Abstract
Introduction: Heiner syndrome is a very rare but reversible lung disease caused by non-IgE-mediated hypersensitivity to cow's milk proteins resulting in an atypical pulmonary disease in babies and infants. Very few cases have been reported. Due to its heterogeneous manifestations, the diagnosis can be delayed since it can occur with chronic or recurrent infections of the upper or lower respiratory tract, fever, growth failure, or gastrointestinal symptoms. Pulmonary infiltrates can be mistaken for pneumonia, but Heiner’s syndrome is refractory to antibiotic treatment.
Case report: We describe the case of a 1-month-old newborn baby whose main symptom was hematemesis, which is a rare symptom. The diagnosis was confirmed with the complete disappearance of the symptoms when milk and dairy products were strictly avoided.
Conclusions: The prognosis is favorable if a milk-free diet is begun early. Most children will tolerate cow´s milk within a few years.
References
Sicherer SH, Sampson HA. Food allergy. A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41-58. DOI: 10.1016/j.jaci.2017.11.003.
Fiocchi A, Brozek J, Schünemann H, Bahna SL, von Berg A, Beyer K, et al. World Allergy Organization (WAO) diagnosis and rationale for action against cow’s milk allergy (DRACMA) guidelines. World Allergy Organ J. 2010;3(4):57-161. DOI: 10.1111/j.1399-3038.2010.01068.x
Moissidis I, Chaidaroon D, Vichyanond P, Bahna SL. Milk-induced pulmonary disease in infants (Heiner syndrome). Pediatr Allergy Immunol. 2005;16(6):545-552. DOI: 10.1111/j.1399-3038.2005.00291.x
Heiner DC, Sears JW, Kniker WT. Multiple precipitins to cow’s milk in chronic respiratory disease. A syndrome including poor growth, gastrointestinal symptoms, evidence of allergy, iron deficiency anemia, and pulmonary hemosiderosis. Am J Dis Child. 1962;103(5):634-654. DOI: 10.1001/archpedi.1962.02080020649003
Bergmann MM, Eigenmann PA. Food Allergy in childhood (Infancy to school age). En: Ebisawa M, Ballmer-Weber BK, Vieths S, Wood RA, editores. Food allergy: molecular basis and clinical practice. Chem Immunol Allergy. 2015;101:38-50. DOI: 10-1159/000371666.
Lee SK, Kniker WT, Cook CD, Heiner DC. Cow’s milk-induced pulmonary disease in children. Adv Pediatr. 1978;25:39-57.
Stafford HA, Polmar SH, Boat TF. Immunologic studies in cow’s milk-induced pulmonary hemosiderosis. Pediatr Res. 1977;11(8):898-903. DOI: 10.1203/00006450-197708000-00009
Liu XY, Huang XR, Zhang JW, Xiao YM, Zhang T. Hematochezia in a child with Heiner syndrome. Front Pediatr. 2019;7:551-55. DOI: 10.3389/fped.2019.00551
Koc AS, Sucu A, Celik U. A different clinical presentation of Heiner syndrome: The case of diffuse alveolar hemorrhage causing massive hemoptysis and hematemesis. Resp Med Case Rep. 2019;26:206-8. DOI: 10.1016/j.rmcr.2019.01.019
Chang CH, Wittig HJ. Heiner’s syndrome. Radiology. 1969;92(3):507-508. DOI: 10.1148/92.3.507
Ojuawo AB, Ojuawo OB, Aladesanmi AO, Adio MO, Abdulkadir MB, Mokuolu OA. Heiner syndrome: an uncommon cause of failure to thrive. Malawi Med J. 2019:31(3);227-229. DOI: 10.4314/mmj.v31i3.11
Sigua JA, Zacharisen M. Heiner syndrome mimicking an immune deficiency. WMJ. 2013;112(5):215-218.
Godfrey S. Pulmonary hemorrhage/hemoptysis in children. Pediatr Pulmonol. 2004;37(6):476-484. DOI: 10.1002/ppul.20020
Cunningham-Rundles C, Brandeis WE, Good RA, Day NK. Milk precipitins, circulating immune complexes, and IgA deficiency. Proc Natl Acad Sci U S A. 1978;75(7):3387-3389. DOI: 10.1073/pnas.75.7.3387
Maggiolo J, Farbinger F, Rubilar L. Hemoptisis/hemorragia pulmonar en pediatría. Neumol Pediatr. 2009;4(2):65-72. Disponible en http://www.neumologia-pediatrica.cl
González-Ortiz B. Sangrado de tubo digestivo. En: Flores-Calderón J, González-Ortiz B. Enfermedades hepáticas y gastrointestinales en niños. Diagnóstico y tratamiento. México: Corinter; 2017.
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