An interesting, if infrequent, phenomenon is that of thunderstorm-induced asthma. There have been reports all over the world, including the United States, Australia, the United Kingdom and Europe of asthma epidemics occurring during and shortly after thunderstorms.
Many of us are aware that weather/temperature changes and allergen exposure are among the most frequent triggers of asthma episodes. It is not uncommon to hear about people with asthma who have severe asthma flares after visiting a friend who has a cat, or after cleaning out an attic or garage. The spring and fall temperature swings are often associated with increases in doctor and hospital visits for asthma.
In November 2016, emergency departments in Melbourne, Australia were inundated with an influx of people suffering with severe asthma symptoms. This happened during the Australian spring pollen season following an evening of thunderstorms. 8500 people required medical attention and 9 people died from asthma during a 2 day period. Many of these people were previously diagnosed with asthma but many had allergic rhinitis/hay fever with no history of asthma.
We usually think of rainfall as cleansing the atmosphere of pollen. So how can thunderstorms trigger asthma symptoms, even in those without a history of asthma? There are several theories but the most widely held opinion is that during a thunderstorm, the warm updrafts carry pollen and mold particles toward the thunder clouds. Both electrical and osmotic forces from lightening and sudden changes in humidity cause rupture of pollen grains and mold particles, which are subsequently forced back toward land in thunderstorm downdrafts. The original pollen grains, rarely less than 10 microns in size are typically too large to be inhaled into the lung where they can trigger asthma. But after rupture of the pollen grains during a thunderstorm, the resulting fragments are much smaller, 0.5-2.5 microns in size, and can easily be inhaled into the lower airway. This can trigger asthma in those people with allergy, even in those who do not have asthma.
Once again, if you have allergies or asthma, the best advice is to listen to what your mother told you and stay indoors during a thunderstorm!
Alan Aarons, M.D.
Allergy Partners of the Triangle,
Raleigh, North Carolina
“Rhinitis”, the medical term for inflammation of the nose, gets no respect. Rhinitis is a common disorder that affects quality of life and has medical consequences if left untreated. Many medical professionals dismiss rhinitis as trivial, despite the fact that it ranks 5th among chronic conditions in terms of overall economic burden.
Nearly everyone suffers from infectious rhinitis, the “common cold”, at some point in their lives. Infectious rhinitis starts with a virus then resolves on its own.
Allergic rhinitis feels like a cold that lasts for weeks or months. Allergic triggers exist year round, even during winter. Allergic rhinitis can impair physical and social functioning. Persistent nasal congestion is associated with sleep-disordered breathing. Sleep disordered breathing affects our ability to focus, and can lead to irritability and depression. Sleep-disordered breathing in children causes inattention and poor learning. The classmates of children with rhinitis are distracted by sniffing and sneezing. Adults isolate themselves socially due to embarrassment caused by frequent nose blowing.
Untreated rhinitis takes a negative financial toll on other respiratory disorders, increasing treatment costs for asthma, chronic sinusitis and ear infections. Patients struggle to alleviate their misery with over-the-counter and prescription medications, while their health care providers overestimate patient satisfaction with medications.
Some patients take daily allergy medications but are not allergic. They suffer from a different type of rhinitis termed non-allergic rhinitis. Non allergic rhinitis symptoms worsen with certain prescription medications, smoke, and strong odors, including perfumes. These patients do not improve with allergy therapy, but instead of getting an accurate diagnosis, they often add more medications. Non allergic rhinitis sufferers can spend hundreds of dollars on medications and antibiotics that may not help.
Proper rhinitis diagnosis can improve treatment outcomes and cut medical costs. If you are regularly purchasing medications and your rhinitis is not controlled, it’s time to see an Allergy Partners Allergist for an accurate diagnosis and effective treatment plan.
Leigh Anne Schwietz M.D.
Allergy Partners of Western North Carolina
Allergic rhinitis is an increasingly common condition with typical symptoms of itchy and runny nose, sneezing, nasal congestion, and postnasal drainage. Frequently brushed off as “a pesky runny nose”, it has been shown that allergic rhinitis is often not an isolated disorder, but coincides with a multitude of other conditions including asthma, sinusitis, conjunctivitis, chronic otitis media, tonsillar and adenoid hypertrophy, sleep apnea, snoring, pharyngitis, laryngitis and disordered sleep. Allergic rhinitis and related comorbidities often negatively impact quality of life.
Allergic rhinitis results from an abnormal immune response to substances encountered in the environment such as pollens, pet dander, mold, and droppings from dust mites and cockroaches. The incidence of allergic rhinitis is estimated at 10-30% of the world’s population and symptoms are often under-recognized and undertreated. It has also been shown that poorly controlled allergic rhinitis is an exacerbating factor for asthma based on a shared common inflammatory pathway and the concept of “one airway”. Controlling allergic rhinitis is a key to maintaining asthma control. Recurrent sinus infections and worsening conjunctivitis are also often related to uncontrolled allergic rhinitis.
Identifying specific allergens with allergy testing allows customization of a treatment plan to include avoiding allergens, medications, and immunotherapy. Immunotherapy is the only therapy that treats the underlying cause, hence not only reducing pesky nasal symptoms, but significantly impacting eye symptoms, asthma and all the other associated disorders. Studies have shown that treating allergic rhinitis with immunotherapy not only improves allergic asthma, but can prevent it from occurring by eliminating the immune system response to potential triggers.
Don’t brush off a runny nose. Likely there are many other related symptoms that can be influenced by adequately treating allergic rhinitis.
Madeline Dillon, MD
Allergy Partners of Charlottesville
References:
Hadley JA, Derebery MJ, Marple BF. Comorbidities and allergic rhinitis: not just a runny nose. J Fam Pract. 2012 Feb;61(2 Suppl):S11-5.
Meltzer EO, Gross GN, Katial R, Storms WW. Allergic rhinitis substantially impacts patient quality of life: Findings from the Nasal Allergy Survey Assessing Limitations. J Fam Pract. 2012;61(suppl 1):S5-S10.
World Health Organization. White Book on Allergy 2011-2012 Executive Summary. By Prof. Ruby Pawankar, MD, PhD, Prof. Giorgio Walkter Canonica, MD, Prof. Stephen T. Holgate, BSc, MD, DSc, FMed Sci and Prof. Richard F. Lockey, MD.
Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2010. By Jeannine S. Schiller, M.P.H., Jacqueline W. Lucas, M.P.H., Brian W. Ward, PhD and Jennifer A. Peregory, M.P.H., Division of Health Interview Statistics.
Bachert C, Vignola AM, Gevaert P, Leynaert B, Van Cauwenberge P, Bousquet J. Allergic rhinitis, rhinosinusitis, and asthma: one airway disease. Immunol Allergy Clin North Am. 2004;24(1):19-43.
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