• Mark Hew, Joy Lee, Nugroho H Susanto, Shivonne Prasad, Philip G Bardin, Sara Barnes, Laurence Ruane, Anne M Southcott, Andrew Gillman, Alan Young, Kanishka Rangamuwa, Robyn E O'Hehir, Christine McDonald, Michael Sutherland, Matthew Conron, Sarah Matthews, Nur-Shirin Harun, Philippe Lachapelle, Jo A Douglass, Louis Irving, David Langton, Jennifer Mann, Bircan Erbas, and Francis Thien.
• Alfred Health, Melbourne, Victoria, Australia.
• Allergy. 2019 Jan 1; 74 (1): 122-130.

BackgroundThe world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016.ObjectiveAmong thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital.MethodsThunderstorm-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.ResultsWe 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).ConclusionsIn 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.© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

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