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J Asthma Allergy. 2019 May 6;12:101-108. doi: 10.2147/JAA.S175155. eCollection 2019.

Thunderstorm-triggered asthma: what we know so far.

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Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
Lung Health Research Centre, The University of Melbourne, Melbourne, VIC, 3052, Australia.
Department of Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
Pulmonary Division, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.


Thunderstorm-triggered asthma (TA) is the occurrence of acute asthma attacks immediately following a thunderstorm. Epidemics have occurred across the world during pollen season and have the capacity to rapidly inundate a health care service, resulting in potentially catastrophic outcomes for patients. TA occurs when specific meteorological and aerobiological factors combine to affect predisposed patients. Thunderstorm outflows can concentrate aeroallergens, most commonly grass pollen in TA, at ground level to release respirable allergenic particles after rupture by osmotic shock related to humidity and rainfall. Inhalation of high concentrations of these aeroallergens by sensitized individuals can induce early asthmatic responses which are followed by a late inflammatory phase. Other environmental factors such as rapid temperature change and agricultural practices contribute to the causation of TA. The most lethal TA event occurred in Melbourne, Australia, in 2016. Studies on the affected individuals found TA to be associated with allergic rhinitis, ryegrass pollen sensitization, pre-existing asthma, poor adherence to inhaled corticosteroid preventer therapy, hospital admission for asthma in the previous year and outdoor location at the time of the storm. Patients without a prior history of asthma were also affected. These factors are important in extending our understanding of the etiology of TA and associated clinical indicators as well as possible biomarkers which may aid in predicting those at risk and thus those who should be targeted in prevention campaigns. Education on the importance of recognizing asthma symptoms, adherence to asthma treatment and controlling seasonal allergic rhinitis is vital in preventing TA. Consideration of allergen immunotherapy in selected patients may also mitigate risk of future TA. Epidemic TA events are predicted to increase in frequency and severity with climate change, and identifying susceptible patients and preventing poor outcomes is a key research and public health policy priority.


asthma; rhinitis; ryegrass; thunderstorm

Conflict of interest statement

Professor Jo Douglass reports personal fees from Novartis, GSK, and Astra Zeneca; received funds for investigating in commercially funded trials for GSK, Astra Zeneca,  and Sanofi-Aventis; received royalties from Health Press from the publication of Fast Facts, during the conduct of the study. Also received funds outside the submitted work from BioCryst and Grifols for investigating in a commercially sponsored clinical trial; and funds from Novartis for intiatiating a trial at the The Royal Melbourne Hospital. The authors report no other conflicts of interest in this work. 

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