Normally pollen is too large to enter the lungs, but when a thunderstorm is brewing, updrafts of air can lift whole pollen grains up into the clouds. When exposed to moisture, these grains rupture into tiny pieces and this makes them highly allergenic.
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Windy downdrafts then carry these fragments to ground level, resulting in a “pollen shower” & people can inhale the minute fragments deep into their lungs.
If you have hay fever then this can trigger an asthma attack - even if you don't have asthma.
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Not every thunderstorm causes thunderstorm asthma even if pollen counts are high. A number of factors need to come together.
In fact serious outbreaks are v.rare.
But it is worth knowing about it nonetheless.
If a thunderstorm is forecast, take the following simple steps:
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Remain indoors with windows closed before & during & just after a thunderstorm
If you have to go outside, wear a mask to avoid inhaling pollen fragments. I tell my pats to carry a mask in case they get caught out.
Antihistamines may help (& won't harm) but this is debatable
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If you develop a severe asthma attack & have an asthma reliever:
Take 4 puffs of your reliever & wait 4 mins.
If no improvement take 4 more puffs & wait 4 mins.
If no improvement, 999 & take 4 more puffs of your reliever every 4 mins until help arrives (Asthma Australia)
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If you have asthma make sure it is well controlled going into the pollen season & you are taking your preventer inhalers & you have your reliever inhaler with you when going out.
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A few years ago the brilliant @DrLindaDykes (worth a follow) & myself put together an infographic about #thunderstorm#asthma for healthcare professionals & patients.
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If you want to know more about thunderstorm & seasonal asthma, hay fever, food allergy, allergy prevention, anaphylaxis - or know someone with allergies - then this is a brilliant book😉
Many pats tell me nasal steroid sprays for hay fever don't help. But often this is due to not being taught when & how to use them.
Here are several tricks of the trade which help >90% of my pats to put hay fever behind them.
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Nasal steroid sprays take time to build up.
Don't be disappointed if you don't notice a difference for a week or even two. Antihistamine tablets act quickly but nasal steroids need to be used regularly.
If you use them correctly, they are incredibly effective!
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Ideally use a nasal steroid spray a fortnight BEFORE the pollen season begins, too late for this year I know.
But put a reminder on your phone for next year.
So mid March if you get spring time hay fever and start of May if you get summer hay fever.
Cold remedies designed to unblock your nose & nasal steroid sprays, for hay-fever are often found on the same “allergy” shelf
Do not chose the ones that are marketed as cold relief, decongestants or to treat sinusitis!
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You'd think if you had a blocked 'hay-fevery' nose that treatments for a blocked nose would help. And you’d be right. They’ll help for a few days. But they are not designed for hay fever & if you use them for more than a few days you may develop rebound stuffiness/blockage.
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Patients get caught in a vicious cycle of feeling blocked due to allergy, using a decongestant & initially feeling better, but then developing rebound blockage.
There is even a name for this rhinitis medicamentosa. This is why most specialists will not recommend them.
Seen a few tweets where people are reporting #hayfever It is likely this is due to the early tree pollens & suggests birch pollen; the cause of much misery in spring is not that far behind. This calendar from my book can help you work out which pollen is giving you problems
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One tip if antihistamines are not doing the trick is to start using a nasal steroid spray 2 weeks before your pollen season.
If buying over the counter, then I suggest to my patients fluticasone proprionate & if via the GP fluticasone furoate but other products work too.
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Often pats tell me nasal steroid sprays don't work. There are three common reason why:
1) Stopping them too soon 2) Closing one nostril when using them 3) Sniffing in as using the spray
And as I said above, starting them before you get symptoms can make a huge difference.
Urticaria & a persistent cough can be anaphylaxis.
As can angioedema, wheeze & low blood pressure.
However urticaria & angioedema are not essential to make the diagnosis & in severe reactions may not be seen at all.
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The first-line treatment for anaphylaxis is Adrenaline.
Seems easy enough no?
But time & time again studies show a delay in administering it.
Pumphrey (2000). Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 30(8), 1144–1150 ⬇️
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Contrary to popular belief, facial angioedema does not equate to a patient being at increased risk of developing laryngeal oedema. Although people often worry about laryngeal oedema, wheeze with anaphylaxis seems to trigger less concern.