PMID- 16176405
OWN - NLM
STAT- MEDLINE
DCOM- 20060406
LR  - 20080528
IS  - 0905-6157 (Print)
IS  - 0905-6157 (Linking)
VI  - 16
IP  - 6
DP  - 2005 Sep
TI  - Milk-induced pulmonary disease in infants (Heiner syndrome).
PG  - 545-52
AB  - Heiner syndrome (HS) is a food hypersensitivity pulmonary disease that affects 
      primarily infants, and is mostly caused by cow's milk (CM). Only a few reports 
      have been published, which may be due to its misdiagnosis. We review here a 
      series of eight cases. When first diagnosed they were 4-29 months of age. They 
      were fed CM from birth and their chronic respiratory symptoms began at age 1-9 
      months. The symptoms were in the form of cough in seven, wheezing in three, 
      hemoptysis in two, nasal congestion in three, dyspnea in one, recurrent otitis 
      media (OM) in three, recurrent fever in four, anorexia, vomiting, colic or 
      diarrhea in five, hematochezia in one, and failure to thrive (FTT) in two. All 
      had radiologic evidence of pulmonary infiltrates. High titers of precipitating 
      antibodies to CM proteins were demonstrated in six of six and milk-specific 
      immunoglobulin E (IgE) was positive in one of two. Pulmonary hemosiderosis (PH) 
      was confirmed in one patient who showed iron-laden macrophages (ILM) in the 
      bronchoalveolar lavage (BAL), gastric washing, and open lung biopsy. Additional 
      findings, in a descending frequency, were eosinophilia, anemia, and elevated 
      level of total IgM, IgE or IgA. Milk elimination resulted in remarkable 
      improvement in symptoms within days and clearing of the pulmonary infiltrate 
      within weeks. Parents consented to milk challenge in only three cases, all of 
      whom developed recurrence of symptoms. After 2 yr of milk avoidance in one 
      patient, milk challenge was tolerated for 2 months, and then the patient 
      developed symptoms, serum milk precipitins, pulmonary infiltrate, and ILM. The HS 
      should be suspected in young children with chronic pulmonary disease of obscure 
      cause. The diagnosis is supported with a positive milk precipitin test and 
      improvement on a trial of milk elimination. Severe cases may be complicated with 
      PH, which should be suspected in the presence of anemia or hemoptysis and be 
      confirmed with the demonstration of ILM.
FAU - Moissidis, Ioannis
AU  - Moissidis I
AD  - Allergy and Immunology Section, Louisiana State University Health Sciences 
      Center, Shreveport, LA 71130-3932, USA.
FAU - Chaidaroon, Darunee
AU  - Chaidaroon D
FAU - Vichyanond, Pakit
AU  - Vichyanond P
FAU - Bahna, Sami L
AU  - Bahna SL
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Pediatr Allergy Immunol
JT  - Pediatric allergy and immunology : official publication of the European Society 
      of Pediatric Allergy and Immunology
JID - 9106718
RN  - 0 (Immunoglobulin A)
RN  - 0 (Immunoglobulin G)
RN  - 0 (Immunoglobulin M)
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Antibody Specificity
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Immunoglobulin A/blood
MH  - Immunoglobulin E/blood
MH  - Immunoglobulin G/blood
MH  - Immunoglobulin M/blood
MH  - Infant
MH  - Lung Diseases/diagnosis/*etiology/immunology
MH  - Male
MH  - Milk Hypersensitivity/*complications/immunology
MH  - Respiratory Hypersensitivity/diagnosis/*etiology/immunology
EDAT- 2005/09/24 09:00
MHDA- 2006/04/07 09:00
CRDT- 2005/09/24 09:00
PHST- 2005/09/24 09:00 [pubmed]
PHST- 2006/04/07 09:00 [medline]
PHST- 2005/09/24 09:00 [entrez]
AID - PAI291 [pii]
AID - 10.1111/j.1399-3038.2005.00291.x [doi]
PST - ppublish
SO  - Pediatr Allergy Immunol. 2005 Sep;16(6):545-52. doi: 
      10.1111/j.1399-3038.2005.00291.x.