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Publisher Copyright: © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2022. Introduction: Temperature and relative humidity affect health, particularly the respiratory system. Children represent a risk group, due to immature systems and continual development. The present study aimed to analyze the effects of temperature and relative humidity on hospitalizations of children due to asthma exacerbations and respiratory infections. Methods: This retrospective study analyzed administrative data from patients with respiratory infections and/or asthma exacerbations who were admitted to the pediatric service in a central hospital from 2018 to 2020. Pearson and Spearman correlations, Student t test, analysis of variance, and the equivalent non-parametric tests were used to describe the association between environmental factors, such as temperature and relative humidity, on children hospitalizations due to asthma exacerbations and acute respiratory infections. Negative binomial regression was used to model the daily expected hospitalizations. Results: This study was conducted on a total of 369 clinical records of primary and secondary discharge diagnoses related to 338 children. In 2020, there was a decline in admissions, due to the COVID-19 pandemic. The viral lower respiratory infections, asthma, upper respiratory infections, and non-viral lower respiratory infections accounted for 51.2%, 17.9%, 16.3%, and 14.6% of recorded diagnoses, respectively. The mean ± standard deviation of daily temperature and relative humidity was 14.8ºC ± 4.0ºC and 77.7% ± 12.7%, respectively. A negative correlation was found with maximum temperature (p = 0.012), and a positive correlation was observed with mean relative humidity (p = 0.045). There was a significant association between viral lower respiratory infections and hospitalizations, which increased with the mean temperatures < 10.0ºC and relative humidity > 86.67%. Finally, our best model showed a negative correlation between daily mean temperature and hospitalizations (incidence rate ratio = 0.989). Conclusion: Cold and humidity were associated with hospitalizations for asthma and respiratory infections. Further studies with other variables (eg pollutants) may identify other factors more precisely and advocate prevention and health planning. publishersversion published

Background Allergic reactions to the common house plant Hoya compacta (HC) have not previously been described. Aims To confirm HC as the cause of rhinoconjunctivitis in three horticultural workers. Methods Greenhouse working conditions were reproduced in our challenge chamber. Results All three cases developed rhinoconjunctivitis when working with HC plants. A control challenge was performed in two cases with iceberg lettuce causing no symptoms. Nasal volume measured by acoustic rhinometry (AR) fell after all three active challenges, but also after one of the control challenges. Conclusions Our study confirms that HC may cause occupational rhinoconjunctivitis and asthma through a Type I hypersensitivity reaction. Specific inhalation challenges, nasal nitric oxide measurement and AR may be useful additional tools in supporting such diagnoses for occupational physicians to consider.

Chlamydia pneumoniae: possible association with asthma in children

Objective: Studies characterizing asthma phenotypes have predominantly included adults or have involved children and adolescents in developed countries. Therefore, their applicability in other populations, such as those of developing countries, remains indeterminate. Our objective was to determine how low-income children and adolescents with asthma in Brazil are distributed across a cluster analysis. Methods: We included 306 children and adolescents (6-18 years of age) with a clinical diagnosis of asthma and under medical treatment for at least one year of follow-up. At enrollment, all the patients were clinically stable. For the cluster analysis, we selected 20 variables commonly measured in clinical practice and considered important in defining asthma phenotypes. Variables with high multicollinearity were excluded. A cluster analysis was applied using a twostep agglomerative test and log-likelihood distance measure. Results: Three clusters were defined for our population. Cluster 1 (n = 94) included subjects with normal pulmonary function, mild eosinophil inflammation, few exacerbations, later age at asthma onset, and mild atopy. Cluster 2 (n = 87) included those with normal pulmonary function, a moderate number of exacerbations, early age at asthma onset, more severe eosinophil inflammation, and moderate atopy. Cluster 3 (n = 108) included those with poor pulmonary function, frequent exacerbations, severe eosinophil inflammation, and severe atopy. Conclusions: Asthma was characterized by the presence of atopy, number of exacerbations, and lung function in low-income children and adolescents in Brazil. The many similarities with previous cluster analyses of phenotypes indicate that this approach shows good generalizability. RESUMO Objetivo: Estudos que caracterizam fenótipos de asma predominantemente incluem adultos ou foram realizados em crianças e adolescentes de países desenvolvidos; portanto, sua aplicabilidade em outras populações, tais como as de países em desenvolvimento, permanece indeterminada. Nosso objetivo foi determinar como crianças e adolescentes asmáticas de baixa renda no Brasil são distribuídos através de uma análise de clusters. Métodos: Foram incluídos 306 crianças e adolescentes (6-18 anos de idade) com diagnóstico clínico de asma e sob tratamento médico por pelo menos um ano de acompanhamento. No momento da inclusão, todos os pacientes estavam clinicamente estáveis. Vinte variáveis comumente determinadas na prática clínica e consideradas importantes na definição dos fenótipos de asma foram selecionadas para a análise de clusters. As variáveis com alta multicolinearidade foram excluídas. Uma análise de clusters foi realizada utilizando-se um teste aglomerativo em duas etapas e log-likelihood distance measure. Resultados: Três clusters foram definidos para nossa população. O cluster 1 (n = 94) incluiu indivíduos com função pulmonar normal, inflamação eosinofílica leve, poucas exacerbações, início mais tardio da asma e atopia leve. O cluster 2 (n = 87) incluiu pacientes com função pulmonar normal, número moderado de exacerbações, início precoce da asma, inflamação eosinofílica mais grave e atopia moderada. O cluster 3 (n = 108) incluiu pacientes com função pulmonar ruim, exacerbações frequentes, inflamação eosinofílica e atopia graves. Conclusões: A asma foi caracterizada por presença de atopia, número de exacerbações e função pulmonar em crianças e adolescentes de baixa renda no Brasil. As muitas semelhanças entre esta e outras análises de clusters de fenótipos indicam que essa abordagem apresenta boa generalização.