Did you know milk can make your lungs bleed?
Milk allergy is quite common and usually presents as eczema, hives, GI symptoms such as vomiting or diarrhea or less commonly anaphylaxis. Rarely, other reactions can occur. Did you know that some young children develop severe lung problems related to ingesting milk?
In 1962, Heiner first reported several children who had severe respiratory symptoms with findings of microscopic bleeding in their lungs triggered by ingesting milk, so the disorder is called Heiner Syndrome.
In 2012, I saw a case of Heiner Syndrome with my allergy fellow Jerome while working in Milwaukee and the case was published. It can be found at: Heiner Syndrome mimicking an Immune Deficiency
Why does this happen?
- The exact reason is unclear. These antibodies directed against milk are not yet proven to cause the disease but are a marker for it. Both immune-complex deposition reaction and cell-mediated reaction have been suspected. In lung biopsy tissue specimens of infants with Heiner Syndrome, IgG, C3 (complement), fibrin, and milk antigen deposits can be seen using immunofluorescence.
How old are children when they develop symptoms?
- Age of onset: Usually before 1 year old, but up to 5 years old.
Do all children have severe bleeding?
- No, only about 10% of children with Heiner Syndrome have the severe form with pulmonary hemosiderosis (blood in the lungs).
How is the diagnosis of Heiner Syndrome made?
- Respiratory: cough, runny nose/congestion, difficulty breathing, wheezing.
- Gastrointestinal: vomiting, diarrhea, failure to thrive (poor growth)
- Fever, enlarged liver, spleen or lymph nodes (rare)
Chest x-ray: appears like “pneumonia.”
- Elevated white blood cells (WBC) called eosinophils, iron deficiency anemia, elevated IgG antibodies to milk and precipitating antibodies to milk.
- Lung aspirate (performed by a pulmonologist) showing lung cells called macrophages that contain iron.
What is the treatment for Heiner Syndrome?
- Eliminate cow’s milk: recovery time ranges from 5-21 days!
- Reintroduce cow’s milk after a few years under the direction of an allergist.
At Family Allergy & Asthma Care of Montana, we consider Heiner Syndrome a possibility in any infant who has findings of pneumonia on chest x-ray! Sounds strange, but it’s true!