Epidemic thunderstorm asthma has been reported about a dozen times in the past 35 years; the threshold for reporting seems to be an increase of at least five to ten times in asthma presentations to emergency departments over a short time.’? Most cases have occurred in Australia (especially in Melbourne) and in the UK; one has occurred in North America and two smaller events have occurred in continental Europe (Italy). Many individuals are affected by these events but do not seek acute medical care.** The accepted mechanism is extreme allergen exposure, predominantly grass pollen, in susceptible allergic individuals. The rapidity of onset and the speed of recovery (compared with usual emergency department asthma presentations) suggest these cases probably represent allergen-induced and mainly bronchospastic early asthmatic responses, an otherwise unusual precipitant for asthma exacerbation that is severe enough to merit emergency department requirement.” The early asthmatic responses is dependent on the degree of allergy (allergen specific IgE assessed by prick skin test or serology); the magnitude of (untreated) airway hyper-responsiveness; and the dose of allergen.* Because the early asthmatic response can occasionally be life threatening,’ and sometimes fatal as in the Melbourne epidemic in 2016, rapid access to life-saving medical care is also important.
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