There are observations that thunderstorms occurring during pollen season can induce severe asthma attacks in pollinosis patients (Andrew et al. 2017; Bellomo et al. 1992; D’Amato et al. 2007, 2016a, 2017, 2018b).

According to current climate change scenarios, there will be an increase in intensity and frequency of heavy rainfall episodes, including thunderstorms, which can be expected to be associated with an increase in the number and severity of asthma attacks both in adults and in children (Andrew et al. 2017; D’Amato et al. 2005, 2007, 2016a, 2017, 2018b).

Associations between thunderstorms and asthma attacks have been identified in multiple locations around the world and especially during the pollen season when the concentrations of allergenic pollen grains was higher (Table 1). So, was called “thunderstorm asthma,” due by dispersion of more respirable allergenic particles derived from pollen and spores outbreaks (Andrew et al. 2017; D’Amato et al. 2007, 2016a, 2017, 2018b). The emergency episodes occurred at the beginning of thunderstorms, with an increase in signaling for asthma attack by chronic patients and also by subjects affected only by seasonal rhinitis. Recently, a dramatic event in Melbourne occurred on November 21, 2016, with 10 deaths and 9000 patients who needed medical treatments in Emergency Department of Melbourne Hospital for asthma attacks (Andrew et al. 2017; Lindstrom et al. 2017). This in Melbourne has been the worst event of thunderstorm asthma with an extraordinary association of environmental factors, a very unusual weather occurrence with wind and torrential rain combined with a high pollen amount (the grass pollen was more than 100/m³) sending, an high quantity of pollens and microparticles derived from pollens over the city. In Melbourne, ambulance and hospitals experienced high scale of involvement in such a reduced time period of a few hours on 21 November with grass allergens dispersed over a very large geographical area of Victoria. The rapid onset of the medical emergency and its consequences were unprecedented in the scale of the intensity in comparison with previous events and it tested the capacity of Melbourne health system to be ready for this type of medical emergency. However, demand management strategies were insufficient to manage such a widespread and rapid onset event, with ambulance resources quickly depleted and using police officers to conduct welfare check (Andrew et al. 2017; Lindstrom et al. 2017). The event of Melbourne greatly surpassed the previous epidemic of London of June 1994 that was the largest documented outbreak before the Victoria epidemic.