Asthma Rep 2004, 4:409–413.

    Article  PubMed  Google Scholar 

  26. Taylor PE, Flagan RC, Valenta R, Glovsky MM: Release of allergens as respirable aerosols: a link between grass pollen and asthma. J Allergy Clin Immunol 2002, 109:51–56.

    Article  PubMed  Google Scholar 

  27. Dales RE, Cakmak S, Judek S, et al.: The role of fungal spores in thunderstorm asthma. Chest 2003, 123:745–750.

    Article  PubMed  Google Scholar 

  28. Burge HA, Rogers CA: Outdoor allergens. Environ Health Perspect 2000, 108(Suppl 4):653–659.

    Article  PubMed  CAS  Google Scholar 

  29. O’Hollaren MT, Yunginger JW, Offord KP, et al.: Exposure to an aeroallergen as a possible precipitating factor in respiratory arrest in young patients with asthma. N Engl J Med 1991, 324:359–363.

    PubMed  Google Scholar 

  30. Targonski PV, Persky VW, Ramekrishnan V: Effect of environmental molds on risk of death from asthma during the pollen season. J Allergy Clin Immunol 1995, 95:955–961.

    Article  PubMed  CAS  Google Scholar 

  31. Black PN, Udy AA, Brodie SM: Sensitivity to fungal allergens is a risk factor for life-threatening asthma. Allergy 2000, 55:501–504.

    Article  PubMed  CAS  Google Scholar 

  32. Aas K, Leegaard J, Aukrust L, Grimmer O: Immediate type hypersensitivity to common moulds. Comparison of different diagnostic materials. Allergy 1980, 35:443–451.

    Article  PubMed  CAS  Google Scholar 

  33. Esch RE: Manufacturing and standardizing fungal allergen products. J Allergy Clin Immunol 2004, 113:210–215.

    Article  PubMed  Google Scholar 

  34. Cantani A, Ciaschi V: Epidemiology of Alternaria alternata allergy: a prospective study in 6840 Italian asthmatic children. Eur Rev Med Pharmacol Sci 2004, 8:289–294.

    PubMed  CAS  Google Scholar 

  35. Tariq SM, Matthews SM, Stevens M, Hakim EA: Sensitization to Alternaria and Cladosporium by the age of 4 years. Clin Exp Allergy 1996, 26:794–798.

    Article  PubMed  CAS  Google Scholar 

  36. D’Amato G, Chatzigeorgiou G, Corsico R, et al.: Evaluation of the prevalence of skin prick test positivity to Alternaria and Cladosporium in patients with suspected respiratory allergy. A European multicenter study promoted by the Subcommittee on Aerobiology and Environmental Aspects of Inhalant Allergens of the European Academy of Allergology and Clinical Immunology. Allergy 1997, 52:711–716.

    Article  PubMed  Google Scholar 

  37. Gergen PJ, Turkeltaub PC, Kovar MG: The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey. J Allergy Clin Immunol 1987, 80:669–679.

    Article  PubMed  CAS  Google Scholar 

  38. Arbes SJ Jr, Gergen PJ, Elliott L, Zeldin DC: Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol 2005, 116:377–383.

    Article  PubMed  Google Scholar 

  39. Lopez M, Salvaggio JE: Mold-sensitive asthma. Clin Rev Allergy 1985, 3:183–196.

    Article  PubMed  CAS  Google Scholar 

  40. Bush RK, Prochnau JJ: Alternaria-induced asthma. J Allergy Clin Immunol 2004, 113:227–234.

    Article  PubMed  Google Scholar 

  41. Mitakakis TZ, Barnes C, Tovey ER: Spore germination increases allergen release from Alternaria. J Allergy Clin Immunol 2001, 107:388–390.

    Article  PubMed  CAS  Google Scholar 

  42. Denning DW, O’Driscoll BR, Hogaboam CM, et al.: The link between fungi and severe asthma: a summary of the evidence. Eur Respir J 2006, 27:615–626.

    Article  PubMed  CAS  Google Scholar 

  43. Newson R, Strachan D, Corden J, Millington W: Fungal and other spore counts as predictors of admissions for asthma in the Trent region. Occup Environ Med 2000, 57:786–792.

    Article  PubMed  CAS  Google Scholar 

  44. Gravesen S: Fungi as a cause of allergic disease. Allergy 1979, 34:135–154.

    Article  PubMed  CAS  Google Scholar 

  45. Zureik M, Neukirch C, Leynaert B, et al.: Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey. BMJ 2002, 325:411.

    Article  PubMed  Google Scholar 

  46. Packe GE, Ayres JG: Aeroallergens in an asthma outbreak. Lancet 1986, 1:1333–1334.

    Article  PubMed  CAS  Google Scholar 

  47. D’Amato G, Cecchi L, Bonini S, et al.: Allergenic pollen and pollen allergy in Europe. Allergy 2007, 62:976–990.

    Article  PubMed  CAS  Google Scholar 

  48. Davis MB, Shaw RG: Range shifts and adaptive responses to quaternary climate change. Science 2001, 292:673–679.

    Article  PubMed  CAS  Google Scholar 

  49. Corden JM, Millington W, Mullins J: Long-term trends and regional variation in the aeroallergen Alternaria in Cardiff and Derby UK—are differences in climate and cereal production having an effect? Aerobiologia 2003, 19:191–199.

    Article  Google Scholar 

  50. Trapp RJ, Diffenbaugh NS, Brooks HE, et al.: Changes in severe thunderstorm environment frequency during the 21st century caused by anthropogenically enhanced global radiative forcing. Proc Natl Acad Sci U S A 2007, 104:19719–19723.

    Article  CAS  Google Scholar 

  51. Burge HA: An update on pollen and fungal spore aerobiology. J Allergy Clin Immunol 2002, 110:544–552.

    Article  PubMed  Google Scholar 

  52. Hyde HA, Williams DA: A daily consensus of Alternaria spores caught from the atmosphere at Cardiff in 1942 and 1943. Trans Brit Mycol Soc 1946, 29:78–85.

    Article  Google Scholar 

  53. Friesen TL, De Wolf ED, Francl LJ: Source strength of wheat pathogens during combine harvest. Aerobiologia 2001, 17:293–299.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Allergy, Cambridge University Hospitals National Health Service Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK

    Shuaib M. Nasser

Authors
  1. Shuaib M. Nasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas B. Pulimood
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuaib M. Nasser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nasser, S.M., Pulimood, T.B. Allergens and thunderstorm asthma. Curr Allergy Asthma Rep 9, 384–390 (2009). https://doi.org/10.1007/s11882-009-0056-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-009-0056-8

Keywords

Search

Navigation