Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study

• DOI: 10.1016/j.jaci.2021.10.028
• Publication Date: 2021-11-10T20:24:25Z
• Authors: Jo A. Douglass; Caroline Lodge; Samantha Chan; Alice Doherty; Ju Ann Tan; Celina Jin; Alastair Stewart; Anne M. Southcott; Andrew Gillman; Joy Lee; Danny Csutoros; Liam Hannan; Laurence Ruane; Sara Barnes; Lou Irving; Nur-Shirin Harun; Phillipe Lachapelle; Kymble Spriggs; Michael Sutherland; Katharine See; Christine F. McDo...; Matthew Conron; Naghmeh Radhakrishna; Christopher Worsnop; Fay H. Johnston; Janet M. Davies; Vanessa Bryant; Linda Iles; David Ranson; Paresa Spanos; Don Vicendese; Adrian Lowe; Edward J. Newbigin; Philip Bardin; Shyamali Dharmage
• Keywords: Adult; ACQ; spirometry; specific IgE; seasonal allergic rhinitis; 610; Rhinitis, Allergic, Seasonal; Allergens; Immunoglobulin E; ryegrass pollen; epidemic; Asthma; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Humans; Pollen; thunderstorm

Asthma epidemics associated with thunderstorms have had catastrophic effects on individuals and emergency services. Seasonal allergic rhinitis (SAR) is present in the vast majority of people who develop thunderstorm asthma (TA), but there is little evidence regarding risk factors for TA among the SAR population.We sought to identify risk factors for a history of TA and hospital presentation in a cohort of individuals with SAR.This multicenter study recruited adults from Melbourne, Australia, with a past diagnosis of TA and/or self-reported SAR. Clinical information, spirometry results, white blood cell count, ryegrass pollen-specific (RGP-sp) IgE concentration, and fractional exhaled nitric oxide were measured to identify risk factors for a history of TA in individuals with SAR.From a total of 228 individuals with SAR, 35% (80 of 228) reported SAR only (the I-SAR group), 37% (84 of 228) reported TA symptoms but had not attended hospital for treatment (the O-TA group), and 28% (64 of 228) had presented to the hospital for TA (the H-TA group). All patients in the H-TA group reported a previous asthma diagnosis. Logistic regression analysis of factors associated with O-TA and H-TA indicated that lower FEV1 value and an Asthma Control Questionnaire score higher than 1.5 were associated with H-TA. Higher blood RGP-sp IgE concentration, eosinophil counts, and fractional exhaled nitric oxide level were significantly associated with both O-TA and H-TA. Receiver operating curve analysis showed an RGP-sp IgE concentration higher than 10.1 kU/L and a prebronchodilator FEV1 value of 90% or lower to be biomarkers of increased H-TA risk.Clinical tests can identify risk of a history of TA in individuals with SAR and thereby inform patient-specific treatment recommendations.