Meteorological factors, environmental allergen exposure, and individual susceptibility in thunderstorm asthma: a meta-analysis

Background Thunderstorm asthma is a rare but severe public health issue characterized by sudden asthma outbreaks linked to thunderstorms.Objective Assess the associations between meteorological factors, environmental allergen exposure and individual susceptibility with thunderstorm asthma risk.Methods We systematically searched PubMed, Embase, and Web of Science for studies published up to March 2025. Random-effects models were used to analysis, with subgroup analyses by study type and geographical location. Heterogeneity was assessed using I2 statistics, publication bias was evaluated via funnel plots and Egger’s test. Sensitivity analyses tested the robustness of findings.Results Research were classified into three categories: meteorological factors, environmental allergen exposure, and individual susceptibility factors. Meteorological factors were associated with a modest elevation (OR = 1.20, 95% CI: 1.05–1.37, I2 = 88.1%), with more pronounced effects observed in Europe (OR = 1.26, 95% CI: 1.17–1.37) and Asia (OR = 1.42, 95% CI: 1.04–1.93). Exposure to environmental allergens demonstrated a significant association with increased risk (OR = 6.32, 95% CI: 3.16–12.64, I2 = 53.4%), with the strongest effect noted in Oceania (OR = 6.99, 95% CI: 2.35–20.80). In contrast, individual susceptibility factors exhibited a weaker association (OR = 1.59, 95% CI: 0.84–2.98, I2 = 78.9%). Sensitivity analyses corroborated the robustness of these findings.Conclusion Environmental allergen exposure poses the greatest risk for thunderstorm asthma, followed by meteorological factors, with regional variations. These findings highlight the need for targeted public health strategies in high-risk regions.