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Okyere-Mensah H, Arthur J, Owusu R, Baah B, Owusu A, Antwi KA, Oppong C, Rockson MA. Risk factors for the development of Thunderstorm-associated asthma among indigenous Ghanaians: A matched case-control study. PUBLIC HEALTH IN PRACTICE 2024; 8:100522. [PMID: 39040976 PMCID: PMC11261870 DOI: 10.1016/j.puhip.2024.100522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 05/17/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Objectives Epidemic Thunderstorm asthma (TA) is a serious public health threat with a potential to overwhelm health systems. Being the first documented incidence in Ghana, we sought to determine whether the chronic respiratory risk factors for the development of TA as identified in other countries were similar or different from that in Ghana. Study design A matched case-control study involving 41 cases and 82 controls was conducted in two conveniently selected health facilities in the Ashanti Region of Ghana. Methods Data were collected from pre-existing patient records and included general demography, a history of allergies and a history of asthma. A chi-square and multiple logistic regression analysis were conducted to identify risk factors for the development of TA. Results Overall, 53.7 % of the TA cases and 7.3 % of controls had a previous history of asthma (AOR = 4.53 p = 0.064, 95 % CI = 0.918-22.365). Also, 29.3 % of the cases and 1.2 % of the controls had a previous history of allergies (AOR = 12.48 p = 0.05, 95 % CI = 0.919-169.305). Conclusions A previous history of allergy was a significant risk factor for TA. A previous history of asthma though associated with TA, was not a significant risk factor for its development. The recognition and awareness of risk factors for TA, by clinicians and health managers, is essential for health education, case management and preparation for the surge capacity occasioned by the event.
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Affiliation(s)
| | - Joshua Arthur
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ruth Owusu
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Birgit Baah
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ashley Owusu
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Chris Oppong
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Simunovic M, Boyle J, Erbas B, Baker P, Davies JM. Airborne grass pollen and thunderstorms influence emergency department asthma presentations in a subtropical climate. ENVIRONMENTAL RESEARCH 2023; 236:116754. [PMID: 37500047 DOI: 10.1016/j.envres.2023.116754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Grass pollen is considered a major outdoor aeroallergen source worldwide. It is proposed as a mechanism for thunderstorm asthma that lightning during thunderstorms promotes electrical rupture of pollen grains that leads to allergic airway inflammation. However, most evidence of associations between grass pollen and asthma comes from temperate regions. The objective of this study was to investigate short-term associations between airborne grass pollen exposure and asthma emergency department presentations in a subtropical population. METHODS Episode level public hospital presentations for asthma (2016-2020) were extracted for greater Brisbane, Australia, from Queensland Health's Emergency Data Collection. Concentrations of airborne pollen were determined prospectively using a continuous flow volumetric impaction sampler. Daily time series analysis using a generalised additive mixed model were applied to determine associations between airborne grass pollen concentrations, and lightning count data, with asthma presentations. RESULTS Airborne grass pollen showed an association with asthma presentations in Brisbane; a significant association was detected from same day exposure to three days lag. Grass pollen exposure increased daily asthma presentations up to 48.5% (95% CI: 12%, 85.9%) in female children. Lightning did not modify the effect of grass pollen on asthma presentations, however a positive association was detected between cloud-to-cloud lightning strikes and asthma presentations (P = 0.048). CONCLUSION Airborne grass pollen exposure may exacerbate symptoms of asthma requiring urgent medical care of children and adults in a subtropical climate. This knowledge indicates an opportunity for targeted management of respiratory allergic disease to reduce patient and health system burden. For the first time, an influence of lightning on asthma was detected in this context. The outcomes support a need for continued pollen monitoring and surveillance of thunderstorm asthma risk in subtropical regions.
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Affiliation(s)
- Marko Simunovic
- School of Biomedical Sciences, Centre for Immunity and Infection Control, Centre for Environment, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Justin Boyle
- Australian E-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Philip Baker
- School of Public Health and Social Work, Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Janet M Davies
- School of Biomedical Sciences, Centre for Immunity and Infection Control, Centre for Environment, Queensland University of Technology, Brisbane, Queensland, Australia; Office of Research, Metro North Hospital and Health Services, Herston, Queensland, Australia.
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Gleeson PK, Morales KH, Buckey TM, Fadugba OO, Apter AJ, Christie JD, Himes BE. Factors associated with aeroallergen testing among adults with asthma in a large health system. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100167. [PMID: 37841071 PMCID: PMC10570953 DOI: 10.1016/j.jacig.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 10/17/2023]
Abstract
Background Aeroallergen testing informs precision care for adults with asthma, yet the epidemiology of testing in this population remains poorly understood. Objective We sought to identify factors associated with receiving aeroallergen testing, the results of these tests, and subsequent reductions in exacerbation measures among adults with asthma. Methods We used electronic health record data to conduct a retrospective, observational cohort study of 30,775 adults with asthma who had an office visit with a primary care provider or an asthma specialist from January 1, 2017, to August 26, 2022. We used regression models to identify (1) factors associated with receiving any aeroallergen test and tests to 9 allergen categories after the index visit, (2) factors associated with positive test results, and (3) reductions in asthma exacerbation measures in the year after testing compared with before testing. Results Testing was received by 2201 patients (7.2%). According to multivariable models, receiving testing was associated with having any office visit with an allergy/immunology specialist during the study period (odds ratio [OR] = 91.3 vs primary care only [P < .001]) and having an asthma emergency department visit (OR = 1.62 [P = .004]) or hospitalization (OR = 1.62 [P = .03]) in the year before the index visit. Age 65 years or older conferred decreased odds of testing (OR = 0.74 vs age 18-34 years [P = .008]) and negative test results to 6 categories (P ≤ .04 for all comparisons). Black race conferred increased odds of testing (OR =1.22 vs White race [P = .01]) and positive test results to 8 categories (P < .04 for all comparisons). Exacerbation measures decreased after testing. Conclusion Aeroallergen testing was performed infrequently among adults with asthma and was associated with reductions in asthma exacerbation measures.
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Affiliation(s)
- Patrick K. Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Timothy M. Buckey
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Olajumoke O. Fadugba
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Andrea J. Apter
- Section of Allergy and Immunology, Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jason D. Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Blanca E. Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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Kvedarienė V, Burzdikaitė P, Česnavičiūtė I. mHealth and telemedicine utility in the monitoring of allergic diseases. FRONTIERS IN ALLERGY 2022; 3:919746. [PMID: 36118170 PMCID: PMC9478181 DOI: 10.3389/falgy.2022.919746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
This literature review discusses the use of mHealth technologies and telemedicine for monitoring various allergic diseases both in everyday life and in the context of COVID-19. Telemedicine, whose popularity, and demand has skyrocketed during the pandemic, rely on mHealth technologies, video calls and websites as a resource-saving and safe way of consulting patients. The incorporation of new mHealth technologies into telemedicine practice may not only be relevant in the context of pandemic restrictions but can also be applied in everyday medical practice as an effective method of patient counseling. The mobile healthcare applications include a wide range of mobile apps for patients' education, monitoring, and disease management. However, applications for the people with food allergies lack relevant information about allergies and, like most other applications, are developed without the contribution of healthcare specialists. During the COVID-19 pandemic, low-risk food-allergic patients were able to rely on telemedicine services where they could get the help, they needed without increasing risk of contracting COVID-19 while saving time. Meanwhile, some applications for allergic rhinitis and asthma patients are showing practical benefits in clinical trials by allowing an efficient assessment of treatment regimens and efficacy. The use of digital symptom diaries further facilitates the implementation of real-life studies. However, for respiratory allergic diseases, the often insufficient quality of pollen prediction needs to be taken into account. Even though studies have shown that asthma is better controlled with mHealth technologies, the quality of mobile apps for asthma patients varies widely, as many products provide information that has not been scientifically proven. Inhaler sensors - have been shown to improve the course of asthma and its monitoring, while push notifications prompting people to take their medication double the likelihood of treatment adherence. Teledermatology has a high level of patient satisfaction - as it is perceived as a more time-saving method of consultation. However, the diagnostic accuracy of contact consultations remains higher. mHealth technologies provide a patient's health data from his/her daily life, which enables insights into behavioral patterns. This closer look at the daily routine can have a significant impact on developing individualized treatment and care guidelines.
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Affiliation(s)
- Violeta Kvedarienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Climate Change Factors and the Aerobiology Effect. Immunol Allergy Clin North Am 2022; 42:771-786. [DOI: 10.1016/j.iac.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Goudarzi G, Birgani YT, Assarehzadegan MA, Neisi A, Dastoorpoor M, Sorooshian A, Yazdani M. Prediction of airborne pollen concentrations by artificial neural network and their relationship with meteorological parameters and air pollutants. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:251-264. [PMID: 35669831 PMCID: PMC9163240 DOI: 10.1007/s40201-021-00773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/21/2021] [Indexed: 06/15/2023]
Abstract
After the early rainfall in the autumn of 2013, respiratory syndromes spread in the Khuzestan province of Iran with the most severity in Ahvaz. There have been recurring outbreaks in recent years. Considering that pollen-derived airborne allergens are regarded as key aeroallergens and the main cause of allergic rhinitis and asthma, this work aimed to forecast total pollen concentration in Ahvaz through an artificial neural network (ANN), followed by evaluating the pollen spatial distribution across the city and the association between pollen concentrations and environmental parameters. The utilized ANN in this work included an input layer with 13 parameters, a hidden layer of five neurons, and an output layer. Data were classified into training, validation, and testing sets. The ANN was implemented with 70% and 80% of data for training. The value of the correlation coefficient for the data validation of these two networks was 0.89 and 0.92, respectively. The results also indicated that despite the difference in the mean concentration of the pollens in various areas of Ahvaz, this difference was not statistically significant (P > 0.05). Furthermore, there was a negative correlation between the concentration of total pollen and relative humidity, precipitation, and air pressure. However, it had a positive correlation with temperature. Consequently, considering the logistical challenges of monitoring bioaerosols in the air, the ANN approach could predict total pollen concentrations. Therefore, in addition to measurements, the ANN technique can be a good tool to enable authorities to mitigate the impact of airborne pollen on people.
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Affiliation(s)
- Gholamreza Goudarzi
- Air Pollution and Respiratory Diseases (APRD) Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yaser Tahmasebi Birgani
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad-Ali Assarehzadegan
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolkazem Neisi
- Air Pollution and Respiratory Diseases (APRD) Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dastoorpoor
- Department of Biostatistics and Epidemiology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Sorooshian
- Department of Chemical and Environmental Engineering, University of Arizona, Tucson, AZ USA
- Department of Hydrology and Atmospheric Sciences, University of Arizona, Tucson, AZ USA
| | - Mohsen Yazdani
- Department of Environmental Health Engineering, School of Public Health, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Thunderstorms, Pollen, and Severe Asthma in a Midwestern, USA, Urban Environment, 2007-2018. Epidemiology 2022; 33:624-632. [PMID: 35580240 DOI: 10.1097/ede.0000000000001506] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous research has shown an association between individual thunderstorm events in the presence of high pollen, commonly called thunderstorm asthma, and acute severe asthma events, but little work has studied risk over long periods of time, using detailed measurements of storms and pollen. METHODS We estimated change in risk of asthma-related emergency room visits related to thunderstorm asthma events in the Minneapolis-St. Paul metropolitan area over the years 2007-2018. We defined thunderstorm asthma events as daily occurrence of two or more lightning strikes during high pollen periods interpolating weather and pollen monitor data and modeling lightning counts. We acquired daily counts of asthma-related emergency department visits from the Minnesota Hospital Association and used a quasi-Poisson time-series regression to estimate overall relative risk of emergency department visits during thunderstorm asthma events. RESULTS We observed a 1.047 times higher risk (95% CI:1.012,1.083) of asthma-related emergency department visits on the day of thunderstorm asthma event. Our findings are robust to adjustment for temperature, humidity, wind, precipitation, ozone, PM2.5, day of week, and seasonal variation in asthma cases. Occurrence of lightning alone or pollen alone showed no association with risk of severe asthma. A two-stage analysis combining individual zip code level results shows similar RR and we see no evidence of spatial correlation or spatial heterogeneity of effect. DISCUSSION Our results support an association between co-occurrence of lightning and pollen and risk of severe asthma events. Our approach incorporates lightning and pollen data and small-spatial area exposure and outcome counts.
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Combined Exposure to Birch Pollen and Thunderstorms Affects Respiratory Health in Stockholm, Sweden-A Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105852. [PMID: 35627390 PMCID: PMC9141405 DOI: 10.3390/ijerph19105852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 01/27/2023]
Abstract
Background: Thunderstorm asthma is a term used to describe surges in acute respiratory illnesses following a thunderstorm and is often attributed to an intense exposure to aeroallergens. Several episodes of thunderstorm asthma have been observed worldwide; however, no such cases have been described in Sweden. In Sweden, the most prominent exposure to air-borne pollen occurs during the blooming of the birch. We aimed to explore the associations between respiratory health and the combined exposure to thunderstorms and birch pollen. Methods: We investigated the association between the daily numbers of outpatient visits due to respiratory cases and the combined exposure to thunderstorms and birch pollen during the period of 1 May–31 September in 2001–2017, in Stockholm County, Sweden, by using time series analysis with log linear models. Results: We detected noticeable increases in the number of outpatient visits on both the same day (max 26%; 95% CI 1.16–1.37) and the day after (max 50%; 95% CI 1.32–1.70) the occurrence of a thunderstorm, when the concentrations of birch pollen and the number of lightning discharges were within the highest categories. Conclusions: It is possible that co-exposure to heavy thunderstorms and high concentrations of birch pollen affects the respiratory health of the Stockholm population. To the best of our knowledge, this is the first study addressing the thunderstorm-related respiratory illnesses in Sweden and the effects of birch pollen. Our study may be important for future public health advice related to thunderstorm asthma.
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Douglass JA, Lodge C, Chan S, Doherty A, Tan JA, Jin C, Stewart A, Southcott AM, Gillman A, Lee J, Csutoros D, Hannan L, Ruane L, Barnes S, Irving L, Harun NS, Lachapelle P, Spriggs K, Sutherland M, See K, McDonald CF, Conron M, Radhakrishna N, Worsnop C, Johnston FH, Davies JM, Bryant V, Iles L, Ranson D, Spanos P, Vicendese D, Lowe A, Newbigin EJ, Bardin P, Dharmage S. Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study. J Allergy Clin Immunol 2022; 149:1607-1616. [PMID: 34774618 DOI: 10.1016/j.jaci.2021.10.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
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.
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Affiliation(s)
- Jo A Douglass
- Department of Medicine, The University of Melbourne, Parkville, Australia.
| | - Caroline Lodge
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
| | - Samantha Chan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Alice Doherty
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
| | - Ju Ann Tan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Celina Jin
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Alastair Stewart
- Department of Pharmacology and Therapeutics, The University of Melbourne, Parkville, Australia
| | - Anne M Southcott
- Department of Respiratory and Sleep Medicine, Western Health, Footscray, Australia
| | - Andrew Gillman
- Department of Respiratory and Sleep Medicine, Western Health, Footscray, Australia
| | - Joy Lee
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Danny Csutoros
- Department of Health and Human Services, State Government of Victoria, Melbourne, Australia
| | - Liam Hannan
- Department of Respiratory Medicine, Northern Health, Epping, Australia
| | - Laurence Ruane
- Monash Lung, Sleep, Allergy and Immunology, Monash Hospital and University, Clayton, Australia
| | - Sara Barnes
- Department of Allergy, Monash Health, Clayton, Australia
| | - Lou Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Nur-Shirin Harun
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | | | - Kymble Spriggs
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Sutherland
- Department of Medicine, The University of Melbourne, Richmond, Australia
| | - Katharine See
- Department of Respiratory Medicine, Northern Health, Epping, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Matthew Conron
- Department of Respiratory Medicine, St. Vincent's Hospital, Fitzroy, Australia
| | | | - Christopher Worsnop
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Janet M Davies
- Centre for Immunology and Infection Control, The University of Queensland, Herston, Australia
| | - Vanessa Bryant
- Immunology Division, Walter and Eliza Hall Institute of Medical Research 1G Royal Parade, Parkville, Australia
| | - Linda Iles
- Victorian Institute of Forensic Medicine, Monash University, Southbank, Australia
| | - David Ranson
- Victorian Institute of Forensic Medicine, Monash University, Southbank, Australia
| | | | - Don Vicendese
- Department of Mathematics and Statistics, La Trobe University, Essendon, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
| | - Edward J Newbigin
- School of BioSciences, The University of Melbourne, Parkville, Australia
| | - Philip Bardin
- Monash Lung, Sleep, Allergy and Immunology, Monash Hospital and University, Clayton, Australia
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, The University of Melbourne, Parkville, Australia
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van Nunen SA, Burk MB, Burton PK, Ford G, Harvey RJ, Lozynsky A, Pickford E, Rimmer JS, Smart J, Sutherland MF, Thien F, Weber HC, Zehnwirth H, Newbigin E, Katelaris CH. 5-grass-pollen SLIT effectiveness in seasonal allergic rhinitis: Impact of sensitization to subtropical grass pollen. World Allergy Organ J 2022; 15:100632. [PMID: 35280502 PMCID: PMC8873945 DOI: 10.1016/j.waojou.2022.100632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background Temperate grass (eg, ryegrass) pollen is a major driver of seasonal allergic rhinitis (SAR) and asthma risks, including thunderstorm asthma. Data for the effectiveness of temperate grass pollen allergen immunotherapy (AIT) in SAR patients from the southern hemisphere, who are frequently polysensitized to subtropical grass pollens, are limited. The 300 IR 5-grass pollen sublingual immunotherapy tablet (300 IR 5-grass SLIT) is known to be effective in polysensitized SAR patients with primary allergy to temperate grasses, however, the influence of polysensitization to subtropical grass pollen on treatment responses has yet to be specifically addressed. Key aims of this study were to measure patient treatment satisfaction during 300 IR 5-grass SLIT treatment and evaluate how polysensitization to subtropical grass pollens affects treatment responses. Methods A prospective observational study was conducted in 63 patients (aged ≥5 years) in several temperate regions of Australia prescribed 300 IR 5-grass SLIT for SAR over 3 consecutive grass pollen seasons. Ambient levels of pollen were measured at representative sites. Patient treatment satisfaction was assessed using a QUARTIS questionnaire. Rhinoconjunctivitis Total Symptom Score (RTSS) and a Hodges-Lehmann Estimator analysis was performed to evaluate if polysensitization to subtropical grass pollen affected SAR symptom intensity changes during SLIT. Results A diagnosis of ryegrass pollen allergy was nearly universal. There were 74.6% (47/63) polysensitized to subtropical and temperate grass pollens. There were 23.8% (15/63) monosensitized to temperate grass pollens. From the first pollen season, statistically significant improvements occurred in SAR symptoms compared with baseline in both monosensitized and polysensitized patients, particularly in those polysensitized (P = 0.0297). Improvements in SAR symptoms were sustained and similar in both groups in the second and third pollen seasons, reaching 70–85% improvement (P < 0.01). Polysensitized patients from both northerly and southerly temperate regions in Australia showed similar improvements. Grass pollen counts in both regions were consistently highest during springtime. Conclusions 300 IR 5-grass SLIT is effective in a real-life setting in SAR patients in the southern hemisphere with primary allergy to temperate grass pollen and predominantly springtime grass pollen exposures. Importantly, SLIT treatment effectiveness was irrespective of the patient's polysensitization status to subtropical grass pollens.
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Chatelier J, Chan S, Tan JA, Stewart AG, Douglass JA. Managing Exacerbations in Thunderstorm Asthma: Current Insights. J Inflamm Res 2021; 14:4537-4550. [PMID: 34526800 PMCID: PMC8436255 DOI: 10.2147/jir.s324282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
Epidemic thunderstorm asthma (ETSA) occurs following a thunderstorm due to the interaction of environmental and immunologic factors. Whilst first reported in the 1980s, the world's largest event in Melbourne, Australia, on November 21, 2016 has led to a wealth of clinical literature seeking to identify its mechanisms, susceptibility risk factors, and management approaches. Thunderstorm asthma (TA) typically presents during an aeroallergen season in individuals sensitized to perennial rye grass pollen (RGP) in Australia, or fungus in the United Kingdom, in combination with meteorological factors such as thunderstorms and lightning activity. It is now well recognized that large pollen grains, which usually lodge in the upper airway causing seasonal allergic rhinitis (SAR), are ruptured during these events, leading to sub-pollen particles respirable to the lower respiratory tract causing acute asthma. The identified risk factors of aeroallergen sensitization, specifically to RGP in Australians with a history of SAR, and individuals born in Australia of South-East Asian descent as a risk factor for TA has been key in selecting appropriate patients for preventative management. Moreover, severity-determining risk factors for ETSA-related asthma admission or mortality, including pre-existing asthma or prior hospitalization, poor inhaled corticosteroid adherence, and outdoor location at the time of the storm are important in identifying those who may require more aggressive treatment approaches. Basic treatments include optimizing asthma control and adherence to inhaled corticosteroid therapy, treatment of SAR, and education regarding TA to increase recognition of at-risk days. Precision treatment approaches may be more beneficial in select individuals, including the use of allergen immunotherapy and even biologic treatment to mitigate asthma severity. Finally, we discuss the importance of environmental health literacy in the context of concerns surrounding the increased frequency of ETSA due to climate change and its implications for the frequency and severity of future events.
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Affiliation(s)
- Josh Chatelier
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Chan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Immunology Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Ju Ann Tan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alastair G Stewart
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Melbourne, Victoria, Australia
- ARC Centre for Personalised Therapeutics Technologies, University of Melbourne, Melbourne, Victoria, Australia
| | - Jo Anne Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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12
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Borchers-Arriagada N, Jones PJ, Palmer AJ, Bereznicki B, Cooling N, Davies JM, Johnston FH. What are the health and socioeconomic impacts of allergic respiratory disease in Tasmania? AUST HEALTH REV 2021; 45:281-289. [PMID: 33789077 DOI: 10.1071/ah20200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/26/2020] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to quantify the direct and indirect costs of asthma and allergic rhinitis (AR) for 2018 in Tasmania. Methods We used publicly available data, and Tasmanian-specific values where available, to estimate direct and indirect costs of both diseases. Direct costs included outcomes such as emergency department (ED) presentations, hospitalisations, general practice visits and medication use. Indirect costs included premature mortality and lost productivity. Results Direct health impacts for both conditions combined included 1454 ED presentations, 682 hospitalisations, 72446 general practice visits and 7122 specialist visits. Indirect health impacts included 13 deaths and between 483000 and 2.8 million days of lost productivity. Total costs ranged between A$126.5 million and A$436.7 million for asthma and between A$65.3 million and A$259.7 million for AR. Per-person annual costs ranged between A$1918 and A$6617 for asthma and between A$597 and A$2374 for AR. Conclusions The main financial burden due to asthma and AR was related to productivity losses from presenteeism and absenteeism. The magnitude of the economic impacts of AR and asthma warrants further analysis to produce a national-level assessment. Such analyses could identify cost-effective interventions that produce highest benefits for the management of these conditions in our community. What is known about the topic? Allergic respiratory diseases, and particularly asthma and AR, pose a significant health burden, with effects including asthma-related hospital admissions, significant pharmaceutical expenditure and lost workforce and school education productivity. Australia, and particularly Tasmania, has a high prevalence of these conditions, but no recent studies have appraised or estimated their health impacts and costs. What does this paper add? This paper proposes a unique and transparent costing model that allows the costs of these conditions to be estimated while accounting for restrictions in data availability. The model is used to provide the first comprehensive costings of asthma and AR in Tasmania, Australia. We identified that the estimated health costs are dominated by productivity losses from presenteeism and absenteeism, and that total per person costs are higher for a person with asthma compared to one with AR. What are the implications for practitioners? This analysis has the potential to guide cost-effective interventions by identifying where the highest benefits may be obtained when managing these conditions in our community.
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Affiliation(s)
- Nicolas Borchers-Arriagada
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tas. 7001, Australia. ; ;
| | - Penelope J Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tas. 7001, Australia. ; ;
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tas. 7001, Australia. ; ; ; and Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 2053, Australia
| | - Bonnie Bereznicki
- Tasmanian School of Medicine, University of Tasmania, Hobart, Private Bag 34, Hobart, Tas. 7001, Australia. ;
| | - Nick Cooling
- Tasmanian School of Medicine, University of Tasmania, Hobart, Private Bag 34, Hobart, Tas. 7001, Australia. ;
| | - Janet M Davies
- School of Biomedical Science, Centre for Immunity and Infection Control & Centre for Environment, Queensland University of Technology, 300 Herston Road, Herston, Qld 4006, Australia. ; and Office of Research, Metro North Hospital and Health Service, 7 Butterfield Street, Herston, Qld 4029, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tas. 7001, Australia. ; ; ; and Corresponding author.
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13
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AlQuran A, Batra M, Harry Susanto N, Holland AE, Davies JM, Erbas B, Lampugnani ER. Community Response to the Impact of Thunderstorm Asthma Using Smart Technology. ALLERGY & RHINOLOGY 2021; 12:21526567211010728. [PMID: 33996193 PMCID: PMC8083005 DOI: 10.1177/21526567211010728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
Background The most severe thunderstorm asthma (TA) event occurred in Melbourne on the 21st November 2016 and during this period, daily pollen information was available and accessible on smart devices via an App. An integrated survey within the App allows users to self-report symptoms. Objective To explore patterns of symptom survey results during the period when the TA event occurred. Methods Symptom data from the Melbourne Pollen Count and Forecast App related to asthma history, hay fever symptoms, and medication use was explored. A one-week control period before and after the event was considered. Chi-square tests and logistic regression were used to assess associations between sex, age, symptoms, and medication use. Results Of the 28,655 responses, during the 2016 pollen season, younger (18 to 40 years) males, with no hay fever and no asthma were the most single and regular responders. During the TA event for new users, sex was only significantly associated with hay fever (p = 0.008) of which 60.2% of females’ responses reported having hay fever, while 43% of males’ responses did not. Those with mild symptoms peaked during the TA event. Conclusions Many individuals completed the survey on the app for the first time during the TA event indicating the potential of digital technologies to be used as indicators of health risk among populations at risk of TA events.
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Affiliation(s)
- Ala AlQuran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Nugroho Harry Susanto
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Indonesia Research Partnership on Infectious Diseases, Jakarta, Indonesia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Janet M Davies
- School of Biomedical Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, and Office of Research, Metro North Hospital and Health Service, Brisbane Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Faculty of Public Health, Universitas AirLangga, Surabaya, Indonesia
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14
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The Role of Mobile Health Technologies in Stratifying Patients for AIT and Its Cessation: The ARIA-EAACI Perspective. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1805-1812. [PMID: 33662672 DOI: 10.1016/j.jaip.2021.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/28/2021] [Accepted: 02/21/2021] [Indexed: 11/21/2022]
Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many international or national practice guidelines have been produced, but the evidence-based method varies and they do not usually propose care pathways. The present article considers the possible role of mobile health in AIT for allergic rhinitis/asthma. There are no currently available validated biologic biomarkers that can predict AIT success, and mobile health biomarkers have some relevance. In the current article, the following aspects will be discussed: patient stratification for AIT, symptom-medication scores for the follow-up of patients, clinical trials, as well as the approach of the European Academy of Allergy and Clinical Immunology.
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15
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D'Amato G, Annesi-Maesano I, Urrutia-Pereira M, Del Giacco S, Rosario Filho NA, Chong-Neto HJ, Solé D, Ansotegui I, Cecchi L, Sanduzzi Zamparelli A, Tedeschini E, Biagioni B, Murrieta-Aguttes M, D'Amato M. Thunderstorm allergy and asthma: state of the art. Multidiscip Respir Med 2021; 16:806. [PMID: 35003735 PMCID: PMC8672486 DOI: 10.4081/mrm.2021.806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 01/22/2023] Open
Abstract
Thunderstorm-triggered asthma (TA) can be defined as the occurrence of acute asthma attacks immediately following a thunderstorm during pollen seasons. Outbreaks have occurred across the world during pollen season with the capacity to rapidly inundate a health care service, resulting in potentially catastrophic outcomes for allergic patients. TA occurs when specific meteorological and aerobiological factors combine to affect predisposed atopic patients with IgE-mediated sentitization to pollen allergens. Thunderstorm outflows can concentrate aeroallergens, most commonly grass pollen but also other pollens such as Parietaria and moulds 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 can be followed by a late inflammatory phase. There is evidence that, during pollen season, thunderstorms can induce allergic asthma outbreaks, sometimes also severe asthma crisis and sometimes deaths in patients suffering from pollen allergy. It has been observed that changes in the weather such as rain or humidity may induce hydratation of pollen grains during pollen seasons and sometimes also their fragmentation which generates atmospheric biological aerosols carrying allergens. Asthma attacks are induced for the high concentration at ground level of pollen grains which may release allergenic particles of respirable size after rupture by osmotic shock. In other words, it is a global health problem observed in several cities and areas of the world that can strike without sufficient warning, inducing sometimes severe clinical consequences also with deaths of asthma patients. Due to constant climate change, future TA events are likely to become more common, more disastrous and more unpredictable, as a consequence it is important to have deep knowledge on this topic to prevent asthma attacks. Other environmental factors, such as rapid changes in temperature and agricultural practices, also contribute to causing TA.
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality Hospital 'A. Cardarelli', Naples, Italy.,Medical School of Specialization in Respiratory Diseases, Federico II University of Naples, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department, IPLESP, Paris, France.,Research Director Co- Directrice/Deputy Director IDESP, INSERM, University of Montpellier, France
| | | | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | | | | | - Dirceu Solé
- Department of Pediatrics, Federal University of São Paulo, SP, Brazil
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quiron Salud Bizkaia, Bilbao, Spain
| | | | - Alessandro Sanduzzi Zamparelli
- Division of Pneumology, High Speciality Hospital 'V. Monaldi', Federico II University of Naples Medical School, Naples, Italy
| | - Emma Tedeschini
- Department of Agricultural Food and Environmental Science, University of Perugia, Italy
| | - Benedetta Biagioni
- The Allergy Outpatient Clinic-, Division of Internal Medicine, IRCCS, Azienda Ospedaliera Universitaria, Bologna, Italy
| | | | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital 'V. Monaldi', Federico II University of Naples Medical School, Naples, Italy
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16
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Davies JM, Berman D, Beggs PJ, Ramón GD, Peter J, Katelaris CH, Ziska LH. Global Climate Change and Pollen Aeroallergens: A Southern Hemisphere Perspective. Immunol Allergy Clin North Am 2020; 41:1-16. [PMID: 33228867 DOI: 10.1016/j.iac.2020.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Climatic change will have an impact on production and release of pollen, with consequences for the duration and magnitude of aeroallergen seasonal exposure and allergic diseases. Evaluations of pollen aerobiology in the southern hemisphere have been limited by resourcing and the density of monitoring sites. This review emphasizes inconsistencies in pollen monitoring methods and metrics used globally. Research should consider unique southern hemisphere biodiversity, climate, plant distributions, standardization of pollen aerobiology, automation, and environmental integration. For both hemispheres, there is a clear need for better understanding of likely influences of climate change and comprehending their impact on pollen-related health outcomes.
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Affiliation(s)
- Janet M Davies
- School of Biomedical Science, Queensland University of Technology, Herston, Queensland 4006, Australia; Office of Research, Metro North Hospital and Health Service, Herston, Queensland 4006, Australia.
| | - Dilys Berman
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town 7700, South Africa
| | - Paul J Beggs
- Department of Earth and Environmental Sciences, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales 2109, Australia
| | - Germán Darío Ramón
- Hospital Italiano Regional DelSur, Bahía Blanca, Buenos Aires, Argentina
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, 7700
- PO Box 34560, 7937, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, George Street, Cape Town, South Africa
| | | | - Lewis H Ziska
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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17
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Price D, Hughes KM, Thien F, Suphioglu C. Epidemic Thunderstorm Asthma: Lessons Learned from the Storm Down-Under. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1510-1515. [PMID: 33172604 DOI: 10.1016/j.jaip.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
Epidemic thunderstorm asthma (ETSA) is a global health problem that can strike without sufficient warning and can have catastrophic consequences. Because of climate change, future events are likely to become more common, more disastrous, and more unpredictable. To prevent loss of life and avoid surge events on health care infrastructure, identifying at-risk individuals and their potential biomarkers is the most prophylactic approach that can be taken to mitigate the deadly consequences of ETSA. In this review, we provide an update on the clinical mechanism, global prevalence, and characteristics of those patients moderately or severely at risk of ETSA. Identifying these patient characteristics will aid clinical professionals to provide suitable and personalized treatment plans and, in turn, avoid future loss of life.
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Affiliation(s)
- Dwan Price
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, VIC, Australia; NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia; Deakin AIRwatch Pollen and Spore Counting and Forecasting Facility, Deakin University, Burwood and Waurn Ponds, VIC, Australia
| | - Kira M Hughes
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia; Deakin AIRwatch Pollen and Spore Counting and Forecasting Facility, Deakin University, Burwood and Waurn Ponds, VIC, Australia
| | - Francis Thien
- Respiratory Medicine, Eastern Health, Box Hill Hospital and Monash University, Box Hill, VIC, Australia
| | - Cenk Suphioglu
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, VIC, Australia; NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia; Deakin AIRwatch Pollen and Spore Counting and Forecasting Facility, Deakin University, Burwood and Waurn Ponds, VIC, Australia.
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18
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Thien F, Davies JM, Hew M, Douglass JA, O'Hehir RE. Thunderstorm asthma: an overview of mechanisms and management strategies. Expert Rev Clin Immunol 2020; 16:1005-1017. [PMID: 32960102 DOI: 10.1080/1744666x.2021.1826310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Epidemic thunderstorm asthma (ETSA) is due to a complex interaction of environmental and individual susceptibility factors, with outbreaks reported globally over the last four decades. Australia has been particularly susceptible with nearly half of episodes reported internationally, culminating in the catastrophic Melbourne 2016 event. AREAS COVERED Reported ETSA episodes are reviewed for common environmental and meteorological risk factors. Allergen aerobiology interaction with thunderstorm activity and rapid weather condition changes is examined. Assessment of the clinical and immunological data highlights risk factors for ETSA presentation, hospital admission, and intensive care admission. Risk factors associated with ETSA deaths are evaluated. Public health strategies, as well as pharmacological and immunological management approaches to reduce individual susceptibility and prevent ETSA are discussed. EXPERT OPINION Improved understanding of the specific meteorological factors predisposing to the greatest risk of ETSA to improve forecasting is required. Better monitoring of aeroallergen levels in areas of greatest geographic risk, with further research into allergen aerobiology underpinning mechanisms of allergen exposure is needed. The role of climate change in increasing the risk of ETSA outbreaks requires further research. Public awareness and education are required to reduce exposure, and to improve uptake of pharmacological and immunological risk reduction and preventive strategies.
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Affiliation(s)
- Francis Thien
- Eastern Health Clinical School, Box Hill Hospital , Melbourne, Australia.,Monash University , Melbourne, Australia
| | - Janet M Davies
- Queensland University of Technology , Brisbane, Australia.,Metro North Hospital and Health Service , Brisbane, Australia
| | - Mark Hew
- Monash University , Melbourne, Australia.,Allergy, Asthma & Clinical Immunology, Alfred Health , Melbourne, Australia
| | - Jo A Douglass
- Royal Melbourne Hospital , Parkville, Australia.,Department of Medicine, University of Melbourne , Melbourne, Australia
| | - Robyn E O'Hehir
- Monash University , Melbourne, Australia.,Allergy, Asthma & Clinical Immunology, Alfred Health , Melbourne, Australia
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19
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Hew M, Lee J, Varese N, Aui PM, McKenzie CI, Wines BD, Aumann H, Rolland JM, Mark Hogarth P, Zelm MC, O’Hehir RE. Epidemic thunderstorm asthma susceptibility from sensitization to ryegrass (Lolium perenne) pollen and major allergen Lol p 5. Allergy 2020; 75:2369-2372. [PMID: 32293712 PMCID: PMC7540598 DOI: 10.1111/all.14319] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Mark Hew
- Allergy, Asthma & Clinical Immunology Alfred Health Melbourne VIC Australia
- School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia
| | - Joy Lee
- Allergy, Asthma & Clinical Immunology Alfred Health Melbourne VIC Australia
- School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia
| | - Nirupama Varese
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University and Alfred Health Melbourne VIC Australia
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
| | - Pei M. Aui
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
| | - Craig I. McKenzie
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
| | - Bruce D. Wines
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
- Immune Therapies Group Burnet Institute Melbourne VIC Australia
- Department of Clinical Pathology University of Melbourne Parkville VIC Australia
| | - Heather Aumann
- Department of Haematology Alfred Health Melbourne VIC Australia
| | - Jennifer M. Rolland
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University and Alfred Health Melbourne VIC Australia
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
| | - Phillip Mark Hogarth
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
- Immune Therapies Group Burnet Institute Melbourne VIC Australia
- Department of Clinical Pathology University of Melbourne Parkville VIC Australia
| | - Menno C. Zelm
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University and Alfred Health Melbourne VIC Australia
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
| | - Robyn E. O’Hehir
- Allergy, Asthma & Clinical Immunology Alfred Health Melbourne VIC Australia
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University and Alfred Health Melbourne VIC Australia
- Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
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20
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Lambert KA, Katelaris C, Burton P, Cowie C, Lodge C, Garden FL, Prendergast LA, Toelle BG, Erbas B. Tree pollen exposure is associated with reduced lung function in children. Clin Exp Allergy 2020; 50:1176-1183. [PMID: 32662228 DOI: 10.1111/cea.13711] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 05/03/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Allergic disease is a recognized global epidemic and a significant cause of ill health and poor quality of life. The prevalence of pollen allergy is high throughout the world, and pollen exposure itself plays a role in emergency department presentations and hospitalizations for asthma. Lung function and airway inflammation are important measures of asthma activity and control. OBJECTIVE To examine associations between exposure to multiple pollen types and lung function and markers of airway inflammation at 8 and 14 years of age, and to explore potential modification by residential greenness. METHODS A cohort of high-risk children living in Sydney, Australia had spirometry and fractional exhaled nitric oxide (FeNO) measured at 8 and 14 years of age. Ambient pollen concentration on the day of lung function measurement and up to three days prior was used as the exposure measure. Residential greenness was derived from satellite imagery. We modelled the association between six pollen types and lung function and FeNO. We also assessed modifying effects of residential greenness. RESULTS Casuarina, cypress and Pinus pollen in the air the day before measurement and 3 days prior respectively, were associated with reduced lung function in 8-year-olds. The pollen exposures were associated with decreases in FEV1 and FVC; however, the FEV1 /FVC ratio was not affected. Effect modification by greenness was not observed due to loss of power. CONCLUSIONS & CLINICAL RELEVANCE Airborne tree pollen of cypress, Casuarina and Pinus and not grass in some regions may be detrimental to childhood lung function.
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Affiliation(s)
- Katrina A Lambert
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Constance Katelaris
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.,Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Pamela Burton
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Christine Cowie
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Frances L Garden
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, Vic., Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
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21
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Simunovic M, Dwarakanath D, Addison-Smith B, Susanto NH, Erbas B, Baker P, Davies JM. Grass pollen as a trigger of emergency department presentations and hospital admissions for respiratory conditions in the subtropics: A systematic review. ENVIRONMENTAL RESEARCH 2020; 182:109125. [PMID: 32069762 DOI: 10.1016/j.envres.2020.109125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/11/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION It is unknown if high concentration of airborne grass pollen, where subtropical grasses (Chloridoideae and Panicoideae) dominate, is a risk factor for respiratory health. Here we systematically reviewed the association between airborne grass pollen exposure and asthma emergency department (ED) presentations and hospital admissions in subtropical climates. OBJECTIVES A systematic review was performed to identify and summarise studies that reported on respiratory health (asthma ED presentations and hospital admissions) and airborne grass pollen exposure in subtropical climates. METHODS Searches were conducted in: MEDLINE, Web of Science, Scopus, CINAHL (EBSCO), Embase and Google Scholar databases (1966-2019). Risk of bias was assessed using a validated quality assessment tool. A meta-analysis was planned, however due to the heterogeneity in study design it was determined inappropriate and instead a narrative synthesis was undertaken. RESULTS Nineteen studies were identified for inclusion, with a total of 598,931 asthma ED presentation participants and 36,504 asthma hospital admission participants in six countries (Australia, India, Israel, Italy, Spain, USA). The narrative synthesis found airborne grass pollen appears to have a small and inconsistent increase on asthma ED presentations (judged as: probably little effect n = 5, may have little effect n = 4, no effect n = 2 and uncertain if there is an effect n = 4) and hospital admissions (judged as: probably increase slightly n = 2 probably little effect n = 1, may have a little effect n = 1, no effect n = 3 and we are uncertain if there is an effect n = 4) in the subtropics. Furthermore, the reported effect sizes were small and its clinical relevance may be difficult to discern. CONCLUSION Exposure to airborne grass pollen appears to have a small and inconsistent increase on asthma ED presentations and hospital admissions in the subtropics. These findings are comparable to reported observations from studies undertaken in temperate regions.
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Affiliation(s)
- Marko Simunovic
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Divya Dwarakanath
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Beth Addison-Smith
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nugroho H Susanto
- School of Public Health and Epidemiology, LaTrobe University, Bundoora, Victoria, Australia
| | - Bircan Erbas
- School of Public Health and Epidemiology, LaTrobe University, Bundoora, Victoria, Australia
| | - Philip Baker
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Janet M Davies
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Office of Research, Metro North Hospital and Health Services,Herston, Queensland, Australia
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22
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Yorgancıoğlu AA, Gemicioğlu B, Cingi C, Kalaycı Ö, Kalyoncu AF, Bachert C, Hellings P, Pfaar O, Schünemann HJ, Wallace D, Bedbrook A, Czarlewski W, Bousquet J. ARIA 2019, Allerjik Rinite Tedavi Yaklaşımı-Türkiye. Turk Thorac J 2020; 21:122-133. [PMID: 32203003 DOI: 10.5152/turkthoracj.2019.19084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
Gerçek yaşamda, çevresel maruziyetlerin de etkilediği rinit ve astım mültimorbidite durumlarında, dijitalleşmiş ve kişiye odaklanan tedaviler için bütünleştirilmiş tedavi yollarının değerlendirilmesi önerilmektedir. Gerçek yaşamdaki bu durum mültisipliner bir yaklaşımla basamaklandırılıp, rehberilerinde ülkelerdeki gereksinimlere göre değiştilmesini gerektirebilir. Allerjik rinitte hem farmakoterapi hem immünoterapi açısından acil yeni yaklaşımlara ihtiyaç olduğu görülmüştür. 3. Aralık 2018'de Paris'te bir toplantı yapılmış ve iki ayrı belge hazırlanmıştır. Bu yayında bunlara ait bir özet sunulup, ülkeye ve sağlık sistemine uygun kullanımın çerçevesi oluşturulmak istenmiştir.
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Affiliation(s)
| | - Bilun Gemicioğlu
- Department of Chest Diseases, İstanbul University-Cerrahpaşa, Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Cemal Cingi
- Department of Ear Nose Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ömer Kalaycı
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - Peter Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Belgium, and Academic Medical Center, University of Amsterdam, The Netherlands and Euforea, Brussels, Belgium
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | | | - Jean Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
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23
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Kailaivasan TH, Timbrell VL, Solley G, Smith WB, McLean-Tooke A, van Nunen S, Smith P, Upham JW, Langguth D, Davies JM. Biogeographical variation in specific IgE recognition of temperate and subtropical grass pollen allergens in allergic rhinitis patients. Clin Transl Immunology 2020; 9:e01103. [PMID: 32025301 PMCID: PMC6997006 DOI: 10.1002/cti2.1103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Globally, grass pollens (GP) are major aeroallergen triggers of allergic rhinitis (AR) and asthma. However, patterns of allergic sensitisation to pollen of temperate (Pooideae: Lolium perenne) and subtropical (Chloridoideae: Cynodon dactylon and Panicoideae: Paspalum notatum) subfamilies in diverse climates remain unclear. This study aims to evaluate the level of allergic sensitisation and IgE specificity for major GP allergens representing the three subfamilies in biogeographically distinct regions. Methods Participants (GP‐allergic with AR, 330; non‐atopic, 29; other allergies, 54) were recruited in subtropical: Queensland, and temperate: New South Wales, Western and South Australia, regions. Clinical history, skin prick test (SPT), total and specific IgE to GP and purified allergens (ImmunoCAP) were evaluated. Cross‐inhibition of sIgE with Pas n 1, Cyn d 1 and Lol p 1 by GP extracts was investigated. Results Queensland participants showed higher sensitisation to P. notatum and C. dactylon than L. perenne GP. sIgE was higher to Pas n 1 and Cyn d 1, and sIgE to Pas n 1 and Cyn d 1 was inhibited more by Panicoideae and Chloridoideae, respectively, than Pooideae GP. Conversely, participants from temperate regions showed highest sensitisation levels to L. perenne GP and Lol p 1, and sIgE to Lol p 1 was inhibited more by Pooideae than other GP. Conclusion Levels and patterns of sensitisation to subtropical and temperate GP in AR patients depended on biogeography. Knowledge of the specificity of sensitisation to local allergens is important for optimal diagnosis and choice of allergen‐specific immunotherapy to maximise benefit.
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Affiliation(s)
- Thina H Kailaivasan
- School of Biomedical Sciences Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane QLD Australia
| | - Victoria L Timbrell
- School of Biomedical Sciences Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane QLD Australia
| | | | | | | | - Sheryl van Nunen
- Royal North Shore Hospital and The University of Sydney Sydney NSW Australia
| | - Peter Smith
- Queensland Allergy Services Gold Coast QLD Australia
| | - John W Upham
- The University of Queensland and The Princess Alexandra Hospital Brisbane QLD Australia
| | | | - Janet M Davies
- School of Biomedical Sciences Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane QLD Australia.,Metro North Hospital and Health Service Herston QLD Australia
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24
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Idrose NS, Dharmage SC, Lowe AJ, Lambert KA, Lodge CJ, Abramson MJ, Douglass JA, Newbigin EJ, Erbas B. A systematic review of the role of grass pollen and fungi in thunderstorm asthma. ENVIRONMENTAL RESEARCH 2020; 181:108911. [PMID: 31759647 DOI: 10.1016/j.envres.2019.108911] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Thunderstorm asthma is defined as epidemics of asthma occurring shortly after a thunderstorm. While grass pollen has been implicated in thunderstorm asthma events, little is known about the role of fungi and studies have not been synthesised. OBJECTIVE This systematic review aims to evaluate whether grass pollen is necessary in thunderstorm asthma events and whether fungi also play a part in these associations. METHODS We conducted a systematic search using six electronic databases (i.e. CINAHL, Medline (Ovid), Web of Science, ProQuest Central, EMBASE and Google Scholar) and checked reference lists. The search terms used were pollen AND thunderstorm* AND asthma. The inclusion criteria were studies published in English with original human data relating to outdoor pollen and thunderstorm asthma. RESULTS Twenty of 2198 studies were eligible. Reported findings differed due to variation in methodological approaches and a meta-analysis was not possible. Nonetheless, of the 20 studies included, 15 demonstrated some relationship with nine demonstrating lagged effects up to four days for increasing grass pollen counts associated with increased risk of thunderstorm asthma. Of the 10 studies that examined fungi, nine demonstrated a positive relationship with thunderstorm asthma. The fungal taxa involved varied, depending on whether measurements were recorded before, during or after the thunderstorm. Nevertheless, none of the studies considered fungi as a potential effect modifier for the pollen-thunderstorm asthma association. CONCLUSION We found evidence to suggest that grass pollen was a necessary factor for thunderstorm asthma but there are other as yet unrecognised environmental factors that may also be important. Further research is required to examine the role of fungi and other environmental factors such as air quality as potential effect modifiers of the association.
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Affiliation(s)
- Nur S Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Katrina A Lambert
- School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Jo A Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, 3050, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Ed J Newbigin
- School of BioSciences, The University of Melbourne, Victoria, 3052, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
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25
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Bousquet J, Ansotegui IJ, Anto JM, Arnavielhe S, Bachert C, Basagaña X, Bédard A, Bedbrook A, Bonini M, Bosnic-Anticevich S, Braido F, Cardona V, Czarlewski W, Cruz AA, Demoly P, De Vries G, Dramburg S, Mathieu-Dupas E, Erhola M, Fokkens WJ, Fonseca JA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Jormanainen V, Klimek L, Kuna P, Kvedariene V, Laune D, Larenas-Linnemann D, Lourenço O, Onorato GL, Matricardi PM, Melén E, Mullol J, Papadopoulos NG, Pfaar O, Pham-Thi N, Sheikh A, Tan R, To T, Tomazic PV, Toppila-Salmi S, Tripodi S, Wallace D, Valiulis A, van Eerd M, Ventura MT, Yorgancioglu A, Zuberbier T. Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:2511-2523. [PMID: 31445223 DOI: 10.1016/j.jaip.2019.07.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/02/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023]
Abstract
Smart devices and Internet-based applications (apps) are largely used in allergic rhinitis and may help to address some unmet needs. However, these new tools need to first of all be tested for privacy rules, acceptability, usability, and cost-effectiveness. Second, they should be evaluated in the frame of the digital transformation of health, their impact on health care delivery, and health outcomes. This review (1) summarizes some existing mobile health apps for allergic rhinitis and reviews those in which testing has been published, (2) discusses apps that include risk factors of allergic rhinitis, (3) examines the impact of mobile health apps in phenotype discovery, (4) provides real-world evidence for care pathways, and finally (5) discusses mobile health tools enabling the digital transformation of health and care, empowering citizens, and building a healthier society.
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Affiliation(s)
- Jean Bousquet
- University Hospital, Montpellier, France; MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France; VIMA, INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France; Euforea, Brussels, Belgium; Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany.
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain
| | - Josep M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - Xavier Basagaña
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Annabelle Bédard
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | - Matteo Bonini
- UOC Pneumologia, Istituto di Medicina Interna, F Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, London, United Kingdom
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia; Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Fulvio Braido
- Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Vicky Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL Research Network, Barcelona, Spain
| | | | - Alvaro A Cruz
- ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil; WHO GARD Planning Group, Salvador, Brazil
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Equipe EPAR-IPLESP, Sorbonne Université, Paris, France
| | | | - Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | | | - Marina Erhola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Wytske J Fokkens
- Euforea, Brussels, Belgium; Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, the Netherlands
| | - Joao A Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Medida, Lda, Porto, Portugal
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Peter W Hellings
- Euforea, Brussels, Belgium; Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium; Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | | | | | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Olga Lourenço
- Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - Paolo M Matricardi
- AG Molecular Allergology and Immunomodulation, Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - Erik Melén
- E. Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Nikos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Marburg, Germany
| | - Nhân Pham-Thi
- Allergy Department, Pasteur Institute, Paris, France
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel Tan
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia; Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Teresa To
- Sidkkids Hospital and Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Fla
| | - Arunas Valiulis
- Institute of Clinical Medicine, Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania; Institute of Health Sciences, Department of Public Health, Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | | | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Berlin, Germany; Corporate member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Berlin, Germany; Member of GA(2)LEN, Berlin, Germany
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26
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Bousquet J, Pfaar O, Togias A, Schünemann HJ, Ansotegui I, Papadopoulos NG, Tsiligianni I, Agache I, Anto JM, Bachert C, Bedbrook A, Bergmann K, Bosnic‐Anticevich S, Bosse I, Brozek J, Calderon MA, Canonica GW, Caraballo L, Cardona V, Casale T, Cecchi L, Chu D, Costa E, Cruz AA, Czarlewski W, Durham SR, Du Toit G, Dykewicz M, Ebisawa M, Fauquert JL, Fernandez‐Rivas M, Fokkens WJ, Fonseca J, Fontaine J, Gerth van Wijk R, Haahtela T, Halken S, Hellings PW, Ierodiakonou D, Iinuma T, Ivancevich JC, Jacobsen L, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kleine Tebbe J, Klimek L, Kowalski ML, Kuna P, Kvedariene V, La Grutta S, Larenas‐Linemann D, Lau S, Laune D, Le L, Lodrup Carlsen K, Lourenço O, Malling H, Marien G, Menditto E, Mercier G, Mullol J, Muraro A, O’Hehir R, Okamoto Y, Pajno GB, Park H, Panzner P, Passalacqua G, Pham‐Thi N, Roberts G, Pawankar R, Rolland C, Rosario N, Ryan D, Samolinski B, Sanchez‐Borges M, Scadding G, Shamji MH, Sheikh A, Sturm GJ, Todo Bom A, Toppila‐Salmi S, Valentin‐Rostan M, Valiulis A, Valovirta E, Ventura M, Wahn U, Walker S, Wallace D, Waserman S, Yorgancioglu A, Zuberbier T. 2019 ARIA Care pathways for allergen immunotherapy. Allergy 2019; 74:2087-2102. [PMID: 30955224 DOI: 10.1111/all.13805] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/02/2023]
Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
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Affiliation(s)
- Jean Bousquet
- MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
- INSERM U 1168, VIMA : Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- Euforea Brussels Belgium
- Charité‐Universitätsmedizin Berlin, Humboldt‐Universität zu Berlin Berlin Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT) National Institute of Allergy and Infectious Diseases, NIH Bethesda Maryland
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | | | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou” University of Athens Athens Greece
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Josep M. Anto
- Centre for Research in Environmental Epidemiology (CREAL) ISGlobAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Claus Bachert
- ENT Department, Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium
| | - Anna Bedbrook
- MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
| | - Karl‐Christian Bergmann
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GALEN, Humboldt‐Uniersität zu Berlin Berlin Germany
| | - Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District University of Sydney Glebe New South Wales Australia
| | | | - Jan Brozek
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Moises A. Calderon
- Imperial College London ‐ National Heart and Lung Institute Royal Brompton Hospital NHS London UK
| | - Giorgio W. Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital Humanitas University Milan Italy
| | - Luigi Caraballo
- Institute for Immunological Research University of Cartagena, Campus de Zaragocilla Cartagena Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb) Cartagena Colombia
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
| | - Derek Chu
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Elisio Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Salvador Brazil
- WHO GARD Planning Group Salvador Brazil
| | | | - Stephen R. Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute Imperial College London London UK
| | - George Du Toit
- Guy's and st Thomas' NHS Trust, Kings College London London UK
| | - Mark Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Jean Luc Fauquert
- Unité de pneumo‐allergologie de l'enfant, pôle pédiatrique CHU de Clermont‐Ferrand‐Estaing Clermont‐Ferrand France
| | | | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centres Amsterdam The Netherlands
| | - João Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- Medida, Lda Porto Portugal
| | | | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology Erasmus MC Rotterdam The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
| | - Peter W. Hellings
- Department of Otorhinolaryngology University Hospitals Leuven Leuven Belgium
- Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
| | - Tomohisa Iinuma
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | | | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology National Research Center Moscow Russian Federation
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey
| | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy, Healthy Ageing Research Center Medical University of Lodz Lodz Poland
- Sach's Children and Youth Hospital, Södersjukhuset Stockholm Sweden
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Violeta Kvedariene
- Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences Vilnius University Vilnius Lithuania
- Faculty of Medicine, Institute of Clinical medicine, Clinic of Chest diseases and Allergology Vilnius University Vilnius Lithuania
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology (IBIM) National Research Council (CNR) Palermo Italy
| | - Désirée Larenas‐Linemann
- Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico
| | - Susanne Lau
- Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
| | | | - Lan Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI, Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | | | | | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics University of Naples Federico II Naples Italy
| | - Gregoire Mercier
- Département de l’Information Médicale, Unité Médico‐Economie University Hospital Montpellier France
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department Hospital Clínic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy IDIBAPS, CIBERES, University of Barcelona Barcelona Spain
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health Padua General University Hospital Padua Italy
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Giovanni B. Pajno
- Department of Pediatrics, Allergy Unit University of Messina Messina Italy
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Petr Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino ‐University of Genoa Genoa Italy
| | | | - Graham Roberts
- David Hide Centre, St Mary's Hospital Isle of Wight and University of Southampton Southampton UK
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | | | | | - Dermot Ryan
- Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico‐Docente La Trinidad Caracas Venezuela
| | - Glenis Scadding
- The Royal National TNE Hospital University College London London UK
| | - Mohamed H. Shamji
- Immunomodulation and Tolerance Group Imperial College London London UK
- Allergy and Clinical Immunology Imperial College London London UK
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - Gunter J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
- Outpatient Allergy Clinic Reumannplatz Vienna Austria
| | - Ana Todo Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
| | | | - Arunas Valiulis
- Clinic of Children's Diseases Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- Department of Public Health Institute of Health Sciences Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic University of Turku Turku Finland
| | - Maria‐Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Ulrich Wahn
- Pediatric Department Charité, Berlin Germany
| | | | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine Celal Bayar University Manisa Turkey
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GALEN, Humboldt‐Uniersität zu Berlin Berlin Germany
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27
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Foo CT, Yee EL, Young A, Denton E, Hew M, O'Hehir RE, Radhakrishna N, Matthews S, Conron M, Harun NS, Lachapelle P, Douglass JA, Irving L, Lee J, Stevenson W, McDonald CF, Langton D, Banks C, Thien F. Continued loss of asthma control following epidemic thunderstorm asthma. Asia Pac Allergy 2019; 9:e35. [PMID: 31720246 PMCID: PMC6826110 DOI: 10.5415/apallergy.2019.9.e35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/15/2019] [Indexed: 11/22/2022] Open
Abstract
Background Epidemic thunderstorm asthma (ETSA) severely affected Melbourne, Australia in November 2016. There is scant literature on the natural history of individuals affected by ETSA. Objective A multicentre 12-month prospective observational study was conducted assessing symptomatology and behaviors of ETSA-affected individuals. Methods We used a structured phone questionnaire to assess asthma symptom frequency, inhaled preventer use, asthma action plan ownership and healthcare utilization over 12 months since the ETSA. Analysis of results included subgroup analyses of the “current,” “past,” “probable,“ and “no asthma” subgroups defined according to their original 2016 survey responses. Results Four hundred forty-two questionnaires were analyzed. Eighty percent of individuals reported ongoing asthma symptoms at follow-up, of which 28% were affected by asthma symptoms at least once a week. Risk of persistent asthma symptoms was significantly higher in those with prior asthma diagnosis, current asthma, and probable undiagnosed asthma (all p < 0.01). Of 442 respondents, 53% were prescribed inhaled preventers, of which 51% were adherent at least 5 days a week. Forty-two percent had a written asthma action plan and 16% had sought urgent medical attention for asthma in the preceding year. Conclusions Following an episode of ETSA, patients experience a pivotal change in asthma trajectory with both loss of asthma control and persistence of de novo asthma. Suboptimal rates of inhaled preventer adherence and asthma action plan ownership may contribute to asthma exacerbation risk and susceptibility to future ETSA episodes. Longer-term follow-up is needed to determine the extent and severity of this apparent change.
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Affiliation(s)
| | | | - Alan Young
- Eastern Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Eve Denton
- Alfred Health, Melbourne, VIC, Australia
| | - Mark Hew
- Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | - Robyn E O'Hehir
- Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | | | | | | | | | | | - Jo Anne Douglass
- Melbourne Health, Melbourne, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Louis Irving
- Melbourne Health, Melbourne, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Joy Lee
- Austin Health, Melbourne, VIC, Australia
| | | | | | - David Langton
- Monash University, Melbourne, VIC, Australia.,Peninsula Health, Melbourne, VIC, Australia
| | - Ceri Banks
- Peninsula Health, Melbourne, VIC, Australia
| | - Francis Thien
- Eastern Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
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28
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Clayton-Chubb D, Con D, Rangamuwa K, Taylor D, Thien F, Wadhwa V. Thunderstorm asthma: revealing a hidden at-risk population. Intern Med J 2019; 49:74-78. [PMID: 29573176 DOI: 10.1111/imj.13800] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Epidemic thunderstorm asthma (ETSA) refers to large-scale acute bronchospasm events associated with thunderstorm. The most serious episode ever recorded occurred in Melbourne, Australia, in November 2016, where more than 3500 patients were treated in hospitals and 10 died. Previous work has been focused primarily on patient presentations to emergency departments. The prevalence of individuals with milder, non-emergent symptoms and who may be at risk of more serious episodes in the future has not previously been explored. AIM To characterise the nature and extent of respiratory symptoms in healthcare workers during the Melbourne ETSA event. METHODS A survey was conducted among staff and volunteers across Eastern Health, distributed on the intranet homepage, by email and by word of mouth. Anonymous survey questions were constructed to assess prior and current diagnoses of relevance, symptoms, and demography. RESULTS There were 515 participants (80% female, n = 411) of approximately 9000 potential respondents (~6% response rate) who completed the survey; 132 (25.6%) had symptoms suggestive of asthma during the Melbourne ETSA event, the majority of whom did not seek professional medical help. Notably, of those with ETSA-like symptoms, only 58 (43.9%) had a history of asthma, while 97 (73.5%) had a history of allergic rhinitis. Specifically, a history of allergic rhinitis (OR 2.77, P < 0.001), a history of asthma (OR 1.67, P = 0.037) and being of self-identified Asian ethnicity (OR 3.24, P < 0.001) were all strong predictors of ETSA-like symptoms. Being predominantly indoors was not protective. CONCLUSIONS Our study provides evidence of the presence of a large cohort of sufferers during the Melbourne ETSA event of 2016 that did not come to the attention of medical services, implying a potentially hidden and significant susceptible population. Further research should help clarify the true prevalence of vulnerability in the general population, with important public health implications.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Kanishka Rangamuwa
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Melbourne, Victoria, Australia
| | - Francis Thien
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Vikas Wadhwa
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
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29
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Harun NS, Lachapelle P, Douglass J. Thunderstorm-triggered asthma: what we know so far. J Asthma Allergy 2019; 12:101-108. [PMID: 31190900 PMCID: PMC6512777 DOI: 10.2147/jaa.s175155] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/14/2019] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Nur-Shirin Harun
- 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
| | - Philippe Lachapelle
- Department of Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.,Pulmonary Division, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jo Douglass
- 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
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30
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Sultana RV, McKenzie DP, Fahey MT, Sutherland M, Nimorakiotakis V. Beta-blocker use is an independent risk factor for thunderstorm asthma. Emerg Med Australas 2019; 31:955-960. [PMID: 30887729 DOI: 10.1111/1742-6723.13275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify risk factors for thunderstorm asthma (TA) in subjects ≥15 years of age from information available in routine clinical records. METHODS Retrospective and hospital-based case-control study of various clinical factors in all TA cases (n = 53) who presented to a single-site ED in November 2016 (TA16) and in a control group of patients (n = 156) who presented to the same ED with asthma during the pollen season over eight non-TA years. Bivariate analysis and multivariable logistic regression modelling was performed to calculate the odds of TA asthma in the presence of potential risk factors. RESULTS A logistic regression model revealed that the odds of TA were lower for age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.95-0.99), higher for Asian country of birth (OR 4.09, 95% CI 1.40-11.95) and higher for oral beta-blocker use (OR 6.43, 95% CI 1.58-26.33) compared to controls. No difference was found between TA16 cases and controls for allergies (to medication, grass pollen, animal), hayfever, smoking, oral non-steroidal anti-inflammatory drugs, or aspirin. Newly diagnosed asthma was higher in TA16 cases versus controls (32.1% vs 12.2%, P = 0.001). CONCLUSIONS Oral beta-blocker medications, younger age and Asian-born heritage are risk factors for TA. Further study is required to explore the potential association between beta-blockers and TA.
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Affiliation(s)
- Ron V Sultana
- Emergency Department, Epworth Richmond Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dean P McKenzie
- Epworth HealthCare, Melbourne, Victoria, Australia.,Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Michael T Fahey
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Michael Sutherland
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Epworth HealthCare, Melbourne, Victoria, Australia
| | - Vasilios Nimorakiotakis
- Emergency Department, Epworth Richmond Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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31
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Hew M, Lee J, Susanto NH, Prasad S, Bardin PG, Barnes S, Ruane L, Southcott AM, Gillman A, Young A, Rangamuwa K, O'Hehir RE, McDonald C, Sutherland M, Conron M, Matthews S, Harun N, Lachapelle P, Douglass JA, Irving L, Langton D, Mann J, Erbas B, Thien F. The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission. Allergy 2019; 74:122-130. [PMID: 30243030 DOI: 10.1111/all.13609] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016. OBJECTIVE Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital. METHODS Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed. RESULTS We interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83). CONCLUSIONS In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.
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Affiliation(s)
- Mark Hew
- Alfred Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Joy Lee
- Alfred Health Melbourne Victoria Australia
| | | | | | - Philip G. Bardin
- Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | | | | | | | | | - Alan Young
- Eastern Health Melbourne Victoria Australia
| | | | - Robyn E. O'Hehir
- Alfred Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Christine McDonald
- Austin Health Melbourne Victoria Australia
- Melbourne University Melbourne Victoria Australia
| | - Michael Sutherland
- Austin Health Melbourne Victoria Australia
- Melbourne University Melbourne Victoria Australia
| | - Matthew Conron
- Melbourne University Melbourne Victoria Australia
- St Vincent's Health Melbourne Victoria Australia
| | | | | | | | - Jo A. Douglass
- Melbourne University Melbourne Victoria Australia
- Melbourne Health Melbourne Victoria Australia
| | - Louis Irving
- Melbourne University Melbourne Victoria Australia
- Melbourne Health Melbourne Victoria Australia
| | - David Langton
- Monash University Melbourne Victoria Australia
- Peninsula Health Melbourne Victoria Australia
| | | | - Bircan Erbas
- La Trobe University Melbourne Victoria Australia
| | - Francis Thien
- Monash University Melbourne Victoria Australia
- Eastern Health Melbourne Victoria Australia
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32
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Lai VWY, Bowatte G, Knibbs LD, Rangamuwa K, Young A, Dharmage S, Thien F. Residential NO 2 exposure is associated with urgent healthcare use in a thunderstorm asthma cohort. Asia Pac Allergy 2018; 8:e33. [PMID: 30402400 PMCID: PMC6209594 DOI: 10.5415/apallergy.2018.8.e33] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/27/2023] Open
Abstract
Background There is increasing interest in the role of traffic-related air pollution (TRAP) in allergic airway diseases. Few studies investigate the relationship between TRAP exposure and acute exacerbations of asthma. Objective The 2016 Melbourne thunderstorm asthma epidemic provided an opportunity to investigate the relationship between proxies of TRAP exposure and asthma exacerbation requiring urgent healthcare in the previous 12 months. Methods Current asthmatics who presented to the 3 Emergency Departments of Melbourne's second-largest health service with epidemic thunderstorm asthma in November 2016 were identified and completed a standard questionnaire. Their residential addresses were geocoded and the annual average nitrogen dioxide (NO2) exposure for each patient was assigned using a validated satellite-based land use regression model. Residential distance to the nearest major road was calculated using ArcGIS. Multivariate logistic regression was used to investigate the relationship between each TRAP proxy and healthcare use, adjusting for potential confounders. Results From 263 thunderstorm asthma patients, 88 patients identified with current asthma were analysed. Those with higher mean annual residential NO2 exposure had greater odds of urgent healthcare use in the previous year (odds ratio [OR], 3.45 per one interquartile-range increase; 95% confidence interval [CI], 1.31–9.10; p = 0.01), however distance from major road (OR, 0.95 per 100-m increase; 95% CI, 0.80–1.13; p = 0.57) and living <200 m from a major road (OR, 1.47; 95% CI, 0.29–7.45; p = 0.64) were not significantly associated. Conclusion In current asthmatics who presented during an epidemic thunderstorm asthma event, greater exposure to residential NO2 was significantly associated with greater odds of asthma exacerbations requiring urgent healthcare in the previous 12 months.
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Affiliation(s)
- Vivien Wai Yun Lai
- Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Luke David Knibbs
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | | | - Alan Young
- Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Francis Thien
- Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
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33
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Remote Detection of the Fluorescence Spectrum of Natural Pollens Floating in the Atmosphere Using a Laser-Induced-Fluorescence Spectrum (LIFS) Lidar. REMOTE SENSING 2018. [DOI: 10.3390/rs10101533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A mobile laser-induced fluorescence spectrum (LIFS) lidar was developed for monitoring pollens floating in the atmosphere. The fluorescence spectrum of pollens excited at 355 nm was measured with a fluorescence spectrometer and the results suggested that in general they had peaks at around 460 nm and the ranges were 400–600 nm. A fluorescence spectrum database of 25 different pollens was made with the 355 nm excitation. Based on these results, we developed a LIFS lidar that had features in pollen species identification and daytime operation. The former was achieved by the database and the latter was possible by introducing a synchronous-delay detection to a gated CCD spectrometer in an operation time of 200 ns. Fluorescence detection of pollens floating in the atmosphere was performed using the LIFS lidar in a field where cedars grow in the spring and ragweed in the autumn. The LIFS lidar system successfully detected fluorescence spectrums of the pollens at a distance of approximately 20 m away. We discussed the performance of the LIFS lidar by estimating the number of cedar pollens using a lidar equation, introducing a fluorescence cross section of cedar pollens and a sensitivity of the CCD spectrometer that was measured by ourselves.
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34
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Sierra-Heredia C, North M, Brook J, Daly C, Ellis AK, Henderson D, Henderson SB, Lavigne É, Takaro TK. Aeroallergens in Canada: Distribution, Public Health Impacts, and Opportunities for Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1577. [PMID: 30044421 PMCID: PMC6121311 DOI: 10.3390/ijerph15081577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/04/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
Aeroallergens occur naturally in the environment and are widely dispersed across Canada, yet their public health implications are not well-understood. This review intends to provide a scientific and public health-oriented perspective on aeroallergens in Canada: their distribution, health impacts, and new developments including the effects of climate change and the potential role of aeroallergens in the development of allergies and asthma. The review also describes anthropogenic effects on plant distribution and diversity, and how aeroallergens interact with other environmental elements, such as air pollution and weather events. Increased understanding of the relationships between aeroallergens and health will enhance our ability to provide accurate information, improve preventive measures and provide timely treatments for affected populations.
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Affiliation(s)
| | - Michelle North
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 3H7, Canada.
- Department of Biomedical & Molecular Sciences and Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
- Allergy Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Jeff Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M3H 5T4, Canada.
| | - Christina Daly
- Air Quality Health Index, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Anne K Ellis
- Department of Biomedical & Molecular Sciences and Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON K7L 3N6, Canada.
- Allergy Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada.
| | - Dave Henderson
- Health and Air Quality Services, Environment and Climate Change Canada, Gatineau, QC K1A 0H3, Canada.
| | - Sarah B Henderson
- Environmental Health Services, BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON K1A 0K9, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
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35
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O’Hehir RE, Varese NP, Deckert K, Zubrinich CM, van Zelm MC, Rolland JM, Hew M. Epidemic Thunderstorm Asthma Protection with Five-Grass Pollen Tablet Sublingual Immunotherapy: A Clinical Trial. Am J Respir Crit Care Med 2018; 198:126-128. [DOI: 10.1164/rccm.201711-2337le] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Robyn E. O’Hehir
- Monash UniversityMelbourne, Australiaand
- Alfred HealthMelbourne, Australia
| | - Nirupama P. Varese
- Monash UniversityMelbourne, Australiaand
- Alfred HealthMelbourne, Australia
| | - Kirsten Deckert
- Monash UniversityMelbourne, Australiaand
- Alfred HealthMelbourne, Australia
| | - Celia M. Zubrinich
- Monash UniversityMelbourne, Australiaand
- Alfred HealthMelbourne, Australia
| | - Menno C. van Zelm
- Monash UniversityMelbourne, Australiaand
- Alfred HealthMelbourne, Australia
| | | | - Mark Hew
- Monash UniversityMelbourne, Australiaand
- Alfred HealthMelbourne, Australia
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36
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Cockcroft DW. Epidemic thunderstorm asthma. Lancet Planet Health 2018; 2:e236-e237. [PMID: 29880151 DOI: 10.1016/s2542-5196(18)30123-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Donald W Cockcroft
- Division of Respirology, Critical Care and Sleep Medicine, Saskatoon, SK S7N0W8, Canada; Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada; Royal University Hopital, Saskatoon, SK S7N0W8, Canada.
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Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM, Bardin PG, Bannister T, Barnes S, Bellomo R, Byrne T, Casamento A, Conron M, Cross A, Crosswell A, Douglass JA, Durie M, Dyett J, Ebert E, Erbas B, French C, Gelbart B, Gillman A, Harun NS, Huete A, Irving L, Karalapillai D, Ku D, Lachapelle P, Langton D, Lee J, Looker C, MacIsaac C, McCaffrey J, McDonald CF, McGain F, Newbigin E, O'Hehir R, Pilcher D, Prasad S, Rangamuwa K, Ruane L, Sarode V, Silver JD, Southcott AM, Subramaniam A, Suphioglu C, Susanto NH, Sutherland MF, Taori G, Taylor P, Torre P, Vetro J, Wigmore G, Young AC, Guest C. 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:e255-e263. [PMID: 29880157 DOI: 10.1016/s2542-5196(18)30120-7] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies. METHODS Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions. FINDINGS Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74-2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28-16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died. INTERPRETATION Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma. FUNDING None.
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Affiliation(s)
- Francis Thien
- Eastern Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia.
| | | | - Danny Csutoros
- Department of Health and Human Services, Melbourne, VIC, Australia
| | - Jai Darvall
- Melbourne Health, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Hew
- Alfred Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Janet M Davies
- Queensland University of Technology, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Philip G Bardin
- Monash Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | | | | | - Rinaldo Bellomo
- The University of Melbourne, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia; Austin Health, Melbourne, VIC, Australia
| | | | | | | | | | | | - Jo A Douglass
- Melbourne Health, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia
| | | | - John Dyett
- Eastern Health, Melbourne, VIC, Australia
| | | | | | | | - Ben Gelbart
- Royal Children's Hospital, Melbourne, VIC, Australia
| | | | | | - Alfredo Huete
- University of Technology Sydney, Sydney, NSW, Australia
| | - Louis Irving
- Melbourne Health, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia
| | | | - David Ku
- Monash Health, Melbourne, VIC, Australia
| | | | | | - Joy Lee
- Alfred Health, Melbourne, VIC, Australia
| | - Clare Looker
- Department of Health and Human Services, Melbourne, VIC, Australia
| | | | | | - Christine F McDonald
- The University of Melbourne, Melbourne, VIC, Australia; Austin Health, Melbourne, VIC, Australia
| | | | | | - Robyn O'Hehir
- Alfred Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - David Pilcher
- Alfred Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Torre
- Environmental Protection Authority Victoria, Melbourne, VIC, Australia
| | | | | | - Alan C Young
- Eastern Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Charles Guest
- Department of Health and Human Services, Melbourne, VIC, Australia
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D'Amato G, Annesi-Maesano I, Vaghi A, Cecchi L, D'Amato M. How Do Storms Affect Asthma? Curr Allergy Asthma Rep 2018; 18:24. [PMID: 29574559 DOI: 10.1007/s11882-018-0775-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW There are observations in various geographical areas that thunderstorms occurring during pollen seasons can induce severe asthma attacks in pollinosis patients. RECENT FINDINGS An accredited hypothesis explaining the association between thunderstorms and asthma suggests that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20-30 min of a thunderstorm, patients affected by pollen allergy may inhale a high quantity of the allergenic material that is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. A key message is that all subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe asthma exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events. Patients with respiratory allergy induced by pollens and molds need to be informed about a correct therapeutic approach of bronchial asthma by inhalation, including the use of bronchodilators and inhaled corticosteroids. The purpose of this review is to focalize epidemiological, etiopathogenetic, and clinical aspects of thunderstorm-related asthma.
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Specialty Hospital A.Cardarelli, Via Rione Sirignano, 10, 80121, Naples, Italy. .,School of Specialization in Respiratory Diseases, University of Napoli Federico II, Naples, Italy.
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases, IPLESP, INSERM and Sorbonne Université, Paris, France
| | - Adriano Vaghi
- Division of Pneumology, General Hospital Garbagnate Milanese, Milan, Italy
| | - Lorenzo Cecchi
- Interdepartmental Center of Bioclimatology, University of Florence, Florence, Italy
| | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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