Thunderstorm asthma: mechanisms and prevention strategies: a prospective observational study from a tertiary allergy clinic in Eastern India

Gautam Modi

doi:10.18203/2320-6012.ijrms20264169

Authors

Gautam Modi Department of Allergy and Immunology, Modi Allergy Clinic, Patna Bihar India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20264169

Keywords:

Thunderstorm asthma, Pollen rupture, Allergic rhinitis, Grass pollen, Epidemic asthma

Abstract

Background: Thunderstorm asthma (TA) is an environmental phenomenon in which specific meteorological conditions convert pollen into respirable allergenic particles, triggering acute asthma exacerbations in sensitised individuals. Although well documented internationally, data from the Indo-Gangetic plain remain limited. The objective of the study is to evaluate the clinico-epidemiological profile, aeroallergen sensitisation patterns, and risk factors associated with thunderstorm-triggered asthma exacerbations in patients attending a tertiary allergy clinic in Patna, and to assess effectiveness of a structured prevention and patient-education strategy.

Methods: This prospective observational study was conducted at Modi Allergy Clinic, Rajendra Nagar, Patna, from March 2025 to March 2026. A total of 135 patients with physician-diagnosed asthma, allergic rhinitis, or symptoms associated with thunderstorms were enrolled. Clinical history, ARIA-based rhinitis grading, skin prick testing, spirometry, peak expiratory flow rate monitoring, and serum total IgE estimation were performed. Thunderstorm-associated exacerbations occurring within 24–48 hours during the pollen season were documented and correlated with sensitisation status. A structured prevention protocol comprising weather/pollen alerts, inhaled corticosteroid optimisation, written asthma action plans, indoor sheltering, air filtration, and mask use was implemented.

Results: Most participants were sensitised to grass and weed pollens. Thunderstorm-associated exacerbations were more frequent among patients with moderate-to-severe allergic rhinitis and grass-pollen sensitisation. The prevention strategy was associated with fewer thunderstorm-related emergency visits and unscheduled exacerbations.

Conclusions: Identification of high-risk patients and pre-season optimisation of controller therapy, combined with early-warning and patient-education strategies, may reduce clinical impact of thunderstorm-triggered asthma in the Indo-Gangetic plain.

References

Bellomo R, Gigliotti P, Treloar A, Holmes P, Suphioglu C, Singh MB, 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(12):834-7.

Suphioglu C, Singh MB, Taylor P, Bellomo R, Holmes P, Puy R, et al. Mechanism of grass-pollen-induced asthma. Lancet. 1992;339(8793):569-72.

D'Amato G, Annesi Maesano I, Molino A, Vitale C, D'Amato M. Thunderstorm-related asthma attacks. J Allergy Clin Immunol. 2017;139(6):1786-7.

Girgis ST, Marks GB, Downs SH, Kolbe A, Car GN, Paton R. Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk? Eur Respir J. 2000;16(1):3-8.

Dabrera G, Murray V, Emberlin J, Ayres JG, Collier C, Clewlow Y, et al. Thunderstorm asthma: an overview of the evidence base and implications for public health advice. QJM. 2013;106(3):207-17.

D'Amato G, Annesi-Maesano I, Urrutia-Pereira M, Del Giacco S, Rosario Filho NA, Chong-Neto HJ, et al. Thunderstorm allergy and asthma: state of the art. Multidiscip Respir Med. 2021;16:806.

Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM, et al. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health. 2018;2(6):e255-63.

Emmerson KM, Silver JD, Thatcher M, Wain A, Jones PJ, Dowdy A, et al. Atmospheric modelling of grass pollen rupturing mechanisms for thunderstorm asthma prediction. PLoS One. 2021;16(4):e0249488.

Xiao Z, Shi Y, Zhao D, Wang Y, Gu Y. Triggering mechanisms of acute thunderstorm asthma: epithelial barrier disruption and immune dysregulation. Respir Res. 2026;27:125.

Harun NS, Lachapelle P, Douglass J. Thunderstorm-triggered asthma: what we know so far. J Asthma Allergy. 2019;12:101-8.

D'Amato G, Annesi-Maesano I, Vaghi A, Cecchi L, D'Amato M. How do storms affect asthma? Curr Allergy Asthma Rep. 2018;18(4):24.

Cecchi L, Scala E, Caronni S, Citterio S, Asero R. Allergenicity at component level of sub-pollen particles from different sources obtained by osmolar shock: a molecular approach to thunderstorm-related asthma outbreaks. Clin Exp Allergy. 2021;51(2):253-61.

Rangamuwa KB, Young AC, Thien F. An epidemic of thunderstorm asthma in Melbourne 2016: asthma, rhinitis, and other previous allergies. Asia Pac Allergy. 2017;7(4):193-8.

Venkatesan P. Epidemic thunderstorm asthma. Lancet Respir Med. 2022;10(4):325-6.

Lee J, Kronborg C, O'Hehir RE, Hew M. Who's at risk of thunderstorm asthma? The ryegrass pollen trifecta and lessons learnt from the Melbourne thunderstorm epidemic. Respir Med. 2017;132:146-8.

Marks GB, Colquhoun JR, Girgis ST, Koski MH, Treloar AB, Hansen P, et al. Thunderstorm outflows preceding epidemics of asthma during spring and summer. Thorax. 2001;56(6):468-71.

Douglass JA, Lodge C, Chan S, Doherty A, Tan JA, Jin C, et al. Thunderstorm asthma in seasonal allergic rhinitis: the TAISAR study. J Allergy Clin Immunol. 2022;149(5):1607-16.

Hew M, Lee J, Susanto NH, Prasad S, Bardin PG, Barnes S, et al. The 2016 Melbourne thunderstorm asthma epidemic: risk factors for severe attacks requiring hospital admission. Allergy. 2019;74(1):122-30.

D'Amato G, Annesi-Maesano I, Cecchi L, D'Amato M. Latest news on relationship between thunderstorms and respiratory allergy, severe asthma, and deaths for asthma. Allergy. 2019;74(1):9-11.