A trans-disciplinary overview of case reports of thunderstorm-related asthma outbreaks and relapse

There is evidence that, during the pollen season, thunderstorms can be associated with allergic asthma outbreaks in patients suffering from pollen allergy 1, and there are observations in favour of the possibility that thunderstorms disturb ground-level pollen grains, which may release allergenic particles of respirable size into the atmosphere after rupture by osmotic shock 2, 3. During the first 20–30 min of a thunderstorm, patients suffering from pollen allergy may inhale a high concentration of the allergenic material that is dispersed into the atmosphere, which in turn can induce (severe) asthmatic reactions in some cases 3–6. Even though thunderstorms can induce severe asthma attacks or exacerbations, they are neither frequent nor responsible for a high amount of disease exacerbation. However, physicians and pollen allergy patients should know the mechanisms involved in the release of allergens from airborne pollen grains during thunderstorms and the associated risk in view of prevention. Information about the risk of an asthma attack is also relevant in subjects affected only by seasonal allergic rhinitis who can inhale lower airways pollen aerosol. In addition, there is a potential risk of thunderstorm-related relapse of asthma attacks in some patients. This constitutes a major concern nowadays as the possibility of thunderstorm-associated asthma outbreaks have become of dramatic actuality due to the “highly likely” increase in frequency of heavy precipitation events, including thunderstorms, projected by the climate change scenarios for the future decades 7. The purpose of this article is to gather existing trans-disciplinary data on thunderstorm-related asthma attacks and potential relapse in the same patient. Pollen grain, which is a causative agent of allergic respiratory responses, is among the commonest allergens and pollen allergy due to its elevated prevalence and associated costs is now a public health problem …