Pulmonary disease caused by milk allergy may be a rare presentation but should be thought of in a child with recurrent infections and pulmonary infiltrates. [consultant360.com]

Case Presentation A sixteen week old male infant who was a product of term gestation presented with poor weight gain and respiratory distress noticed at 10th week of life. [ncbi.nlm.nih.gov]

In the present review we aimed at presenting clinical, diagnostic and therapeutic characteristics of HS, starting from current evidence. 2. [mdpi.com]

2020/34/2/123/300925 Introduction Cow's milk protein allergy (CMPA) commonly presents with atopic dermatitis in infancy. [ijaai.in]

It is the purpose of this report to familiarize radiologists with the characteristics and differentiating features of this syndrome by presenting a case in the radiologic literature. D. [pubs.rsna.org]

• Intermittent Fever

  The most commonly described systemic clinical manifestations were intermittent fever, progressive anorexia and FTT. Inflammatory markers were usually found to be high. [encyclopedia.pub]

• Recurrent Bronchitis

  1 12 persistent cough; progressive anorexia; intermittent fever; weight loss; iron deficiency anemia yes (CXR) no BAL yes NS sIgE –ve yes doubtful, based on CH 11 Yavuz, 2014 Turkey 1 36 respiratory distress; hemoptysis; recurrent bronchitis; FTT; iron [encyclopedia.pub]

• High Fever

  The patient was discharged on Feb. 21 but readmitted three days later with a left upper lobe atelectasis, high fever, and positive nasopharyngeal cultures for Hemophilus injluenzae. A favorable response was obtained with antibiotic therapy. [pubs.rsna.org]

• Turkish

  Turkish J Pediatr. 2014;56(6):661–664. [PubMed] [Google Scholar] 8. 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. [ncbi.nlm.nih.gov]

• Sputum Production

  Clinical Characteristics Respiratory features of the disease included persistent cough, dyspnea, tachypnea, wheezing, occasional sputum production and rales. [encyclopedia.pub]

• Chronic Cough

  cough (7/7); wheezing (7/7); chronic rhinitis (7/7); frequent fever (7/7); frequent earache (6/7); diarrhea (6/7); vomiting (5/7); hemoptysis (4/7) yes, recurrent yes (5/7) gastric or bronchial aspirates (4/7); pulmonary needle biopsy (1/7) yes intradermal [encyclopedia.pub]

• Nasal Flaring

  Physical examination revealed clinical pallor, tachypnoea of 60 breaths per minute with nasal flaring and subcostal recessions. However, there was no head nodding, grunting or wheezing. [ncbi.nlm.nih.gov]

• Failure to Thrive

  Keywords: Cow milk proteins; Failure to thrive; Heiner syndrome; Hypersensitivity; Infant formula. © 2019 The College of Medicine and the Medical Association of Malawi. [pubmed.ncbi.nlm.nih.gov]

  It is characterised by recurrent respiratory tract symptoms, infiltrates mimicking pneumonia on chest radiograph, fever, anaemia and failure to thrive. [ncbi.nlm.nih.gov]

  Patients may have prolonged exposure to cow’s milk and a history of chronic rhinitis, recurrent otitis media, persistent cough, or failure to thrive. The immune-mediated response in Heiner syndrome is not completely understood. [consultant360.com]

  A syndrome, comprised of chronic pulmonary disease, iron-deficiency anemia, recurrent diarrhea, and failure to thrive in the presence of precipitating serum antibodies against cow's milk, was described by Heiner, Sears, and Kniker (11) in 1962. [pubs.rsna.org]

• Recurrent Diarrhea

  A syndrome, comprised of chronic pulmonary disease, iron-deficiency anemia, recurrent diarrhea, and failure to thrive in the presence of precipitating serum antibodies against cow's milk, was described by Heiner, Sears, and Kniker (11) in 1962. [pubs.rsna.org]

  Upon Milk Reintroduction 1 Heiner, 1960 USA 7 1–17 chronic cough (7/7); wheezing (7/7); chronic rhinitis (7/7); frequent fever (7/7); frequent earache (6/7); diarrhea (6/7); vomiting (5/7); hemoptysis (4/7) yes, recurrent yes (5/7) gastric or bronchial [encyclopedia.pub]

  HSD: Probable. (13) Alsukhon et al., 2017 [15]—A 2-month-old male with recurrent diarrhea and FTT had persistent cough, tachypnea and high inflammatory markers despite antibiotic therapy for pneumonia [15]. [mdpi.com]

• Hepatosplenomegaly

  Abdominopelvic ultrasound confirmed hepatosplenomegaly. [ncbi.nlm.nih.gov]

  Patients of this population showed signs and symptoms suggestive of the syndrome but also different clinical manifestations, such as isolated upper respiratory diseases, hepatosplenomegaly and congenital heart diseases. [mdpi.com]

• Hepatic Bruit

  The liver was palpable 6cm below the right costal margin with a liver span of 10cm, firm, non-tender with no hepatic bruit. The spleen was palpable 2cm below the left costal margin. [ncbi.nlm.nih.gov]

• Sweating

  Chromosome studies and sweat electrolyte determinations were reported as normal. Total gamma globulin was 800 mg per 100 ml of serum. The patient received blood transfusions, and on Feb. 2 a right upper and middle lobe excision was performed. [pubs.rsna.org]

  Cystic fibrosis essentially can be excluded by a normal chloride level on the sweat test and second line tests if there is a strong suspicion. [encyclopedia.pub]

• Ear Discharge

  There was associated cough and nasal discharge. No wheeze and no ear discharge. [ncbi.nlm.nih.gov]

• Grunting

  However, there was no head nodding, grunting or wheezing. The trachea was central with the apex beat at the 4th left intercostal space along the midclavicular line. [ncbi.nlm.nih.gov]

The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. 2006 Oct. 118(4):923-9. [Medline]. Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. [medscape.com]

• Pericardial Effusion

  The liver span was 9cm while the splenic length was 6cm Echocardiography was normal asides for mild pericardial effusion (0.2cm maximum diameter) and increased flow velocity across the pulmonary valve. [ncbi.nlm.nih.gov]

• Heinz Bodies

  bodies Heinz body anemia Heinz, Robert Heister, spiral valve of HeLa cell HeLa cells [tabers.com]

• Ventricular Hypertrophy

  SOF (1/6): Iron deficiency (5/6); Anemia (4/6); Eosinophilia (4/6); right ventricular hypertrophy (3/6); adenoid hypertrophy (3/6) yes (6/6) yes (5/6) gastric washing or bronchoalveolar lavage (BAL) yes (6/6) 4 ID delayed response total IgE –ve (6/6); [encyclopedia.pub]

Corticosteroids remain the first line of treatment. In more severe cases, immunosuppressive therapy with agents such as cyclophosphamide( may be indicated. Without treatment, PH can progress to pulmonary fibrosis and ultimately respiratory failure. [consultant360.com]

The peculiarity of pneumonia in these case series was the refractoriness of antibiotic treatments. [encyclopedia.pub]

It can mimic so many diseases thus contributing to it's under diagnosis, delayed treatment and increased medical costs. [ncbi.nlm.nih.gov]

The diagnosis was further confirmed based on the positive response to the treatment and the elimination of milk. [frontiersin.org]

Corticosteroids remain the first line of treatment. In more severe cases, immunosuppressive therapy with agents such as cyclophosphamide may be indicated. Without treatment, PH can progress to pulmonary fibrosis and ultimately respiratory failure. [contemporarypediatrics.com]

Patients with PH as a result of exposure to cow’s milk have a better prognosis than do those with other forms of hemosiderosis. [consultant360.com]

PMID: 16176405 [The role of specific IgE to evolution and prognosis of cow's milk protein allergies in children]. Constantinide P, Trandafir LM, Burlea M. Constantinide P, et al. Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1012-7. [pubmed.ncbi.nlm.nih.gov]

HS IPH Age infants or young children older children/adults Hemosiderosis often always GI symptoms often rarely Precipitins yes no Response to diet yes no Prognosis good variable 9. [encyclopedia.pub]

Patients with PH as a result of exposure to cow’s milk have a better prognosis than do those with other forms of hemosiderosis. References: REFERENCES: 1. Dearborn DG. Pulmonary hemorrhage in infants and children. [contemporarypediatrics.com]

The prognosis is generally good, even if the extent of the exclusion diet necessary to reach a complete recovery is unclear. [mdpi.com]

Crescentic glomerulonephritis in a child with Heiner syndrome. 61 Yavuz S...Anarat A 26388600 2014 7 Heiner syndrome mimicking an immune deficiency. 61 Sigua JA...Zacharisen M 24734417 2013 8 [Heiner syndrome in a case]. 61 Shi LF...Li J 21055273 2010 9 Etiology [malacards.org]

Discussion Diffuse alveolar hemorrhage or pulmonary hemosiderosis is a chronic disease in children with varied etiologies. [ijaai.in]

Etiology of hemoptysis in children: a single institutional series of 40 cases. Allergy Asthma Immunol Res. (2009)1:41–4. doi: 10.4168/aair.2009.1.1.41 PubMed Abstract | CrossRef Full Text | Google Scholar 3. [frontiersin.org]

Etiology Although HS is more likely to be induced by homogenized CM, the disease also may occur in some infants fed with CM-derived formula. [encyclopedia.pub]

Some clinical, epidemiological and immunological aspects. Høst A. Høst A. Pediatr Allergy Immunol. 1994;5(5 Suppl):1-36. Pediatr Allergy Immunol. 1994. PMID: 7704117 Review. [pubmed.ncbi.nlm.nih.gov]

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2018;141:41-58. 4. Moissidis I, Chaidaroon D, Vichyanond P, Bahna SL. [ijaai.in]

Epidemiology of food allergy. J Allergy Clin Immunol. 2011 Mar. 127(3):594-602. [Medline]. Gupta R, Warren C, Smith B, et al. Prevalence and Severity of Food Allergies Among US Adults. [medscape.com]

Articles related to Heiner Syndrome: (show all 11) # Title Authors PMID Year 1 Cow's Milk Protein Allergy in Term and Preterm Infants: Clinical Manifestations, Immunologic Pathophysiology, and Management Strategies. 61 33262206 2020 2 Diffuse alveolar [malacards.org]

Diverse non-IgE-based mechanisms have been postulated for its pathophysiology, but nothing is conclusive. We were able to demonstrate an IgE-mediated food hypersensitivity in an infant with Heiner's syndrome. [ijaai.in]

Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol. 1999 Sep. 104(3 Pt 2):S114-22. [Medline]. Burks AW, James JM, Hiegel A, et al. [medscape.com]

The pathophysiology of IPH has not been delineated, but the combination of genetic predisposition with environmental triggers such as toxin-producing fungus (Stachybotryschatarum) has been proposed [5,6]. [mdpi.com]

Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Aug 26. 60(33):1128-32. [Medline]. [medscape.com]

Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2018;141:41-58. 4. Moissidis I, Chaidaroon D, Vichyanond P, Bahna SL. [ijaai.in]

Early diagnosis is critical to initiate proper treatment and to prevent recurrent hemorrhagic episodes that lead to pulmonary fibrotic changes, and thus to increase the survival rate of affected patients. [mdpi.com]