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The TAISAR study: spotlighting risk thresholds in thunderstorm asthma

Published: November 10, 2021

Epidemic thunderstorm asthma (ETSA) is an environmental health emergency. Whilst reported world-wide, ETSA is recurrent and severe in south-eastern Australia. It is established that symptomatic hay fever (seasonal allergic rhinitis-SAR) and the presence of allergen specific IgE to ryegrass pollen (RGP-spIgE) are almost universal in those who suffer from ETSA. Preventive asthma treatments are indicated to protect from ETSA but implementing these to the one-in five people who suffer from SAR is impractical. Estimation of risk for ETSA is essential to inform clinical practice.

In a recent study published in The Journal of Allergy and Clinical Immunology (JACI), Douglass et al conducted the TAISAR study: Thunderstorm Asthma in Seasonal Allergic Rhinitis - recruiting an adult cohort of 228 patients who reported SAR and compared clinical features and biomarkers for those who did not report any ETSA (35%) with those who suffered prior ETSA symptoms (37%) and those reporting previous hospital presentation with ETSA (28%). Biomarkers included blood eosinophil counts, spirometry (FEV1), exhaled nitric oxide and RGP-spIgE.  

Analysis indicated that a blood eosinophil count of > 0.3x109 cells/L was associated with an odds ratio of 3.7 for any ETSA. Receiver-operating curve (ROC) analysis demonstrated a threshold of RGP-spIgE >10.1 kU/L held a sensitivity of 0.84 and specificity of 0.57 for hospital presentation with ETSA. Prebronchodilator FEV1 < 90% of predicted had a sensitivity of 0.73 and specificity 0.62 for predicting hospital presentation for ETSA.   

This study is the first to compare clinical features and biomarkers for those who suffer from ETSA to those who suffer from SAR. The demonstration of biomarkers for risk for ETSA can be used to guide clinical decisions to implement preventive strategies.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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