Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study

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 McDonald; 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

doi:10.1016/j.jaci.2021.10.028

Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study

J Allergy Clin Immunol. 2022 May;149(5):1607-1616. doi: 10.1016/j.jaci.2021.10.028. Epub 2021 Nov 11.

Authors

Jo A Douglass¹, Caroline Lodge², Samantha Chan³, Alice Doherty², Ju Ann Tan³, Celina Jin³, Alastair Stewart⁴, Anne M Southcott⁵, Andrew Gillman⁵, Joy Lee⁶, Danny Csutoros⁷, Liam Hannan⁸, Laurence Ruane⁹, Sara Barnes¹⁰, Lou Irving¹¹, Nur-Shirin Harun¹¹, Phillipe Lachapelle¹², Kymble Spriggs³, Michael Sutherland¹³, Katharine See⁸, Christine F McDonald⁶, Matthew Conron¹⁴, Naghmeh Radhakrishna¹⁴, Christopher Worsnop⁶, Fay H Johnston¹⁵, Janet M Davies¹⁶, Vanessa Bryant¹⁷, Linda Iles¹⁸, David Ranson¹⁸, Paresa Spanos¹⁹, Don Vicendese²⁰, Adrian Lowe², Edward J Newbigin²¹, Philip Bardin⁹, Shyamali Dharmage²

Affiliations

¹ Department of Medicine, The University of Melbourne, Parkville, Australia. Electronic address: jdouglass@unimelb.edu.au.
² Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia.
³ Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia.
⁴ Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Australia.
⁵ Department of Respiratory and Sleep Medicine, Western Health, Footscray, Australia.
⁶ Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.
⁷ Department of Health and Human Services, State Government of Victoria, Melbourne, Australia.
⁸ Department of Respiratory Medicine, Northern Health, Epping, Australia.
⁹ Monash Lung, Sleep, Allergy and Immunology, Monash Hospital and University, Clayton, Australia.
¹⁰ Department of Allergy, Monash Health, Clayton, Australia.
¹¹ Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia.
¹² Pulmonary Division, University of Sherbrooke, Sherbrooke, Québec, Canada.
¹³ Department of Medicine, The University of Melbourne, Richmond, Australia.
¹⁴ Department of Respiratory Medicine, St. Vincent's Hospital, Fitzroy, Australia.
¹⁵ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
¹⁶ Centre for Immunology and Infection Control, The University of Queensland, Herston, Australia.
¹⁷ Immunology Division, Walter and Eliza Hall Institute of Medical Research 1G Royal Parade, Parkville, Australia.
¹⁸ Victorian Institute of Forensic Medicine, Monash University, Southbank, Australia.
¹⁹ Coroners Court of Victoria, Southbank, Australia.
²⁰ Department of Mathematics and Statistics, La Trobe University, Essendon, Australia.
²¹ School of BioSciences, The University of Melbourne, Parkville, Australia.

PMID: 34774618
DOI: 10.1016/j.jaci.2021.10.028

Abstract

Background: 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.

Objective: We sought to identify risk factors for a history of TA and hospital presentation in a cohort of individuals with SAR.

Methods: 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.

Results: 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.

Conclusion: Clinical tests can identify risk of a history of TA in individuals with SAR and thereby inform patient-specific treatment recommendations.

Keywords: ACQ; Asthma; epidemic; ryegrass pollen; seasonal allergic rhinitis; specific IgE; spirometry; thunderstorm.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Allergens
Asthma* / diagnosis
Humans
Immunoglobulin E
Pollen
Rhinitis, Allergic, Seasonal* / complications

Substances

Allergens
Immunoglobulin E