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Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study


Douglass, JA and Lodge, C and Chan, S and Doherty, A and Tan, JA and Jin, C and Stewart, A and Southcott, AM and Gillman, A and Lee, J and Csutoros, D and Hannan, L and Ruane, L and Barnes, S and Irving, L and Harun, NS and Lachapelle, P and Spriggs, K and Sutherland, M and See, K and McDonald, CF and Conron, M and Radhakrishna, N and Worsnop, C and Johnston, F and Davies, JM and Bryant, V and Iles, L and Ranson, D and Spanos, P and Vicendese, D and Lowe, A and Newbigin, EJ and Bardin, P and Dharmage, S, Thunderstorm asthma in seasonal allergic rhinitis: The TAISAR study, Journal of Allergy and Clinical Immunology, 149, (5) pp. 1607-1616. ISSN 0091-6749 (2022) [Refereed Article]

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DOI: doi:10.1016/j.jaci.2021.10.028


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.

Item Details

Item Type:Refereed Article
Keywords:ACQ; Asthma; epidemic; ryegrass pollen; seasonal allergic rhinitis; specific IgE; spirometry; thunderstorm
Research Division:Environmental Sciences
Research Group:Climate change impacts and adaptation
Research Field:Human impacts of climate change and human adaptation
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Johnston, F (Professor Fay Johnston)
ID Code:155607
Year Published:2022
Web of Science® Times Cited:3
Deposited By:Menzies Institute for Medical Research
Deposited On:2023-03-02
Last Modified:2023-03-02

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