A major outbreak of asthma associated with a thunderstorm: experience of accident and emergency departments and patients' characteristics

Davidson, Amber; Emberlin, Jean; Cook, Adrian; Venables, K M

doi:10.1136/bmj.312.7031.601

Cited by 96 publications

(37 citation statements)

References 15 publications

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“…The rupture of pollen grains due to an osmotic shock during thunderstorms or under especially wet conditions has been studied. Suphioglu et al [37] and Davidson et al [38] confirmed that after strong storms, there were notable asthmatic epidemics due to the osmotic rupture of the Poaceae pollen grain, which releases starch granules ranging in size from 2.5 to 0.6 µm into the atmosphere. In 2002, Taylor et al [39] observed in the laboratory that grass anthers under various meteorological conditions are a site of pollen rupture and a source of fine particulate aerosols that contain pollen allergens.…”

Section: Discussionmentioning

confidence: 56%

Airborne Study of Grass Allergen (Lol p 1) in Different-Sized Particles

Linares

Guardia

Nieto‐Lugilde

et al. 2009

Int Arch Allergy Immunol

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Background: The Poaceae family is considered one of the main causes of pollen allergy in industrialized countries. The aim of this study is to establish the dynamics of the Poaceae allergens and determine their distribution in the different-sized particles in the atmosphere. Methods: The air of Granada (southern Spain) was sampled during the pollination period of Poaceae using a cascade impactor and a Hirst-type volumetric collector simultaneously. The sampled airborne allergens were analyzed by indirect ELISA and field emission scanning electron microscopy. Airborne pollen was evaluated with the Spanish Aerobiological Network methodology. Results:Poaceae pollen and allergenic activity have parallel dynamics during the period of maximum pollination, which is reflected in the positive correlations between the 2 variables. In addition, the highest Lol p 1 concentrations were recorded in particle sizes lower than 3.3 µm (stage 4-F). The Spearman correlation test showed that airborne allergens are not dependent on meteorological factors, such as humidity, wind direction or sunshine, however, Lol p 1 allergen correlated positively with Poaceae pollen. Conclusions: The results of the present study confirm that the Lol p 1 allergen is detected more frequently with pollutants than with coarse particles with similar dynamics and a positive correlation between airborne pollen and aeroallergens. Moreover, Lol p 1 is released in stable weather conditions without large changes in humidity or temperature.

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Section: Discussionmentioning

confidence: 56%

Airborne Study of Grass Allergen (Lol p 1) in Different-Sized Particles

Linares

Guardia

Nieto‐Lugilde

et al. 2009

Int Arch Allergy Immunol

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“…It is likely that the proportions of daily asthma events (hospitalisations, etc) attributable to aeroallergen exposure are likely to be small. However, analyses of asthma epidemics occurring during thunderstorms [33][34][35][36][37][38] and the unloading of soya beans in Barcelona 39 suggest that aeroallergens can play a significant role in precipitating asthma attacks. Furthermore, studies have linked the magnitude of the effects of fungal spores to asthma severity in subjects.…”

Section: Discussionmentioning

confidence: 99%

Temporal associations between daily counts of fungal spores and asthma exacerbations

Atkinson

Strachan²,

Anderson³

et al. 2006

Occup Environ Med

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Background: Outdoor aeroallergens are one of a number of environmental factors thought to precipitate asthma exacerbations. Aims: To investigate the short term associations between daily fungal spore concentrations and indicators of daily asthma exacerbations in a large urban population. Methods: Daily counts of visits for asthma to family physicians and hospital accident and emergency (A&E) departments and emergency hospital admissions in London 1992-93 were compiled. Daily concentrations of fungal spores (30 species), daily average temperature, humidity, and concentrations of pollen and outdoor air pollution were also compiled. The analysis was restricted to the period when fungal spores were most prevalent (June to mid October). Non-parametric regression time series methods were used to assess associations controlling for seasonality, day of week, and meteorological factors. The sensitivity of the findings to the inclusion of pollen and air pollution into the models was also assessed. Results: In children aged 0-14 years the relative risks for increases in the number of A&E visits and hospital admissions associated with changes in fungal spore concentrations from the lower to upper quartiles were 1.06 (95% CI 0.94 to 1.18) and 1.07 (0.97 to 1.19) respectively. The addition of pollen or air pollutants had little impact on the observed associations. A number of individual spore taxa, in particular Alternaria, Epicoccum, Agrocybe, Mildews, and both coloured and colourless Basidiospores and Ascospores, were associated with increases in the number of emergency visits and hospital admissions for asthma, although the precision of these estimates were low. No evidence was found for associations in adults. Conclusions: Fungal spore concentrations may provoke or exacerbate asthma attacks in children resulting in visits to A&E departments and emergency hospital admissions. These findings were unlikely to be due to confounding by other environmental factors. The associations were comparable to those observed for ambient air pollution from similarly designed studies.

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“…Several patients who were examined, who were not known to be asthmatics or were affected only by seasonal rhinitis, experienced an asthma attack [50-52]. During a 30-h period from 6 p.m. on June 24, 1994, 640 patients with asthma or other airways disease (283 of whom were not known to be asthmatic and 403 were affected only by seasonal rhinitis) attended several emergency departments, nearly 10 times the expected number of 66 patients.…”

Section: Introductionmentioning

confidence: 99%

Climate change, air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases

D’Amato

Baena-Cagnani

Cecchi³

et al. 2013

Multidiscip Respir Med

126

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The prevalence of asthma and allergic diseases has increased dramatically during the past few decades not only in industrialized countries. Urban air pollution from motor vehicles has been indicated as one of the major risk factors responsible for this increase.Although genetic factors are important in the development of asthma and allergic diseases, the rising trend can be explained only in changes occurred in the environment. Despite some differences in the air pollution profile and decreasing trends of some key air pollutants, air quality is an important concern for public health in the cities throughout the world.Due to climate change, air pollution patterns are changing in several urbanized areas of the world, with a significant effect on respiratory health.The observational evidence indicates that recent regional changes in climate, particularly temperature increases, have already affected a diverse set of physical and biological systems in many parts of the world. Associations between thunderstorms and asthma morbidity in pollinosis subjects have been also identified in multiple locations around the world.Allergens patterns are also changing in response to climate change and air pollution can modify the allergenic potential of pollens especially in presence of specific weather conditions.The underlying mechanisms of all these interactions are not well known yet. The consequences on health vary from decreases in lung function to allergic diseases, new onset of diseases, and exacerbation of chronic respiratory diseases.Factor clouding the issue is that laboratory evaluations do not reflect what happens during natural exposition, when atmospheric pollution mixtures in polluted cities are inhaled. In addition, it is important to recall that an individual’s response to pollution exposure depends on the source and components of air pollution, as well as meteorological conditions. Indeed, some air pollution-related incidents with asthma aggravation do not depend only on the increased production of air pollution, but rather on atmospheric factors that favour the accumulation of air pollutants at ground level.Considering these aspects governments worldwide and international organizations such as the World Health Organization and the European Union are facing a growing problem of the respiratory effects induced by gaseous and particulate pollutants arising from motor vehicle emissions.

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A major outbreak of asthma associated with a thunderstorm: experience of accident and emergency departments and patients' characteristics

Cited by 96 publications

References 15 publications

Airborne Study of Grass Allergen (Lol p 1) in Different-Sized Particles

Airborne Study of Grass Allergen (Lol p 1) in Different-Sized Particles

Temporal associations between daily counts of fungal spores and asthma exacerbations

Climate change, air pollution and extreme events leading to increasing prevalence of allergic respiratory diseases

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