Hyperreactivity to cow milk in young children with pulmonary hemosiderosis and cor pulmonale secondary to nasopharyngeal obstruction.
Six black infants and young children with high titers of milk precipitins were identified by screening the sera of 160 children with idiopathic chronic lung disease. None of the six had immunoglobulin deficiency, elevation of sweat chlorides, SS hemoglobin, or recurrent aspiration. All six children had typical manifestations of milk-induced pulmonary hemosiderosis: recurrent pulmonary infiltrates (6/6), hemosiderin-laden pulmonary macrophages (5/6), intermittent wheezing (5/6), eosinophilia (4/6), anemia (4/6), iron deficiency (4/4), failure to thrive (4/6), and elevated levels of serum IgE (4/4). Three children also had chronic rhinitis and eventually developed large adenoids, hypercapnia and acidosis during sleep, and right heart failure. Elimination of cow milk from the diet, symptomatic therapy, and adenoidectomy when indicated resulted in improvement of all six patients. Pulmonary hemosiderosis and some cases of upper airway obstruction with pulmonary hypertension appear to be two stages, early and delayed, of the same immunophysiologic process. Early dietary intervention may prevent the cardiovascular complications of this process.
D001741:Black or African American; D000747:Anemia, Hypochromic / Q000209:etiology; D000818:Animals; D002675:Child, Preschool; D004802:Eosinophilia / Q000209:etiology; D005260:Female; D006486:Hemosiderosis / Q000097:blood / Q000209:etiology / Q000276:immunology*; D006801:Humans; D006967:Hypersensitivity / Q000097:blood / Q000276:immunology*; D007073:Immunoglobulin E / Q000032:analysis; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008171:Lung Diseases / Q000097:blood / Q000209:etiology / Q000276:immunology*; D008297:Male; D008892:Milk / Q000009:adverse effects*; D008894:Milk Proteins / Q000009:adverse effects; D009302:Nasopharyngeal Diseases / Q000276:immunology*; D011233:Precipitin Tests; D011660:Pulmonary Heart Disease / Q000097:blood / Q000209:etiology / Q000276:immunology*; D011859:Radiography; D013577:Syndrome
D008894:Milk Proteins; D007073:Immunoglobulin E